AI-powered revenue cycle and intake for skilled nursing
Flexbone runs AI browser agents that monitor payer portals for Medicare Advantage and Medicaid MCO changes, and voice agents that collect intake data and answer family billing calls. Skilled nursing facilities stop losing margin to administrative bottlenecks and manual portal checks, and the business office keeps its time for work that needs human judgment.
Why does SNF administrative volume keep growing?
Medicare Advantage and Medicaid MCO rules change mid-stay, which means prior authorizations, continued-stay reviews, and eligibility monitoring land on the same business office that is already underwater.
Managing portals for multiple MA plans and MCOs takes time away from actual revenue collection and patient care. Bad data at intake causes denied claims downstream. Your staff is buried in manual tracking and family billing inquiries while the tasks that require human judgment are left waiting.
What does Flexbone automate for skilled nursing facilities?
We bridge the gap between admissions, the business office, and the payer portals, from eligibility monitoring to insurance eligibility verification and family billing calls.
Eligibility Monitoring
Continuous automated browser tracking across Availity, UHC, BCBS, Humana, and state Medicaid MCO portals. Catch mid-stay payer switches, Part A exhaustion, and Medicaid renewal lapses before they hit billing.
Intake & Insurance Collection
Automated outbound calls to collect Medicare numbers, MA plan details, secondary coverage, and billing contacts. Structured, repeatable data capture that prevents downstream denials.
Family Billing Inquiries
High-volume, low-complexity inbound calls handled by voice AI. Medicare day counts, cost-share explanations, balance inquiries, and coverage status, escalated to staff only when complex.
Balance & Copay Collection
Systematic outbound voice campaigns for MA coinsurance and private pay balances. Reminders, payment arrangements, and statement explanations handled at scale without burying your billing staff.
Post-Discharge Follow-Up & Referral Coordination
Automate outbound calls at 48-72 hours post-discharge covering prescriptions and clinical flags to drive quality scores and VBP bonuses. On the inbound side, automate the communication wrapper for hospital referral packets (confirming receipt, requesting documents) while your clinical staff focuses on the actual review.
Targeted automation where you need it most
We don't make live payer phone calls for prior auths because it's restricted and unreliable. Instead, we use intelligent portal-based submission and tracking. We deploy voice AI for patient and family interactions, and secure browser agents to do the heavy lifting on payer portals.
Cross-mode platform
We connect voice operations (family calls, patient intake) with web operations (payer portal scraping) under one intelligent data platform.
Fix data before it's billed
By automating intake collection and continuous eligibility checks, we catch missing data and payer changes before they turn into denied claims.
Deep system integration
We integrate directly with your core systems. The AI pulls patient history to personalize calls and writes statuses back automatically.
Human-in-the-loop escalation
When complex clinical questions or tricky billing situations arise, Flexbone escalates to your staff with full context and a warm handoff.
Live in four weeks
We pilot at a single facility, document the hours and denials avoided on your real payer mix, then scale. No legacy setup disruption. Denials that still land can be worked with AI denials management.
Week 1: Discovery and Workflow Mapping
We analyze your payer mix, map the necessary portals (UHC, BCBS, Medicaid MCOs), and build the call trees for your admissions and billing workflows.
Week 2: Build and Integration
We configure the browser agents for eligibility monitoring and build the voice AI flows. Everything is connected to your EHR and tested against real scenarios.
Week 3: Go-Live
Automated portal tracking begins and the voice AI starts handling tier 1 intake and family billing calls at your pilot facility.
Week 4: Measure and Scale
We tune accuracy with your staff, measure the exact number of coverage changes caught and calls handled, then prepare to roll out across the rest of your organization.
What a pilot is meant to show
We baseline your portal volume, family call mix, and intake gaps, then report what changed on that same population, not a national benchmark.
Missing authorizations and payer switches surfaced while the patient is still in the building, not on a remit two weeks later
Browser agents own the repeat logins so business office staff stop living inside Availity and state MCO portals
Continuous tracking of MA and Medicaid eligibility changes without overnight human shifts
Post-discharge scripts executed with transcripts attached for quality reviewers
HIPAA compliant from day one
Architected for protected health information, not retrofitted after the fact.
Encryption
AES-256 at rest, TLS 1.3 in transit. All data and transcripts encrypted end-to-end.
HIPAA Compliant
Full BAA execution. PHI handling aligned with HIPAA Privacy and Security Rules.
Full Audit Trail
Calls and portal interactions are logged with timestamps, actions, and outcomes.
Access Controls
Role-based permissions with MFA. Configurable for admin, clinical, and billing roles.
Frequently asked questions
Flexbone runs browser agents that sweep payer portals for Medicare Advantage and Medicaid MCO changes, and voice agents that collect intake data and answer family billing calls. Catching mid-stay payer switches, Part A exhaustion, and Medicaid renewal lapses before they reach billing prevents denied claims and keeps the business office focused on work that needs human judgment.
Flexbone submits and tracks prior authorizations and continued-stay reviews through payer portals rather than live payer phone calls, which are restricted and unreliable for automation. Browser agents monitor status and write updates back to the EHR, and complex clinical cases escalate to your staff with full context.
Eligibility agents work across Availity, UnitedHealthcare, BCBS, Humana, and state Medicaid MCO portals, and connect to SNF EHRs such as PointClickCare and MatrixCare. Coverage changes and call outcomes are written back to the chart so admissions and billing work from the same data.
The voice agent handles high-volume, low-complexity calls: Medicare day counts, coinsurance and cost-share explanations, balance inquiries, and coverage status. It follows the script your director approves, texts written breakdowns, and sets up payment arrangements, escalating to staff only when a question is clinical or complex.
Yes. Flexbone runs under a signed BAA with AES-256 encryption at rest, TLS 1.3 in transit, role-based access with MFA, and a full audit trail of the calls and portal interactions it handles. PHI handling aligns with the HIPAA Privacy and Security Rules.
Give your team the capacity to grow
Your facilities shouldn't be limited by administrative bloat. Let's build an AI operations platform that scales with your footprint.