Healthcare

Starts from the website, portal or a call; demographics, guarantor and contact details captured once and written to the EHR registration record.

Parties: Patient, Registration staff. Rules: HIPAA. Callvu moves: prefill, write back.

Starts before the first visit; history, consents and insurance captured from the patient and checked, then written to the EHR.

Parties: Patient, Front desk. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back. Use case and claims

Starts at booking; member ID captured, masked and checked for active coverage before the visit, result written to the registration record.

Parties: Patient, Patient access team, Payer. Rules: HIPAA; Payer eligibility rules. Callvu moves: prefill, chase and verify, write back.

Starts in the portal or at check-in; address, phone, guarantor or new insurance card captured, verified and updated in the EHR.

Parties: Patient, Registration staff. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts when a service is booked; demographics, coverage, forms and copay details completed before arrival and filed to the EHR.

Parties: Patient, Patient access team. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts by text before the visit; card and photo ID images collected, read on arrival and attached to the patient record.

Parties: Patient, Front desk. Rules: HIPAA. Callvu moves: chase and verify, write back.

Starts when a patient has no coverage on file; income and household details captured to screen for Medicaid, marketplace or assistance, result routed to a counselor.

Parties: Patient, Financial counselor, Eligibility vendor. Rules: HIPAA. Callvu moves: prefill, classify, decide, write back.

Starts when a parent, guardian or caregiver asks for access; relationship documents and patient authorization collected, verified and recorded before access is granted.

Parties: Patient, Proxy, Health information management. Rules: HIPAA. Callvu moves: chase and verify, decide, write back.

Starts when a visit is requested; referral, network and payer rules checked before the appointment is confirmed in the scheduling system.

Parties: Patient, Scheduler, Referring provider, Payer. Rules: Payer network and referral rules. Callvu moves: prefill, classify, chase and verify, write back.

Starts from a fax, portal or e-referral; referral reason, notes and coverage captured, missing items chased from the referring office, then queued for scheduling.

Parties: Referring provider, Referral coordinator, Patient. Rules: HIPAA. Callvu moves: classify, chase and verify, write back.

Starts from the ordering provider; clinical notes and coverage packaged, sent to the specialist and tracked until the appointment is booked.

Parties: Ordering provider, Referral coordinator, Specialist office. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts from a text, portal or call; the patient picks a new slot or cancels, and the change and reason are written to the scheduling system.

Parties: Patient, Scheduler. Callvu moves: prefill, write back.

Starts when a slot opens; the next eligible patient is offered it by text, accepts, and the booking is updated.

Parties: Patient, Scheduler. Callvu moves: classify, write back.

Starts a few days before the visit; the visit type sets the questions, answers go to the chart before the clinician sees the patient.

Parties: Patient, Clinic staff. Rules: HIPAA. Callvu moves: prefill, classify, write back.

Starts at booking of a virtual visit; consent to telehealth, location and contact details captured before the visit link is sent.

Parties: Patient, Clinic staff. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts from the booking; prefilled from the EHR, the procedure type sets the questions and documents, and the completed file returns to the EHR.

Parties: Patient, Surgical scheduler, Pre-admission nurse. Rules: HIPAA. Callvu moves: prefill, classify, chase and verify, write back.

Starts when a procedure is booked; required tests, clearances and forms are chased from the patient and outside providers on the procedure-date clock.

Parties: Patient, Pre-admission team, Outside providers. Rules: HIPAA. Callvu moves: chase and verify, write back. Use case and claims

Starts when surgery needs clearance; the request goes to the PCP, the clearance letter and results are chased, checked and filed before the date.

Parties: Surgeon's office, Primary care physician, Patient. Rules: HIPAA. Callvu moves: chase and verify, decide, write back.

Starts after booking; health history and medications captured, flagged answers routed to anesthesia for review before the procedure.

Parties: Patient, Anesthesia team. Rules: HIPAA. Callvu moves: prefill, classify, decide, write back.

Starts before the procedure; fasting, medication and arrival instructions delivered and acknowledged, with the acknowledgment kept in the record.

Parties: Patient, Pre-admission nurse. Callvu moves: chase and verify, write back.

Starts the day before; consent, clearance, labs, authorization and payment status checked, and gaps routed to the right team before the case starts.

