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Calvient

Agents Skilled in
Every Tedious Task

Calvient's agentic AI agents — purpose-built AI workflow automation agents for healthcare operations — handle the administrative work between task creation and human decision. They trigger on conditions, run defined action sequences, and hand off with full context when judgment is needed.

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What is Agentic AI?

AI that takes action,
not just answers

A chatbot answers questions. An agentic AI agent takes action. Calvient's agents watch for specific conditions in your workflows, execute defined sequences of operational tasks, and hand off to staff only when the situation requires judgment.

This is what the industry calls agentic AI — or AI workflow automation — autonomous agents that operate within configured guardrails, taking administrative work off staff plates without removing human oversight.

Trigger-based, not command-based

Agents activate on conditions — a new fax, a missed deadline, a form left unsigned — without staff having to initiate each task.

Action-oriented, not response-oriented

Each agent runs a defined sequence: verify, route, follow up, notify, escalate. It completes the work, not just reports on it.

Staff-supervised, not staff-replaced

Agents don't close loops that require judgment. They surface exceptions to the right person with full context so nothing requires starting over.

The Four-Phase Model

How every agent works

Every Calvient agent follows the same four-phase model from detection to handoff.

Trigger

Every agent watches for a specific condition — a new fax, a missed deadline, an unsigned form, or an eligibility mismatch. When the condition is met, the agent activates automatically.

Analyze

The agent evaluates context: patient data, payer rules, workflow state, and prior history. It applies configured logic to determine which action sequence fits the situation.

Act

The agent executes its action sequence — routing a document, sending a follow-up, submitting an authorization, verifying eligibility — completing the repetitive middle work without staff involvement.

Handoff

When a case exceeds its SLA, contains ambiguity, or requires clinical judgment, the agent stops and surfaces the item to staff with the full task history, communications log, and extracted data attached.

Special Agents

Meet the agents

Each agent is designed for a specific workflow — with a defined trigger, a set of autonomous actions, and a clear handoff condition. They handle the repetitive middle so staff can focus on what requires judgment.

Intelligent Document Processing

Intake & Document Agents

AI agents that classify, extract, and route inbound documents — faxes, forms, and messages — without manual triage.

Inbox Triage Agent

AI document classification and routing agent

Reads incoming faxes, forms, and messages; extracts structured data; and routes each item to the correct queue without staff intervention.

Trigger

A new item arrives in the practice inbox from any channel — fax, web form, email, or EHR message.

Actions

  • Classifies the document type (referral, prior auth request, records request, etc.)
  • Extracts key fields: patient demographics, payer, procedure, urgency indicators
  • Matches the item to an existing patient record
  • Routes to the appropriate team queue with context attached

Handoff to Staff

Items that cannot be classified with sufficient confidence are surfaced to a staff review queue with the agent's best classification and confidence score.

Missing Info Chaser

automated document completeness verification agent

Compares incoming packets against configurable completeness checklists, flags gaps, and sends targeted follow-up via fax, text, or email.

Trigger

An intake item fails a completeness check against the required fields for its workflow type.

Actions

  • Identifies which specific fields or documents are missing
  • Sends a targeted follow-up request to the source via fax, text, or email
  • Tracks the response and re-evaluates completeness when materials arrive
  • Escalates if no response is received within the configured SLA window

Handoff to Staff

If the SLA window closes without a complete response, the item is escalated to staff with a full outreach log attached.

Urgent Item Escalator

priority triage automation agent

Scans new intake items against rule-based urgency criteria and immediately pins high-risk cases to a priority queue before staff reviews the general backlog.

Trigger

A new intake item is classified and contains keywords, procedure codes, or payer flags that match configured urgency rules.

Actions

  • Evaluates the item against configured urgency criteria
  • Pins matching items to the priority queue immediately
  • Sends an alert notification to the assigned team lead
  • Logs the escalation reason for audit purposes

Handoff to Staff

All escalated items require staff acknowledgment before they can be progressed, ensuring no high-risk case moves without human awareness.

Referral Management Automation

Referral Agents

AI agents that manage the completeness, tracking, and provider communication lifecycle of inbound and outbound referrals.

Referral Completeness Checker

referral packet validation and completeness agent

Verifies that an inbound referral contains all required clinical and payer data before it progresses to scheduling, reducing downstream rework.

Trigger

A new referral arrives or advances to the scheduling stage.

Actions

  • Compares referral packet contents against payer-specific and specialty-specific requirements
  • Flags missing items with specific descriptions of what is needed
  • Creates targeted follow-up tasks for the appropriate team member
  • Re-evaluates completeness when missing items are received

Handoff to Staff

Referrals that cannot be completed within the SLA window are escalated to a senior coordinator with a full gap report attached.

