End-to-End Workflow
From Scheduled Case to Submitted Claim
One connected system across three surfaces. No manual handoffs between charting and billing. No data re-entry. Every step feeds the next.
Six Steps. One Record.
The same case record moves from scheduling through claim submission without re-entry at any handoff point.
Scheduled
Pre-Op
Intraop
Post-Op
Billing
Paid
Case Scheduled
The case board populates itself.
HL7 v2 messages from QGenda arrive before the provider walks in the door. Patient demographics, procedure assignments, and OR room numbers appear on every device automatically — no manual scheduling entry.
- HL7 v2 / MLLP feed from QGenda — zero manual case creation for scheduled ORs
- SIU-S12 creates the case, SIU-S14 cancels it, SIU-S15 reschedules it
- Feed health monitored with 5-minute heartbeat — staff see offline status instantly
- Manual case creation available when the feed is offline
Providers
Walk in and see the case board fully loaded — no keyboard required
Billing
Patient demographics pre-populated from the schedule, not re-entered at post-op
Leaders
Full OR schedule visible in real time across all facilities
Case Board — OR Schedule
Smith, J. — OR 4
General Adult — ETT
Scheduled
Torres, M. — OR 7
Spinal — L3/L4
Scheduled
Chen, R. — OR 2
MAC — Shoulder
Scheduled
Auto-populated from QGenda feed · HL7 v2
Pre-Op Summary — iPad
Smith, J. — OR 4
General Adult · ETT · 07:30
Allergies
Penicillin — Anaphylaxis
Preset Applied
General Adult — ETT
Drug grid, monitors, and airway loaded
Payer · Rounding Rule
Blue Cross · Ceiling 15 min
Begin Case ▶
Pre-Op on iPad
Everything set before the provider enters the OR.
The anesthesia plan is built on iPad before the case starts. A preset template defaults the drug grid, monitoring configuration, and airway plan. The payer rounding rule is visible on screen before anesthesia start time is locked.
- 8 preset templates — General Adult, MAC, Spinal, Epidural, OB, and more
- Allergies displayed in bold red — unmissable visual weight, patient safety requirement
- Payer rounding rule shown before case start (Hard Constraint #6 from the spec)
- Pre-op assessment: demographics, current medications, anesthesia plan
Providers
Drug grid pre-sorted for the case type before entering the OR
Billing
Payer confirmed and rounding rule locked before the clock starts
Leaders
Standardized pre-op documentation across all providers and sites
Intraoperative on iPhone
Two taps. Any critical action. Every time.
The iPhone is the primary charting surface during active cases. A dark display for OR-safe low-light conditions. A drug grid with 72px touch targets designed for gloved hands. Every critical action completable in two taps or fewer — a hard design law, not a guideline.
- Two-Tap Rule enforced: Tap drug → tap dose → logged with server-side timestamp
- 72px touch targets — designed for surgical gloves (standard iOS is 44px)
- ASTM D4774 color coding — on-screen drug color matches the physical syringe label
- 8-second undo window — reverse fat-finger errors before audit entry is created
- Offline-first: full charting capability when OR WiFi drops, auto-syncs on reconnect
- Haptic feedback confirms every medication log without requiring visual confirmation
Providers
Fastest point-of-care charting — both hands stay on the patient, not the screen
Billing
Every event server-timestamped automatically — no provider-entered times, ever
Leaders
Append-only event log with HMAC hash chain — legally defensible at every step
Quick Log — General Adult
SyncedPost-Op and Chart Completion
A chart can't reach billing with missing fields.
After the case closes, the chart completion checklist enforces every required field before the record moves to billing. ASA units are calculated in real time. The claim readiness score (0–100) shows exactly what's complete and what's blocking.
