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