Автоматизация соответствия для клиник

I keep running into this while building software for healthcare, and i’m curious how other founders have handled it. on paper, things like eligibility checks, prior auth, claim follow-ups and denials all seem pretty repeatable. then you talk to five clinics and somehow discover eight different workflows. one clinic handles eligibility inside its EHR. another has someone manually checking multiple payer portals. home health prior auth is completely different from cardiology or dental. some customers want the whole process automated, while others just want one painful step fixed. then there are all the random exceptions. half the time, the real workflow isn’t documented anywhere. it just lives in the head of one employee who has been doing it for years and knows what to do when somethin…

The line that's worked for people I know who did this well: configure the input, standardize the output. Every clinic's workflow looks different because of legacy habits, whoever's been doing it for 10 years, and which payer portals they got stuck using. But the actual decision logic underneath, like whether something's covered, what's needed for auth, why a claim got denied, is way more standardized than it looks when you're five customer calls deep and everyone swears their situation is unique. The trap is building configurability into that logic layer instead of the intake layer. That's the moment "flexible SaaS" quietly turns into custom software, because now every customer's special case lives inside a rules engine that only your most senior dev actually understands, and every new f…