Parties: Pre-admission team, Surgical scheduler, Patient financial services. Rules: HIPAA. Callvu moves: classify, chase and verify, decide.

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.

Parties: Patient, Surgeon, Anesthesia team. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back. Use case and claims

Starts at registration; consent and financial responsibility acknowledged and signed, record filed to the EHR.

Parties: Patient, Registration staff. Rules: HIPAA. Callvu moves: prefill, write back.

Starts when a patient authorizes disclosure; recipients, scope and expiry captured with signature, then stored and enforced on release.

Parties: Patient, Health information management. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts when records covered by 42 CFR Part 2 may be shared; specific consent captured and recorded before any disclosure.

Parties: Patient, Behavioral health team, Health information management. Rules: 42 CFR Part 2; HIPAA. Callvu moves: chase and verify, decide, write back.

Starts at the first visit; the notice is delivered and acknowledgment captured and kept with the patient record.

Parties: Patient, Front desk. Rules: HIPAA. Callvu moves: write back.

Starts when a test, infusion, imaging with contrast or other procedure is ordered; the procedure sets the consent form, signed ahead and filed.

Parties: Patient, Clinician. Rules: HIPAA. Callvu moves: prefill, classify, write back.

Starts when clinical photos or media use are needed; consent scope captured and signed, then stored with the record.

Parties: Patient, Clinician. Rules: HIPAA. Callvu moves: write back.

Starts before the first virtual visit; telehealth consent captured and stored before the visit.

Parties: Patient, Clinic staff. Rules: HIPAA. Callvu moves: write back.

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.

Parties: Participant, Study coordinator, Investigator, IRB office. Rules: Common Rule (45 CFR 46); HIPAA. Callvu moves: classify, chase and verify, write back.

Starts when the IRB approves a new consent version; every active participant is re-consented on the new version, tracked until complete.

Parties: Participants, Study coordinators, IRB office. Rules: Common Rule (45 CFR 46). Callvu moves: classify, chase and verify, write back.

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.

Parties: Ordering provider, Authorization team, Payer. Rules: Payer prior authorization rules; CMS prior authorization rule. Callvu moves: prefill, classify, chase and verify, decide, write back.

Starts before an authorization expires or visits run out; updated notes collected and the renewal sent to the payer before the deadline.

Parties: Clinician, Authorization team, Payer. Rules: Payer prior authorization rules. Callvu moves: classify, chase and verify, write back.

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.

Parties: Payer, Authorization team, Health information management. Rules: HIPAA. Callvu moves: classify, chase and verify, write back.

Starts when a prescription needs approval; clinical criteria and history gathered, submitted, and the result returned to the prescriber and patient.

Parties: Prescriber, Pharmacy, Payer. Rules: Payer formulary rules. Callvu moves: prefill, chase and verify, decide, write back.

Starts when a payer offers a peer-to-peer; the clinician's availability and case summary are captured and the call is booked within the payer's window.

Parties: Clinician, Authorization team, Payer medical director. Callvu moves: prefill, chase and verify.

Starts from the provider's order; documentation of need, signed order and coverage captured, then sent to the supplier with the authorization.

Parties: Ordering provider, DME supplier, Payer, Patient. Rules: Payer coverage rules. Callvu moves: prefill, chase and verify, write back.

Starts when discharge is planned; patient choice, clinical packet and authorization sent to post-acute facilities, acceptances tracked until placement.

Parties: Case manager, Patient and family, Post-acute facility, Payer. Rules: HIPAA. Callvu moves: prefill, classify, chase and verify, decide, write back.

Starts with a transfer request; clinical summary and bed needs captured, routed to the accepting physician and bed management, decision recorded.

Parties: Sending facility, Transfer center, Accepting physician, Bed management. Rules: EMTALA. Callvu moves: prefill, classify, decide, write back.

Starts from the discharging provider; orders, face-to-face documentation and coverage packaged and sent to the agency, acceptance tracked.

Parties: Ordering provider, Case manager, Home health agency, Patient. Rules: Payer coverage rules. Callvu moves: prefill, chase and verify, write back.

Starts after a visit or discharge; the care plan is delivered to the patient or caregiver and acknowledgment captured.

Parties: Patient, Care team. Callvu moves: write back.

Starts after discharge; symptom and medication questions asked, flagged answers routed to a nurse for a callback, and results written to the chart.