- 9 Tier 1 universal blockers — hard stops that prevent billing submission
- 7 Tier 2 contextual blockers — payer-specific requirements enforced automatically
- Claim readiness score 0–100 — weighted across all required fields
- Cases below threshold are blocked from claim generation until resolved
- Clinical review routing assigns incomplete charts to the right provider
Providers
Clear checklist — no guessing which fields are missing or why
Billing
Every chart arrives pre-validated — billing team reviews clean data, not raw charts
Leaders
Late completion queue surfaces cases that haven't cleared the checklist by shift end
Chart Completion — iPad
Smith, J. — OR 4
General Adult · 2h 14m
Claim Readiness
- Anesthesia start/end times
- CPT code assigned
- ASA physical status
- Supervising NPI
- Estimated blood loss
1 blocker remaining before billing submission
ASA Unit Calculation
Base Units
CPT 00840
Time Units
134 min ÷ ceil/15
QC Units
No qualifying circumstance
Total Units
16Modifiers Derived
Derived from supervision model and case context
837P Generated
Submitted to Availity clearinghouse
SV2 loop · SSE-KMS archived to S3
Billing Pipeline
ASA units calculated. Modifiers derived. Claim generated.
Once a chart clears the completion checklist, the billing engine takes over. ASA units are calculated from the case timestamps using the payer-specific rounding rule that was locked at pre-op. All six anesthesia modifiers are derived from clinical context — none are entered manually.
- ASA formula: Base Units + Time Units (payer rounding) + Qualifying Circumstance Units
- All 6 modifiers (AA, QK, QX, QZ, AD, QS) derived from clinical context — never manual
- 837P claim generated in SV2 loop format for Availity or Waystar clearinghouse
- Every submitted claim archived to S3 with SSE-KMS encryption
- Batch submission — billing staff review queue and submit in bulk
Providers
Nothing to do — billing runs from the chart, not a second form
Billing
No manual unit calculation, no modifier lookup — the engine derives everything
Leaders
Fixed monthly cost regardless of claim volume — no per-case billing surprises
Adjudication and Correction
Denials don't disappear into a queue — they get assigned.
The clearinghouse returns 999 functional acknowledgments, 277CA transport acknowledgments, and 835 remittance advice. Rejected claims are automatically classified by denial reason and routed to the correct person for correction. The remediation workspace surfaces the exact field that caused the rejection.
- 999 structural acknowledgment — catches format errors before payer processing
- 277CA transport acknowledgment — confirms payer accepted the claim for adjudication
- 835 remittance — payment confirmation or denial with reason codes
- Rejection router classifies denial reason and assigns correction responsibility
- Remediation workspace shows the exact field causing the rejection with inline editing
Providers
Clinical corrections requested with specific context — no vague billing callbacks
Billing
Field-level rejection guidance in the same workspace as claim review
Leaders
Parity dashboard compares AIMS unit totals to legacy system — proves billing accuracy
Smith, J. — OR 4
Paid16 units · $487.20 · Blue Cross
Torres, M. — OR 7
DeniedCO-97 — Benefit not covered under plan
Readiness
Assigned to Billing — Remediation
Missing supervising NPI for QK supervision model. Add NPI to resubmit.
Running Through Every Step
Tamper-Evident Audit Trail
Every action at every step — case scheduled, medication logged, timestamp locked, correction made, claim submitted — is recorded in an append-only audit log. Nothing is deleted. Nothing is overwritten.
HMAC-SHA256 Hash Chain
Each audit record includes the HMAC of the previous record. Any modification breaks the chain — independently detectable.
7-Year Retention
Meets HIPAA record retention requirements. Every event from every case is retained and exportable.
5 Event Classes
Access, Mutation, Privileged, Integration, and Submission — all captured with source tags (Tap, OCR, Voice, Scan, System).
FaceID on Corrections
Corrections require biometric confirmation. Provider identity, original value, corrected value, and reason code are all recorded.
Original Always Preserved
Corrections append a new record with a correction_of reference. The original event is never altered or deleted.
Legal-Grade Export
The full audit log is exportable for malpractice defense, payer audits, and compliance reviews.
Correction model: Corrections create new events with correction_of references to the original. The original is never altered. Every correction records the provider identity, timestamp, and FaceID confirmation.
See the Full Workflow Live
15 minutes. No pitch deck. We walk through every step in your workflow context.