Healthcare
Administrative automation that keeps patient data inside your boundary.
Referral triage, prior authorization and claims follow-up run on deterministic checks and self-hosted AI, with a clinician or coordinator reviewing every consequential decision.
- models, no external data exposure
- Self-hostedmodels, no external data exposure
- on every authorization decision
- Human reviewon every authorization decision
- per case, end to end
- One recordper case, end to end
- integration with existing systems
- API and databaseintegration with existing systems
Operational pressures
The administrative load is real and it is measurable in staff time and patient delay.
Administrative work competes with clinical time
Referral triage, prior authorization and claims follow-up consume staff hours that would otherwise go to patients, and the volume keeps growing.
Patient data cannot leave the boundary casually
Every integration and every AI step that touches a record has to be justified against who is permitted to see it, not assumed acceptable because it speeds things up.
Payer and provider systems rarely agree on format
Claims, eligibility and authorization data moves between systems that were implemented years apart, and reconciliation is still often manual.
Delays in prior authorization affect care timelines
A slow authorization process is not just an administrative cost; it can directly delay a patient's treatment.
Systems typically in scope
What integrations usually need to reach, without replacing the record system.
- Electronic health record adjacent systems
- Referral, scheduling and results systems integrated through their available APIs or database interfaces, without displacing the record system itself.
- Claims and eligibility platforms
- Payer claims and eligibility systems reached through their published interfaces for verification and status checks.
- Prior authorization workflow
- Utilization management systems and the forms or portals used to submit and track authorization requests.
- Document and correspondence
- Referral letters, clinical notes attached to a case and correspondence generated during the authorization process.
Worked scenario: specialist referral
From submission to scheduled appointment, with missing information caught early.
- 01
Trigger
A specialist referral is submitted from the originating clinic.
- 02
Integration
Connector steps retrieve the patient's eligibility status, prior visit history and relevant results.
- 03
Rules + Code
Deterministic checks confirm eligibility, required documentation and whether prior authorization is needed for the referral type.
- 04
Sovereign AI
A self-hosted model summarizes the referral letter and flags missing clinical information against the specialty's intake criteria.
- 05
Human Approval
A care coordinator reviews the assembled referral and confirms scheduling, requests more information, or routes it to a different specialty.
- 06
System Action
The confirmed referral is scheduled and the referring clinic is notified.
- 07
Audit
The referral, eligibility check, rule outcomes, model summary and coordinator decision are retained as one record.
Worked scenario: prior authorization
A documented decision against payer criteria, not a black box.
- 01
Trigger
A prior authorization request is submitted for a planned procedure.
- 02
Integration
Eligibility, clinical documentation and payer-specific criteria are retrieved from the relevant systems.
- 03
Rules + Code
Deterministic checks match the request against payer medical necessity criteria and documentation completeness.
- 04
Human Approval
A utilization reviewer examines the assembled case and approves, denies with a reason, or requests additional clinical information.
- 05
System Action
The decision is written back to the utilization management system and the requesting clinic is notified.
- 06
Audit
The full request, criteria match, reviewer decision and notification are retained for later appeal or audit.
Deployment and data control
Patient data stays inside infrastructure the organization already controls.
Because the platform deploys on-premises or in a private or sovereign cloud, patient data used by a workflow or read by a model does not need to pass through an external service to get the benefit of automation.
Self-hosted models for clinical text
Referral letters, clinical notes and correspondence are read by models running inside the deployment, not sent to an external inference API.
Role-based access aligned to clinical roles
Coordinators, utilization reviewers and administrative staff see the cases relevant to their role, consistent with existing access policies for patient data.
Integration without displacing the record system
Nexus reads and writes through existing system interfaces rather than becoming a second system of record for clinical data.
Evidence and reporting
What a denial appeal or a privacy review needs to see.
Decision record with criteria applied
Authorization decisions retain the criteria checked, the documentation reviewed and the reviewer's reasoning.
Access is attributable
Every read of a patient record through a workflow is tied to the run and the role that triggered it.
Model output kept separate from the decision
Model summaries are stored as proposals; the reviewer's decision is the record that governs the outcome.
Use cases
Processes healthcare teams run on Nexus.
Each combines two or more systems in one governed run, with approval and audit.
Epic + Oracle Health + Microsoft 365
Appointment administration and service follow-up
Appointment changes and service requests reach the right administrative staff and calendars.
View use caseWorkday + Okta + Microsoft 365
Healthcare employee onboarding
New staff get the identity access and collaboration their role needs, after approval.
View use caseEpic + ServiceNow + Microsoft 365
Patient service request escalation
Service requests that need operational support become tracked tickets with communication to staff.
View use caseOracle Health + SAP + ServiceNow
Charge and invoice exception workflow
Administrative charge and invoice mismatches are resolved with approval before finance records change.
View use caseRelevant capabilities
Where healthcare deployments usually start.
Sovereign AI
Self-hosted models for referral and clinical text summarization.
ExploreHuman-in-the-Loop
Approval and correction steps for authorization decisions.
ExploreEnterprise Integration
Connectors and database access to claims and eligibility systems.
ExploreGovernance and Audit
Role-based access and the per-case decision record.
ExploreProcurement notes
Working within existing privacy and security review processes.
Alignment language, not certification claims
Nexus capabilities can be described as aligned with or mapping to the access control, audit trail and data handling objectives referenced in a privacy or security review. Nexus does not claim a certification on the customer's behalf; responsibility for the organization's own regulatory compliance remains with the organization.
Architecture session
Bring us the workflow that competes with patient time.
Referral triage, authorization and claims follow-up are common starting points. We will walk through what stays deterministic, where a self-hosted model helps, and what the reviewer keeps.