Parties: Patient, Care coordinator, Nurse. Rules: HIPAA. Callvu moves: classify, decide, write back.

Starts when outside labs, imaging or notes arrive; documents classified, matched to the patient and routed to the clinician for review.

Parties: Outside provider, Health information management, Clinician. Rules: HIPAA. Callvu moves: classify, chase and verify, write back.

Starts when a procedure needs approval; the case file is assembled, routed to each committee in order, and every decision recorded with who decided.

Parties: Treating physician, Approval committees, Administration. Callvu moves: chase and verify, decide, write back. Use case and claims

Starts when a treatment falls outside standard coverage; clinical justification gathered and routed for an approval decision.

Parties: Physician, Medical director, Finance. Callvu moves: chase and verify, decide, write back.

Starts when a clinician requests a new device or drug; evidence and cost details collected and routed through value analysis for a decision.

Parties: Clinician, Value analysis committee, Supply chain. Callvu moves: chase and verify, decide, write back.

Starts when a practitioner asks for new privileges; training and case logs collected and routed to the department chair and committee.

Parties: Practitioner, Medical staff office, Department chair, Credentials committee. Callvu moves: chase and verify, decide, write back.

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.

Parties: Patient, Patient financial services, Co-providers. Rules: No Surprises Act. Callvu moves: prefill, classify, write back.

Starts before a scheduled service; benefits and expected patient share calculated and delivered, with the estimate stored.

Parties: Patient, Patient financial services. Callvu moves: prefill, write back.

Starts before or after the service; the patient sees their share, picks a plan and pays on a secure screen, and the plan is written to billing.

Parties: Patient, Patient financial services. Callvu moves: prefill, decide, write back.

Starts before the visit; the expected amount is shown and paid on a secure screen, and the payment is posted to the account.

Parties: Patient, Patient access team. Rules: PCI DSS. Callvu moves: prefill, write back.

Starts when a patient asks for help; income and household documents chased until the application is complete, then routed for review and the decision recorded.

Parties: Patient, Financial counselor, Patient financial services. Rules: IRS 501(r). Callvu moves: prefill, chase and verify, decide, write back.

Starts from a patient call or portal message; the disputed charges and reason captured, routed to billing, and the resolution recorded with the account held while open.

Parties: Patient, Billing team, Coding team. Rules: No Surprises Act; FDCPA. Callvu moves: prefill, classify, decide, write back.

Starts when a patient asks for an itemized bill; identity checked and the bill delivered, with the request logged.

Parties: Patient, Billing team. Rules: HIPAA. Callvu moves: chase and verify, write back.

Starts when a claim denies for coverage; the patient supplies the right insurance, it is verified and the claim is rebilled.

Parties: Patient, Billing team, Payer. Callvu moves: prefill, chase and verify, write back.

Starts when a credit balance or overpayment is found; refund details captured and approved, then written to billing.

Parties: Patient, Billing team. Callvu moves: prefill, decide, write back.

Starts when a payer asks for other-coverage details; the patient completes the questionnaire and it is sent to the payer so claims can pay.

Parties: Patient, Billing team, Payer. Callvu moves: prefill, chase and verify, write back.

Starts when an injury may be another party's liability; accident, attorney and auto or workers' compensation insurer details captured and routed to billing.

Parties: Patient, Billing team, Liability insurer, Attorney. Callvu moves: prefill, classify, chase and verify, write back.

Starts when a claim denies; the denial is classified, supporting records and a letter assembled, and the appeal filed within the payer's deadline.

Parties: Billing team, Clinician, Health information management, Payer. Rules: Payer appeal deadlines. Callvu moves: classify, chase and verify, decide, write back.

Starts with a payer or auditor records request; the right records pulled, checked and sent before the due date, with what was sent logged.

Parties: Payer or auditor, Health information management, Billing team. Rules: HIPAA. Callvu moves: classify, chase and verify, write back.

Starts when coding needs clarification; the query goes to the physician, the answer is captured and the chart updated before billing.

Parties: Coder, Physician, Clinical documentation team. Callvu moves: classify, chase and verify, write back.

Starts when a department finds a charge error; the correction and reason captured, approved and posted before the claim goes out.

Parties: Department staff, Revenue integrity team. Callvu moves: decide, write back.

