MSOs & ACOs: The AI Fabric for RAF, Stars & RCM

Population health platforms are excellent at identifying risk, gaps, and cohorts—but they don't actually do most of the work. QuickIntell is the execution layer: AI agents that handle documentation, coding, prior auth, eligibility, RCM, and member outreach. We work alongside (and integrate with) your existing population health tools, turning insight into automated action.

No. QuickIntell is designed to wrap around your existing tech stack. We integrate with major EHR and PM systems via FHIR, HL7, APIs, file drops, and, when needed, RPA. You can keep your current platforms and selectively apply AI agents where they drive the most value. QuickEHR is available as a $0 option for smaller practices that want to standardize, but it's not a pre-requisite.

Yes. Our AI agents work across both models. For fee-for-service, we help optimize coding, first-pass claim rates, and cost-to-collect. For value-based contracts, we focus on RAF capture, care gaps, quality measures, and total cost of care. Most MSOs/ACOs live in both worlds simultaneously; QuickIntell is built with that reality in mind.

No. QuickIntell doesn't replace clinical judgment or the need for humans—it reduces repetitive work and surfaces the right information so your experts can focus on decisions, not data entry. Clinicians remain responsible for diagnoses and documentation; coders and auditors remain responsible for final coding decisions in workflows where you require human oversight.

Our AI coding engines routinely exceed 90% precision and recall on well-configured use cases, especially when trained and tuned on your historical data and payer mix. In high-risk contexts (e.g., RAF), we recommend human-in-the-loop review: AI proposes, humans validate. You control thresholds, auto-approve rules, and which cases always route to a coder.

Prospective: QuickScribe and QuickCode work at the point of care to ensure that chronic conditions and comorbidities are fully and accurately documented during each visit. Retrospective: QuickCode can ingest historical charts (including scanned PDFs and images), extract diagnoses, and surface missed or suspect HCC opportunities for review. Together, they support a continuous RAF program—not just once-a-year chart chases.

We use constrained models, deterministic rules, and guardrails appropriate for medical and financial use cases. Coding engines are trained on labeled data and backed by rulesets; they do not invent diagnoses or procedures. Our design principle is: AI suggests, never fabricates. You can also require human approval for any AI-proposed code or note before it hits the chart or claim.

We don't 'game' RAF—we make it easier to fully document the true complexity of your patients:

• At the visit: QuickScribe captures the encounter and structures it; QuickCode suggests codes aligned with documented problems and chronic conditions.

• Between visits: QuickAgents reach out to high-risk members for AWVs and chronic care visits.

• After the fact: Retrospective review surfaces missed or recapture opportunities for coder review.

All coding recommendations must be supported by documentation and clinician sign-off where required.

Yes. We:

• Provide real-time visibility into open care gaps at patient, provider, clinic, and plan levels.

• Use voice agents to call and schedule patients for screenings, AWVs, follow-ups, and adherence checks.

• Ensure closed gaps are properly documented and coded so they count towards measure performance.

The result is better Stars and quality scores with less manual chasing.

We configure workflows and rules by payer, plan, and contract:

• Different attribution logic? We reflect that in how members and gaps are surfaced.

• Different coding patterns and edits? Our scrubbers and coding rules adapt.

• Different quality measures? We map your measures to data capture points in documentation, coding, and outreach.

You don't get one generic model; you get a contract-aware AI fabric.

QuickIntell can automate or augment:

• Eligibility and benefits verification (including COB, PCP info, basic limitations).

• Prior authorization checks and submissions.

• Code assignment (ICD-10, CPT, HCPCS, DRG, modifiers).

• Claim scrubbing and edits before submission.

• Claim status checks and follow-ups.

• Payment posting via EOB→ERA automation.

• Denial prediction, prevention, and appeal package assembly.

You can deploy these modules end-to-end, or selectively where you have the most pain.

QuickERA reads payer EOBs (PDF, scanned, or digital), extracts line-level and payment information, and converts it into standard 835 ERA files. Those can be auto-posted into your PM or billing systems. For an MSO/ACO, this means:

• Less manual posting and fewer posting errors.

• Faster financial close and reconciliation.

• Cleaner data for denial analytics, RAF revenue tracking, and payer performance reporting.

Both. Our denial management engine:

• Analyzes historical denials to find patterns by payer, plan, code, provider, and location.

• Flags high-risk claims before submission so they can be corrected.

• Creates feedback loops to update coding rules, documentation prompts, and scrubber logic.

We still help you work existing denials more efficiently, but the bigger win is preventing avoidable ones.

QuickAuth combines:

• Rule engines that determine whether PA is required given payer, plan, benefit, and service.

• Connectors (APIs, portals via RPA) to submit and track PAs to a large universe of payers.

• Document retrieval from EHR and documents (notes, labs, imaging, history) to build a complete submission.

Status is tracked centrally; humans intervene only for exceptions or complex cases.

Yes. By checking eligibility and PA rules before the visit or procedure (triggered by orders, schedules, or worklists), QuickAuth helps ensure:

• You know when PA is required in advance.

• Documentation is ready before the patient shows up.

• Fewer cases are rescheduled or cancelled due to last-minute surprises.

For payers without mature APIs, we use secure RPA bots to interact with portals—combined with human exception handling. You still get centralized tracking in one place, but the 'how' (API vs portal) is abstracted from your staff.

QuickAgents can manage:

• Inbound calls (e.g., appointment booking, basic triage, directions, FAQs).

• Outbound campaigns (AWV reminders, preventive screening outreach, follow-up reminders, benefits explanations).

• Structured tasks (confirming demographics, contact details, preferred pharmacy, simple SDOH screening questions).