Referral Status Follow-Up Agent

automated referral tracking and status follow-up agent

Runs recurring checks on open referrals, identifies cases approaching SLA thresholds, and initiates outreach to surface stalled items before they go overdue.

Trigger

A referral has been open longer than the configured check-in interval or is approaching an SLA deadline.

Actions

  • Reviews open referral status across the queue
  • Identifies cases at risk of missing turnaround-time targets
  • Initiates follow-up outreach to the specialist or receiving provider
  • Logs all status checks and responses in the referral timeline

Handoff to Staff

Referrals that remain stalled after agent outreach are assigned to a staff coordinator for direct intervention.

Provider Update Agent

automated provider communication and status notification agent

Automatically informs referring providers at key referral milestones — scheduling confirmed, appointment completed, consult note returned — eliminating manual phone-tag.

Trigger

A referral reaches a defined milestone: scheduled, appointment completed, or consult note returned.

Actions

  • Detects the milestone event in the referral workflow
  • Generates a status update with the relevant milestone details
  • Delivers the update to the referring provider via their preferred channel (fax, message, or EHR notification)
  • Records the notification in the referral's communication log

Handoff to Staff

If a milestone triggers an exception — a no-show or cancelled appointment — the agent flags the referral for staff review instead of sending a routine update.

Prior Authorization Automation

Prior Auth & Payer Agents

AI agents that handle the submission, status tracking, and eligibility verification steps that make payer operations slow and staff-intensive.

Prior Auth Agent

automated prior authorization submission and follow-up agent

Collects required clinical details, builds submission packets, submits to payer portals, and tracks authorization decisions — handling the full prior authorization lifecycle.

Trigger

A procedure or referral requiring prior authorization is identified, either from scheduling data or a manual flag.

Actions

  • Verifies the procedure code and payer requirements for authorization
  • Collects required clinical documentation from the EHR
  • Builds and submits the authorization packet to the payer portal
  • Tracks decision status and sends follow-up when a response is overdue

Handoff to Staff

Denials, peer-to-peer requests, and appeals require clinical staff review. The agent surfaces these with the full payer response and a suggested next step.

Insurance Update Chaser

automated real-time eligibility verification agent

Contacts patients with outdated or mismatched insurance information before their appointment, collecting corrected coverage details to prevent claim denials from eligibility failures.

Trigger

A scheduled patient's insurance information fails an eligibility check or does not match the payer's current records.

Actions

  • Identifies the specific mismatch or gap in the patient's coverage data
  • Contacts the patient via SMS, email, or automated phone call to request updated information
  • Captures the updated insurance details and logs them against the appointment
  • Re-runs the eligibility check to confirm coverage is verified before the visit

Handoff to Staff

Patients who do not respond after multiple outreach attempts are flagged for a staff phone call, with the full outreach history attached.

Appointment Prep Agent

procedure-specific patient preparation automation agent

Delivers procedure-specific preparation instructions to patients before their appointment based on the scheduled procedure type, ensuring patients arrive ready.

Trigger

An appointment is confirmed and the procedure type requires pre-appointment preparation steps.

Actions

  • Identifies the procedure type and matches it to the configured prep protocol
  • Delivers prep instructions to the patient via SMS or email
  • Sends a follow-up reminder if the patient has not confirmed receipt
  • Flags appointments where the patient has not acknowledged prep instructions

Handoff to Staff

Patients who do not acknowledge prep instructions are surfaced to front desk staff for a direct call before the appointment date.

Patient Readiness & Follow-Up Automation

Scheduling & Follow-Up Agents

AI agents that handle patient outreach for appointment readiness, form completion, and post-task follow-up — closing loops without staff chasing.

Reminder Agent

automated patient appointment reminder and outreach agent

Delivers personalized appointment reminders via SMS, phone, and email on configurable pre-appointment schedules, with escalation sequences for high-risk appointment slots.

Trigger

An appointment is scheduled and the first reminder interval is reached based on appointment type and patient risk profile.

Actions

  • Sends an initial reminder via the patient's preferred channel
  • Runs follow-up reminder sequences based on appointment-type cadence
  • Detects confirm, cancel, or reschedule responses and updates the schedule accordingly
  • Flags high-risk appointments for enhanced outreach (new patients, complex procedures)

Handoff to Staff

Appointments that remain unconfirmed close to the appointment time are surfaced to front desk staff for a direct phone call.

Paperwork Completion Nudger

patient intake form completion automation agent

Monitors digital intake form completion status and sends follow-up prompts to patients who have not finished required paperwork before their appointment.

Trigger

A patient has been sent a digital intake packet but has not completed required forms within the expected window.

Actions

  • Checks form completion status against appointment timing
  • Sends a reminder with a direct link to the incomplete forms
  • Tracks completion after each outreach attempt
  • Escalates to staff if forms remain incomplete within 24 hours of the appointment

Handoff to Staff

Patients flagged as unable or unwilling to complete digital forms are routed to staff for assisted completion at check-in.

