Long-Term Care Billing

Client Snapshot

• Industry: Healthcare (long-term care physicians, US)
• Client: US physician group (under NDA)
• Headquarters: United States
• Timeline: January 2026 to launch in July 2026
• Team: 1 AI Architect · 2 Backend Engineers · 1 Frontend Engineer · 1 Cloud/DevOps Engineer · 1 Project Manager
• Services: AI Solutions · AI Agents and Automation · Platform Development · Healthcare Integrations · Cloud/DevOps
• Stack: Claude (Anthropic) · OpenAI · NestJS · PostgreSQL 16 · Redis + BullMQ · React 19 · Playwright · Stedi · Terraform · AWS
• Traction: About 1,400 claims processed in the 90 days to October 2026

The Problem

Physicians wrote notes in each facility's EHR, and coders turned every note into codes and a claim by hand, in a different system.

The problem wasn't writing the note. It was everything between the note and getting paid.

• Coding by hand: every note has to be read to pick ICD-10 diagnoses, CPT codes and modifiers.
• Systems that don't talk: PointClickCare, athenahealth, Elation Health, DrChrono and NextGen, some without a usable API.
• Clearinghouse work: eligibility checks, claim submission and remittances all run on X12 standards.
• PHI everywhere: several medical groups on one platform, each needing its data isolated and every access logged.
• Care coordination: care teams and patients need to talk inside the same system that holds the record.

‍

The Solution

We built one modular platform that follows the money: from the visit, to the note, to the code, to the claim, with compliance checks at each step.

AI Core

• Multi-model by task: Claude (Sonnet 4, Opus 4.5 and 4.6, Haiku) and OpenAI (GPT-5, GPT-4o, GPT-4o-mini) through OpenRouter, each used where it fits best.
• AI Scribe: drafts clinical notes and stages them for physician review and approval.
• Automated coding: extracts ICD-10 codes from the note and selects CPT codes and modifiers by visit complexity.
• Clinical triage: AI-assisted triage and care coordination.
• Prompts under control: versioned prompts managed in the database, with usage tracked.

Billing Automation Agent

• Separate service: Node.js and Playwright with an isolated browser context per system; APIs where they exist, UI automation where they don't.
• End to end: EHR, then LLM clinical analysis, then ICD-10 and CPT coding, then the claim captured in the billing system, with compliance validation.
• Clearinghouse: Stedi for X12 270/271 eligibility, 837P claims and 835 electronic remittances.
• EHR sync: athenahealth and Elation Health by API; PointClickCare by RPA; DrChrono and NextGen through the billing agent.
• Patient matching: fuzzy search reconciles the same patient across systems.

HIPAA and PHI Protection

• Field-level encryption: AES-256-GCM with per-client keys in AWS Secrets Manager, plus searchable SHA-256 hashes.
• Access you can audit: access logs, a reason recorded for every PHI access, and "break-the-glass" emergency access with an approval flow.
• Multi-tenant isolation: each medical organization's data kept apart.
• Session policies: automatic timeouts and password rules.

Cloud

• Multi-account landing zone: AWS Organizations with security, shared services and per-environment accounts, Service Control Policies and SSO.
• Resilient compute and data: ECS with auto scaling, RDS PostgreSQL 16, ElastiCache, encrypted and versioned S3.
• Immutable backups: AWS Backup with vault lock.

‍

AI Core

AI Scribe

Drafts the clinical note from the visit and stages it for physician review and approval.

Automated coding

ICD-10 codes extracted from the note; CPT codes and modifiers selected by visit complexity.

Billing agent

Enters the claim in the billing system through APIs or UI automation, with compliance validation.

______
‍

Infrastructure

PHI encryption

AES-256-GCM field-level encryption with per-client keys and searchable hashes.

Healthcare integrations

Stedi clearinghouse plus five EHR and practice management systems, synced in one flow.

______
‍

Product

Care team workspace

Billing dashboard, AI Scribe dashboard, admin CRM, and real-time chat with the care team and patients.

‍

Results

• One flow from visit to claim: note, codes and claim connected across six systems.
• Coding without the first manual pass: ICD-10 and CPT suggested from every note.
• Claims through the clearinghouse: eligibility, submission and remittance on X12 standards.
• PHI protected by design: field-level encryption, isolated tenants, audited access, immutable backups.
• Model choice per task: Claude and OpenAI models used where each performs best.
• At volume: about 1,400 claims processed in the 90 days to October 2026.

‍

KPIs

6 systems — Stedi, PointClickCare, athenahealth, Elation Health, DrChrono and NextGen in one flow

~1,400 claims — Processed in the 90 days to October 2026

AES-256 — Field-level encryption of patient data, with a separate key for each client

‍

Tech Stack

• AI: Claude Sonnet 4, Opus 4.5 and 4.6, Haiku; OpenAI GPT-5, GPT-4o, GPT-4o-mini; all via OpenRouter
• Backend: Node.js, NestJS 11, TypeScript (strict), PostgreSQL 16 with TypeORM, Redis + BullMQ, Socket.io, Winston, Resend
• Billing agent: Node.js, Express, Playwright, PM2
• Frontend: React 19, TypeScript, Vite, shadcn/ui, Tailwind CSS, TanStack Query, Recharts
• Integrations: Stedi Healthcare API, PointClickCare, athenahealth, Elation Health, DrChrono, NextGen
• Cloud: AWS Organizations, ECS, ECR, ALB, RDS, ElastiCache, S3, CloudFront, Amplify, Secrets Manager, AWS Backup
• DevOps: Terraform (dev, staging, prod), GitHub Actions with OIDC to AWS, Ansible, Docker, CloudWatch
• Quality: Jest, Supertest, Vitest, Testing Library, MSW, Playwright

‍

Team & Delivery Model

A six-person senior squad:

AI Architect / Tech Lead

Model selection, AI Scribe, coding logic and prompt governance.

Backend Engineers (×2)

NestJS platform, clearinghouse and EHR integrations, billing agent.

Frontend Engineer

Billing, AI Scribe and admin dashboards.

Cloud/DevOps Engineer

Landing zone, Terraform, security services and backups.

Project Manager

Scope, milestones and client communication.

Operating Model

Agile, milestone-driven delivery with iterative releases.

‍

Claude Partner Network · Anthropic Services Partner Directory · Claude Certified Architect. Built on Claude and OpenAI by a Claude Partner Network team.