NexusAI's Agentic Workflow Engine deploys intelligent agents across prior authorization, care coordination, discharge planning, and revenue operations — running autonomously, 24 hours a day, across every patient encounter.
Most clinical AI surfaces insights — a finding highlighted, a risk score surfaced. Acting on those insights still falls on already-stretched care teams and administrative staff.
NexusAI's Agentic Engine closes that loop. It ingests clinical findings, EHR context, payer rules, and operational state — then autonomously initiates workflows, submits requests, drafts communications, and escalates exceptions — all within guardrails your clinicians and compliance team define.
The result is not just better information. It's faster care, less administrative drag, and revenue that doesn't leak through the cracks.
Every NexusAI agent follows a five-stage cycle — from clinical signal to closed-loop action — with human oversight at every escalation point.
EHR events, imaging AI findings, lab results, payer rules, and ADT feeds — processed in real-time
Patient timeline, clinical history, payer policy, and current care pathway fused into structured agent context
Specialized LLM agents evaluate clinical and operational state against institutional and payer-specific guidelines
Agent executes — submits PA, generates note, routes alert, initiates order, or flags for human review
Outcomes logged, agent performance measured, models fine-tuned against your institutional workflows
Human-in-the-Loop by Design: All agentic actions occur within configurable guardrail thresholds. Clinical decisions remain with licensed practitioners. Administrative agents can operate autonomously within pre-approved scope; clinical escalations always route to the appropriate care team member. NexusAI is deployed as a workflow automation and clinical decision support tool, not as an autonomous medical device.
Each NexusAI agent is purpose-built for a specific clinical or operational workflow — trained on domain-specific data, tested against real institutional workflows, and configurable to your policies.
Monitors order entry and clinical findings in real-time. Assembles complete clinical justification packages — including relevant imaging findings, diagnosis codes, and supporting documentation — and submits to payer portals autonomously. Tracks status and escalates denials.
Bridges care teams across specialties. When the Clinical AI Engine flags a critical finding — an LVO, aortic dissection, or high-risk PE — the Care Coordination Agent immediately notifies the appropriate specialist, confirms receipt, and activates the relevant care pathway without waiting for manual hand-offs.
Continuously reviews encounter documentation against ICD-10 guidelines and DRG optimization rules during the admission — not after discharge. Flags missing specificity, secondary diagnoses, and documentation gaps in real-time, with suggested query language for the clinical team.
Begins discharge planning at admission, not day-of. Evaluates clinical trajectory, insurance coverage, post-acute options, and social determinants to assemble a discharge pathway — reducing length of stay variation and ensuring safe, appropriate transitions of care.
Monitors inpatient status, clinical criteria (InterQual / MCG), and payer communications to ensure appropriate level-of-care designation throughout the stay. Flags potential observation-to-inpatient conversions and proactively assembles clinical criteria documentation.
Automates care gap closure, preventive care reminders, post-discharge follow-up, and chronic disease management outreach. Multi-channel — SMS, secure messaging, patient portal — with EHR-documented response tracking and escalation to care coordinators when engagement is needed.
NexusAI agents don't just activate at discharge or billing. They're present and acting at every phase of the care continuum.
Before the patient arrives, agents prepare the care team with actionable context.
Agents operate in real-time alongside the care team — surfacing, acting, and documenting.
Agents monitor clinical trajectory and operational status continuously during admission.
Agents support transitions, close revenue loops, and prevent readmissions.
Across pilot deployments in integrated health systems, NexusAI's agentic workflows have delivered measurable, auditable improvements across operations, finance, and care quality.
Figures represent internal pilot benchmarking data. Results may vary by health system size, workflow configuration, and payer mix. Independent validation studies in progress.
Every NexusAI agent operates within a governance architecture designed with clinical compliance, legal accountability, and operational control in mind.
Each agent operates within institutional policies you define. Action thresholds, escalation paths, and autonomous scope are set by your clinical and compliance leadership — not by us.
Every agent action — decision, draft, submission, or escalation — is logged with timestamp, model version, input context, and outcome. Fully auditable for compliance and quality review.
Any clinical action taken or recommended by an agent can be overridden by a licensed clinician with one tap. Override data feeds back into model improvement cycles.
Real-time monitoring flags when agent behavior deviates from expected patterns — triggering review before errors reach the patient or the claim.
Agentic workflows are deployed as CDS tools and workflow automation, aligned with applicable CMS, OIG, and payer compliance frameworks. NexusAI does not operate as an autonomous clinical decision-maker.
A rules layer allows compliance, legal, and clinical leadership to set non-negotiable constraints that no agent can override — ensuring institutional accountability at every step.
Request a live demonstration of NexusAI's agentic workflows — tailored to your service line, payer mix, and operational priorities.