1.7 KiB
1.7 KiB
IamBilly Backend: Business Logic Flows
Based on the documentation at http://34.111.248.204/, the system consists of 9 core flows.
Flow 1: Surgeon Records Dictation
- Patient Search: Surgeon searches via MRN or Name.
- Failures: If EMR connectivity fails, system retries (1s, 4s, 16s backoff). If still failing, cached data (<24h) is used or manual entry is required.
- Audio Capture: Recorded locally on mobile, encrypted with AES-256.
- Connectivity: Auto-uploads via TLS 1.3 when internet is available.
Flow 2: AI Processing Pipeline (System)
- Transcription (Whisper): Converts audio to text using medical vocabulary.
- Entity Extraction: NLP extracts Diagnoses, Procedures, and Anatomy.
- Code Mapping: AI maps to ICD-10 and CPT codes with modifiers.
Flow 3: Surgeon Status Check
- Surgeon monitors claim progress through a "Today's Cases" dashboard.
Flow 4: Biller Review & Approval
- Interface: Side-by-side view (Transcript vs. Coded Claim).
- Mandatory HR: Human review is required before approval. AI-suggested fields are highlighted.
Flow 5: Export & Revocation
- 5a (Export): Claims are pushed to Athena or EMR via API or generated as CMS-1500 PDF.
- 5b (Revoke): Supervisors can revoke approved status only if not yet exported.
Flow 6: Rejection Handling
- Claims rejected by billers come back to the Biller queue with specific reasons for manual correction.
Flow 7 & 8: Management & Administration
- Supervisor: Operational oversight (efficiency, accuracy).
- Admin: System health monitoring, audit log reviews, and MFA management.
Flow 9: Security Safeguards
- Session timeouts (15 mins), MFA requirements, and persistent audit logs.