Follow-Up Sentinel

automated care gap follow-up and closure tracking agent

Monitors open tasks for completion against defined done criteria, triggers outreach sequences for items that stall, and generates closure receipts for audit-ready documentation.

Trigger

A task or follow-up item reaches a configured age threshold without being marked complete.

Actions

  • Reviews open items against their defined completion criteria
  • Triggers an outreach sequence appropriate to the workflow type
  • Records all outreach attempts and responses in the task history
  • Marks items complete when evidence of completion is received and generates a closure receipt

Handoff to Staff

Items that exceed the maximum follow-up attempts are escalated to a supervisor queue with the full history attached — nothing closes without human confirmation.

Coverage

Agents embedded across
every workflow

Calvient's agents aren't a bolt-on add-on. They're part of each use case workflow — sitting inside the operational layer your team already uses.

Intake & Triage

Inbox Triage Agent · Missing Info Chaser · Urgent Item Escalator

See workflow →

Referral Management

Referral Completeness Checker · Status Follow-Up Agent · Provider Update Agent

See workflow →

Prior Auth & Payer Ops

Prior Auth Agent · Insurance Update Chaser · Appointment Prep Agent

See workflow →

Scheduling & Patient Readiness

Reminder Agent · Paperwork Completion Nudger · Appointment Prep Agent

See workflow →

Patient Outreach & Follow-Up

Follow-Up Sentinel · Reminder Agent · Missing Info Chaser

See workflow →

Medical Records & Release of Information

Inbox Triage Agent · Missing Info Chaser · Follow-Up Sentinel

See workflow →

Frequently Asked Questions

What is agentic AI in healthcare? +

Agentic AI in healthcare refers to AI systems that autonomously execute multi-step administrative workflows in response to defined triggers — without requiring step-by-step human instruction for each action. Unlike chatbots that answer questions, agentic AI agents take action: verifying documents, sending follow-ups, routing tasks, checking eligibility, submitting prior authorizations. They handle the repetitive operational middle of healthcare workflows and hand off to staff only when the situation requires clinical judgment or exception handling.

How is agentic AI different from traditional healthcare automation? +

Traditional automation (RPA, rule-based bots) follows rigid scripts that break when data changes or edge cases appear. Agentic AI applies judgment within defined parameters — it can interpret unstructured documents, adapt to different payer requirements, and decide which action is appropriate based on context. The key difference is that agentic AI handles variability; traditional automation requires near-perfect data conditions to function reliably.

What healthcare workflows can Calvient AI agents automate? +

Calvient's agentic AI agents automate workflows across:

  • Document intake and triage — classifying, extracting, and routing faxes, forms, and messages
  • Referral management — validating completeness, tracking status, and notifying referring providers
  • Prior authorization — building and submitting auth packets, tracking decisions, chasing responses
  • Real-time eligibility verification — contacting patients with coverage mismatches before appointments
  • Patient appointment reminders — multi-channel outreach with risk-based escalation
  • Patient form completion follow-up — nudging unsigned digital intake paperwork
  • Queue management and SLA enforcement — auto-assigning work and escalating stalled items
How do Calvient AI agents know when to hand off to staff? +

Each agent has a defined handoff condition configured for its workflow. Handoffs are triggered when:

  • A case exceeds its SLA threshold despite agent outreach
  • An item contains ambiguous data below the agent's confidence threshold
  • A patient or provider has not responded after the maximum number of outreach attempts
  • The situation requires clinical judgment (e.g., a prior auth denial or clinical escalation)

When an agent hands off, it surfaces the item to the appropriate staff queue with the full task history, communications log, and extracted data attached — so staff can act immediately without reprocessing from scratch.

Do Calvient AI agents work with my existing EHR? +

Yes. Calvient's agents are designed to work alongside existing EHR platforms — including eClinicalWorks, athenahealth (athenaOne), NextGen Healthcare, ModMed, Veradigm (Allscripts), AdvancedMD, CureMD, and Greenway Health — without requiring a full system replacement. The agents read workflow state from the EHR, take actions within Calvient's operational layer, and write back to the EHR at defined handoff points.

What is "the repetitive middle" that Calvient agents handle? +

The "repetitive middle" refers to the operational work that happens between when a task is initiated and when it requires a qualified human decision.

For example: a referral arrives → a staff member manually checks whether it is complete → sends a fax to request missing documents → waits for a response → checks again → routes it to the scheduler. Every step in that loop except the final scheduling decision is the repetitive middle.

Calvient's agents handle those steps automatically, leaving staff to focus on the judgment-requiring endpoints — not the administrative connective tissue between them.

Ready to put agents to work?

See how Calvient's agentic AI agents reduce administrative burden, cut turnaround times, and give your staff their time back — inside the workflows they already use.

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