Starts from a patient, attorney or other requester; identity and authorization checked, records pulled and delivered, and the disclosure logged.

Parties: Requester, Patient, Health information management. Rules: HIPAA. Callvu moves: classify, chase and verify, decide, write back.

Starts when patients ask for their own records; identity verified and records delivered within the HIPAA access timeline, with delivery recorded.

Parties: Patient, Health information management. Rules: HIPAA. Callvu moves: chase and verify, write back.

Starts when a patient asks to amend their record; the request routed to the author for a decision, and the outcome and patient notice recorded.

Parties: Patient, Health information management, Clinician. Rules: HIPAA. Callvu moves: classify, decide, write back.

Starts when a patient asks who received their information; the request verified and the accounting produced and delivered.

Parties: Patient, Privacy office. Rules: HIPAA. Callvu moves: chase and verify, write back.

Starts when a patient asks to restrict sharing; the request is recorded, decided, and enforced on later releases.

Parties: Patient, Privacy office, Billing team. Rules: HIPAA. Callvu moves: decide, write back.

Starts from a patient or staff report; details captured, classified and routed to the privacy office, with the investigation tracked to closure.

Parties: Reporter, Privacy office, Compliance. Rules: HIPAA. Callvu moves: classify, decide, write back.

Starts from an application or life event; member, dependent and plan details captured, eligibility documents checked, and the change written to the enrollment system.

Parties: Member, Employer or broker, Enrollment team. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts when a dependent is added; proof of relationship collected and checked before coverage is confirmed.

Parties: Member, Eligibility team. Rules: HIPAA. Callvu moves: chase and verify, decide, write back.

Starts when a member paid out of pocket; receipts and claim details captured and checked, then sent to claims processing.

Parties: Member, Claims team. Rules: HIPAA. Callvu moves: prefill, chase and verify, write back.

Starts from a call, letter or portal; the case is classified as appeal or grievance, documents chased and the decision made within regulatory timeframes.

Parties: Member, Appeals and grievances team, Medical director. Rules: Medicare Advantage and Medicaid appeal timeframes; ACA internal appeals rules. Callvu moves: classify, chase and verify, decide, write back.

Starts in the member portal or a call; the change captured, checked against network rules and written to the member record.

Parties: Member, Member services. Callvu moves: prefill, chase and verify, write back.

Starts from an outreach or referral; consent and health assessment captured and the member assigned to a care manager.

Parties: Member, Care manager. Rules: HIPAA. Callvu moves: prefill, classify, write back.

Starts when a provider disputes a payment; the claim, contract terms and records gathered and routed for a decision.

Parties: Provider, Provider services, Claims team. Callvu moves: classify, chase and verify, decide, write back.

Starts from the offer; employment forms, credentials and benefits elections collected and written to HR systems.

Parties: New hire, HR, Manager. Callvu moves: prefill, chase and verify, write back. Use case and claims

Starts when a practitioner joins; licenses, board certification, malpractice and work history collected, primary-source verified and sent to the committee.

Parties: Practitioner, Credentialing team, Credentials committee. Rules: NCQA and Joint Commission credentialing standards. Callvu moves: prefill, chase and verify, decide, write back.

Starts before the cycle ends; updated documents chased from the practitioner and verified before the deadline.

Parties: Practitioner, Credentialing team. Rules: NCQA and Joint Commission credentialing standards. Callvu moves: prefill, chase and verify, write back.

Starts when a provider must bill a payer; enrollment applications completed and tracked with each payer until the effective date.

Parties: Provider, Enrollment team, Payers. Callvu moves: prefill, chase and verify, write back.

Starts before an expiry date; the renewed license or certification is chased and checked, with escalation before the deadline.

Parties: Staff member, HR, Manager. Callvu moves: chase and verify, write back.

Starts at hire and on schedule; vaccination and screening records collected, checked and filed, with exemptions routed for a decision.

Parties: Employee, Employee health, HR. Callvu moves: chase and verify, decide, write back.

Starts when agency staff are booked; credentials, competencies and access requests collected before the first shift.

Parties: Agency, Staffing office, Department manager. Callvu moves: chase and verify, decide, write back.

Starts when staff need system access; role, approvals and training completion checked before access is provisioned.

Parties: Staff member, Manager, IT security. Rules: HIPAA. Callvu moves: prefill, decide, write back.