AI agents for healthcare operations
Tactical Edge designs AI agents to help prepare, route, and track work across prior authorization, care management, care-gap closure, discharge follow-up, and member engagement. Clinical and operations teams retain decision ownership.
Where we start
We begin with workflows where evidence is spread across systems, rules are inspectable, and human review can be preserved at the right threshold.
Prior Authorization Intake
Agents gather evidence, match criteria, detect missing documentation, and prepare review-ready packets.
Care-Gap Closure
Agents surface members who match customer-defined criteria, prepare outreach for review, track workflow status, and route exceptions to care teams.
Discharge Follow-Up
Agents reconcile discharge notes, coordinate next steps, and flag high-risk transitions for clinical review.
Appeals Preparation
Agents assemble denial reasons, medical evidence, timelines, and policy references for accountable review.
Workflow model
Controls to configure
We define data access, consent handling, tool permissions, policy versions, evaluation thresholds, and action logging for the selected workflow. The design identifies decisions that require named human review and approval.
Clinical teams stay central
Agents prepare, route, and monitor work. Clinicians and operations leaders own judgment, exception handling, program design, and final approvals where risk demands it.
Implementation path
Workflow discovery and risk classification
FHIR, claims, document, and care platform integration
Agent design for evidence, policy, risk, outreach, and routing
Human review console and operating metrics
Evaluation harness, action logs, and production monitoring
Evaluate one healthcare operations workflow
We can help define the first workflow, design the agent control plane, and take the system through evaluation, shadow mode, and monitored production.