How It Works

From scheduled appointment to verified, scored, and routed — in under 4 seconds.

A real-time X12 270 fires to the payer via Stedi the moment an appointment lands in Athena. Eight agents process the 271 in workflow order. Auto-cleared appointments never reach the worklist. Exceptions arrive with the next action attached.

1. Step 01

   Appointment Scheduled

   Patient books in Athena Health. Due Health pulls the appointment, patient demographics, and insurance data automatically. No manual trigger.

2. Step 02

   270 Eligibility Inquiry Sent

   A real-time X12 270 inquiry fires to the payer via Stedi's payer network. This is a live request — not a batch job from yesterday.

3. Step 03

   271 Response Parsed

   The Verification agent extracts structured benefit data: deductible (met/remaining), copay, coinsurance, OOP max, coverage dates, plan type.

4. Step 04

   Network Status Confirmed

   The Network agent verifies in-network status for the specific provider-plan combination — not just whether the plan is active.

5. Step 05

   Referral and Auth Requirements Detected

   The Referral agent scans for referral requirements. The Authorization agent checks procedure codes against auth requirement rules. Both surface before the visit.

6. Step 06

   Financial Risk Scored

   The Risk agent combines benefit data, patient responsibility, and plan behavior history to score the financial risk: LOW · MED · HIGH.

7. Step 07

   Patient Responsibility Estimated

   The Estimator agent calculates expected patient cost share. When responsibility crosses your configured threshold, an estimate is queued.

8. Step 08

   Worklist Populated, Exceptions Routed

   Auto-cleared appointments never appear in the worklist. Exceptions land with the specific issue and recommended next action.