Complex clinical decisions, escalations, and sensitive conversations can be routed to human staff at any point.

Most patients care more about speed and resolution than whether the voice is human or AI. Our agents:

• Sound natural and can speak in multiple languages.

• Clearly identify themselves and can transfer to a human whenever the patient prefers.

• Provide summarized transcripts and structured data back into your systems so staff know what happened.

You control where and when AI is used vs human staff.

We incorporate your consent and contact policies into the campaign setup:

• Honor opt-out lists and preferences.

• Tailor scripts to your compliance guidelines.

• Keep audit trails of calls, outcomes, and opt-out events.

We can work with your internal compliance teams to ensure alignment with your legal and regulatory requirements.

QuickEHR is offered without traditional per-provider licensing fees. Revenue comes from optional AI modules (scribe, coding, RCM automation, voice agents) and related services. There's no hidden 'gotcha' licensing; instead, the model is aligned with usage and value created. For MSOs and ACOs, this creates a low-friction path to standardize smaller practices on a modern, AI-ready EHR.

Yes, QuickEHR is designed to meet ONC certification requirements so that practices can participate fully in US programs and interoperability frameworks. It supports core clinical documentation, ordering, e-prescribing, interoperability, and reporting requirements, and can act as the foundation for AI-enhanced workflows.

Your providers and organizations retain ownership of their patient data. Our role is as a secure processor and steward under HIPAA and related regulations. Data access, sharing, and use for analytics or model improvement are governed by explicit agreements and your governance policies.

Complexity depends on your environment, but we've designed for the reality of multi-EHR, multi-PM networks. Typical patterns include:

• FHIR and HL7 integrations with major EHRs.

• API or file-based integrations with PM and billing systems.

• Secure SFTP or object storage (e.g., S3) for documents and batch files.

• RPA where APIs simply don't exist.

We try to reuse existing feeds and interfaces wherever possible so IT lift is incremental, not a ground-up rebuild.

For a focused pilot (e.g., AI coding + denial prevention for one line of business or subset of practices), 4–8 weeks is typical:

• Discovery and design.

• Integrations and configuration.

• Testing with synthetic and then real data.

• Training your teams and going live.

Enterprise rollouts across multiple practices and modules usually follow in additional phases over 3–6 months.

We typically ask for:

• A technical contact or small IT team to facilitate integrations.

• Clinical champions (e.g., physician lead, nursing lead) to shape workflows and templates.

• RCM/operations leaders to align processes, metrics, and exception handling.

We provide implementation project managers and domain experts to carry the bulk of the design and configuration work.

Yes. QuickIntell is built with HIPAA, SOC 2, and healthcare-grade security as first principles. That includes encryption in transit and at rest, strict access controls, audit logging, incident response processes, and BAAs with all covered entities and business associates we work with.

PHI is handled in secure, compliant environments with clear data residency rules defined in your agreements. Access is role-based, monitored, and limited to what's necessary to run the services you've contracted for. Any use of data for analytics or model improvement is governed by your policies and contracts.

We maintain audit trails for:

• Source documents (notes, labs, EOBs, claims).

• AI suggestions (codes, denials risk scores, recommended actions).

• Human actions (accept, modify, reject).

This makes it possible to reconstruct 'why' a given code, decision, or workflow outcome occurred, supporting internal QA and external audits.

We:

• Co-design templates and workflows with your clinician champions.

• Start with limited cohorts or early adopters to prove value and refine the setup.

• Focus on time saved and reduction in after-hours documentation ('pajama time') as the primary benefit for clinicians.

• Provide training and live support during go-live.

When clinicians see that AI is taking work away from them—not adding to their workload—adoption follows.

We're transparent that AI will change the nature of work, not eliminate the need for human expertise. We:

• Show staff how AI handles repetitive tasks so they can focus on complex, higher-value issues.

• Involve RCM leaders in prioritizing which tasks to automate first.

• Provide dashboards that make the new workflows visible and manageable.

The goal is to elevate the role of your teams, not sideline them.

Pricing is modular and can include a mix of:

• Platform fees (for core infrastructure and integrations).

• Usage-based fees (per chart coded, per claim, per PA, per minute of voice, etc.).

• PMPM models for covered lives.

For some programs, we can discuss outcome-aligned pricing tied to measurable metrics (e.g., RAF uplift, denial reduction), once baselines are established.

We prefer multi-year partnerships because value-based transformation is not a 3-month project—but we don't believe in rigid, one-sided lock-in. Contract length, minimums, and ramp-up schedules are tailored to your size, use cases, and investment appetite. Pilots are usually scoped to prove ROI before large-scale expansion.

We define a baseline and a measurement plan upfront, typically tracking:

• Change in average RAF per member (where applicable).

• Uplift in closed care gaps / Stars measures.

• Denial rates and first-pass claim acceptance.

• Days in A/R and cost-to-collect.

• Time saved per chart/claim or per PA.

Dashboards and periodic reviews make ROI visible and actionable.

Most organizations start with a focused, high-impact use case that aligns with current pain and upcoming contract milestones, such as:

• AI coding + denial prevention for a key MA or MSSP line of business.

• Prior auth automation for high-volume imaging or procedures.

• AI scribing for a cohort of high-burden primary care clinics.

• EOB→ERA automation to clean up payment posting.

From there, we expand into adjacent workflows as you see results.

We recommend inviting:

• A clinical leader (CMO or medical director).

• A risk adjustment/quality leader.

• A finance/RCM leader.

• An IT/data representative.

That ensures we design a roadmap that hits clinical, financial, operational, and technical objectives from day one.