How hospitals enforce HIPAA, informed consent and the No Surprises Act while the work runs
Hospitals and health plans still take consents on paper in pre-op, release records against expired authorizations, and find out at the audit that the good faith estimate went out late or the payer's decision window has passed. Callvu enforces HIPAA, the Conditions of Participation, the No Surprises Act and your own policies on every step as the intake, the consent, the estimate, the authorization or the appeal runs, so a completed run was compliant and the Audit Trace proves it.
The problem today
Most compliance is checked after the fact.By then, the damage is done.
Medication prior authorization
The patient left the pharmacy without the medication, and the prior authorization form was still on the printer in the clinic.
Good faith estimates
The patient asked for an estimate on a Monday; the service was Thursday; the estimate was mailed the following week.
Surgical informed consent, chained with anesthesia consent
The consent was signed in pre-op by a patient who had already received a sedative, for a procedure described in a different word than the schedule.
How Callvu runs it
Twelve healthcare processes,from the request to the system of record.
Twelve healthcare processes where the rules are enforced while the work runs. Each page names the regulations, the policies, the controls, the clocks and the documents, and what the Decision Trace and the Audit Trace record.
Medication prior authorization
Starts when a prescription needs approval; clinical criteria and history gathered, submitted, and the result returned to the prescriber and patient.
Enforces: Payer formulary rules · Electronic prior authorization standards · HIPAA Privacy Rule and the patient notice requirements
Complex: multi-party handoffsGood faith estimates
Starts from the booking of an uninsured or self-pay service; the estimate is built and delivered on the No Surprises Act clock, with delivery recorded.
Enforces: No Surprises Act good faith estimate requirements · Patient-provider dispute resolution · Hospital price transparency and the hospital's self-pay pricing policy
Complex: multi-party handoffsSurgical informed consent, chained with anesthesia consent
Starts after the consult; identity checked, consent explained and signed on a controlled screen ahead of the day, and the signed record filed to the EHR.
Enforces: HIPAA Privacy and Security Rules · Informed consent requirements, 482.24 and 482.51; state informed consent statutes; the Joint Commission RI.01.03.01) · Anesthesia consent and the Universal Protocol
Complex: multi-party handoffsScheduled-procedure prior authorization
Starts from the EHR order; the payer's required documents checked before sending, gaps chased on the procedure-date clock, and the decision written to the EHR.
Enforces: Payer prior authorization rules · CMS prior authorization rule · HIPAA transaction standards and the Privacy Rule
Complex: multi-party handoffsResearch informed consent
Starts when a patient is approached for a study; the approved consent version is presented, questions logged, signatures and witness captured, and the record sent to the research office.
Enforces: Common Rule · HIPAA research authorization) · FDA informed consent regulations and ICH good clinical practice for regulated studies
Complex: multi-party handoffsPayer document requests
Starts when a payer asks for more records; the request is matched to the case, documents pulled and checked, and the response sent on the payer's clock.
Enforces: HIPAA Privacy Rule) · Payer documentation and audit rules · Medical record authentication and retention
Complex: multi-party handoffsMember appeals and grievances
Starts from a call, letter or portal; the case is classified as appeal or grievance, documents chased and the decision made within regulatory timeframes.
Enforces: Medicare Advantage and Medicaid appeal timeframes · ACA internal appeals rules · Representative authority and privacy
Complex: multi-party handoffsEHR access requests
Starts when staff need system access; role, approvals and training completion checked before access is provisioned.
Enforces: HIPAA Security Rule and, 164.312 and 164.308) · Access governance standards · Workforce and contractor requirements
Complex: multi-party handoffsPre-surgery intake
Starts from the booking; prefilled from the EHR, the procedure type sets the questions and documents, and the completed file returns to the EHR.
Enforces: HIPAA Privacy and Security Rules · Surgical and anesthesia standards · Informed consent law) and the medication reconciliation standard
SimpleHIPAA authorizations
Starts when a patient authorizes disclosure; recipients, scope and expiry captured with signature, then stored and enforced on release.
Enforces: HIPAA Privacy Rule authorizations · 42 CFR Part 2 and the state sensitive information laws · Personal representatives and minors) and state minor consent laws
SimpleInsurance eligibility verification
Starts at booking; member ID captured, masked and checked for active coverage before the visit, result written to the registration record.
Enforces: HIPAA Privacy and Security Rules and the HIPAA eligibility transaction standard · Payer eligibility rules · Price transparency and the patient's share
SimplePre-registration for scheduled services
Starts when a service is booked; demographics, coverage, forms and copay details completed before arrival and filed to the EHR.
Enforces: HIPAA Privacy and Security Rules · Informed consent and procedure-specific screening standards · Price transparency and advance payment rules
The rules and the clocks
What is enforcedacross these processes.
The regulations below are preloaded in Callvu Studio as policies and applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant. Each one links to the process pages that enforce it.
By role
What changesfor each team.
Compliance
The rules are applied as steps that run, not as training. The HIPAA Privacy Rule, the informed consent requirements under 42 CFR 482.13 and 482.51, the Common Rule's version control on a research consent, the No Surprises Act good faith estimate clock and the Medicare Advantage and Medicaid appeal timeframes are checked before each step and again as it runs. The Decision Trace shows what the six evaluators judged and what the Completion Orchestrator decided; the Audit Trace shows every signature, estimate and notice with a timestamp, and PHI is masked by policy before either record leaves.
- An authorization that has expired or was revoked blocks the release, every time.
- Surgical consent is signed ahead of the day, before any sedative, and re-consent is triggered on any change.
- A research participant can only be consented on the IRB-approved version in force.
Operations
Intake, pre-registration and pre-surgery files are completed by the patient at home and checked on arrival, so the front desk and the pre-admission nurse handle exceptions instead of clipboards. Every clock is counted back from the visit or procedure date, with escalation before it. What needs a decision goes to the right person in the Decision Desk with the case and only the allowed outcomes.
- Outside clearances and lab results are chased from the provider that holds them, on the procedure-date clock.
- A medication prior authorization is assembled from the EHR against the formulary criteria, and the prescriber is asked only for what the chart lacks.
- A payer's documentation request is matched to the encounter and answered inside its 45-day window.
IT
Callvu reads the booking, the demographics and the coverage from the EHR and writes the signed consents, the eligibility result and the release log back by API, without replacing the EHR, the practice management system or the identity system. The HIPAA 270/271 eligibility and 278 authorization transactions run from the process. Access to the EHR itself is provisioned only after the role, the approvals and the training are checked, and removed on the HR system's termination date.
- Integrates with the major EHRs, by API and webhook, under a business associate agreement.
- Member identifiers and PHI are masked before any record is pushed to your GRC or BI tools.
- A new process goes live in weeks on the integrations you already have.
Customer experience
The patient completes the history, the consents and the insurance once, on their own phone, before the visit, with a tablet at the desk as the fallback. They are not asked again at the counter, in pre-op or by the billing office. A self-pay patient receives the good faith estimate on the No Surprises Act clock, in the form they chose, before the service.
- One link from the booking covers intake, pre-registration and the copay.
- Consent is read and signed at home, in the patient's language, with an interpreter where needed.
- A coverage failure is resolved before the visit, not discovered on the bill.
Proof
In production in healthcare.Published results only.
Each result is a published claim, with its code on agents.callvu.com, where its status, source and last verified date are kept.
At a national hospital network, patient intake checks that the person is insured, and patient profiles are created and updated in real time.
HLT-04 · Self-asserted · verified 2026-11-05
At a national hospital network, a process chains up to five patient forms and signatures and ten internal steps; completing one step starts the next, for example surgery consent starts anesthesia consent and sends the procedure to the approving committee.
HLT-02 · Customer-attested · verified 2026-11-05
A national hospital network runs 23 hospitals on Callvu and keeps adding more, with 3x faster procedure approvals, 78% faster patient consent and more than 1M pages of paper eliminated.
HLT-01 · Self-asserted · verified 2026-11-05
Questions
What healthcare buyers ask,answered plainly.
How do hospitals take surgical informed consent digitally before the day of surgery?
The consent is sent after the consult and signed on a screen the process controls, with identity checked, the required content under 42 CFR 482.13(b)(2) and 482.51(b)(2) shown first, and the anesthesia consent chained to it. It is completed before any sedative, matched to the scheduled procedure, and filed to the EHR for the pre-procedure verification. A change to the procedure, the site or the practitioners triggers re-consent.
How Callvu runs it: Surgical informed consent, chained with anesthesia consent
When is a good faith estimate due under the No Surprises Act, and what must it contain?
Within one business day of scheduling when the service is at least three business days away, within three when it is at least ten, and within three business days of a request. It carries the patient's details, the services and codes, the itemized expected charges, the providers and facilities and the required disclaimers, in the form the patient chose. Callvu computes the deadline from the booking, builds the estimate from the chargemaster and the scheduled services, records the delivery, and the billing system flags a bill above the dispute threshold before it goes out.
What are the decision timeframes for a medication prior authorization, and how is the request kept inside them?
The plan's period runs from submission, for example 72 hours standard and 24 hours expedited under Medicare Part D, and Callvu tracks it with escalation. The request is assembled from the EHR against the payer's criteria for the drug, the prescriber supplies through a link only the evidence the chart lacks, and the patient and the pharmacy are told the result when it arrives. The renewal opens before the approval expires.
What makes a HIPAA authorization invalid, and how is it enforced on a release?
An authorization missing a required element, past its expiry date or event, or revoked is not valid under 45 CFR 164.508. Callvu captures the recipients, the scope and the expiry as structured data at signing, and every release of information checks the stored authorization first. An expired one blocks the release, and substance use records under 42 CFR Part 2 need their own consent.
How do we verify insurance eligibility at booking so claims do not deny for inactive coverage?
The eligibility check runs on the booking through the HIPAA 270/271 transaction, re-runs on the policy's schedule before the visit, and a failure is chased with the patient on the visit-date clock. The member identifier is captured on a secure screen and masked, and the verified result is written to the registration record the claim uses.
What are the decision deadlines for a Medicare Advantage or Medicaid member appeal?
A Medicare Advantage reconsideration is decided within 30 days standard pre-service, 72 hours expedited and 60 days for payment; a Medicaid managed care appeal within 30 days standard or 72 hours expedited. Callvu classifies the appeal or grievance on arrival so the right clock starts on day one, assembles the file, and routes the clinical decision to the medical director from the complete case.
Enforcement runs through the whole healthcare handoff
From the request to the system of record, with nobody re-keying.
Bring the process your auditors worry about most
We build it against your policies and the healthcare systems you already run, train your team and stay with you through launch. You are live in weeks.