Use casesHealthcare

Operational memory for every clinic. Never a clinical guess.

Merriwether runs 23 orthopaedic and imaging clinics. Its assistants draft prior authorisations, propose codes and fill the schedule, and the people who check them know every payer's habits. Thirty days on imaging authorisations at four clinics turned those habits into rules every desk reads, with no patient in memory.

Organisation
Orthopaedic and imaging clinic group, 23 sites, 640 staff
Work in scope
Prior authorisation, coding and billing, scheduling, patient letters for clinician sign-off. Never a clinical decision.
Agents in use
Claude and ChatGPT assistants on the revenue cycle and patient access desks; Claude Code in the platform team
Tools connected
The practice management system, the clearinghouse, Jira, Confluence, Slack
Pilot
Advanced imaging authorisations, four clinics, thirty days
Memory networks
Organisation, revenue cycle, patient access, one per site, personal
Residency
Dedicated tenant in the US. No patient identifier ever enters memory.

01Starting point

Where Merriwether started

Merriwether's assistants do the paperwork. They draft a prior authorisation request from the chart summary, propose codes for the billing desk, fill gaps in the schedule and write the patient's letter for a clinician to sign. Each is a reasonable first attempt. Each is checked by someone who knows the payer, the site and the service line better than any model does, and that knowledge lives with about nine people.

The revenue cycle manager measured a fortnight at the four pilot clinics before anything changed. 23 percent of imaging authorisations came back for missing documentation, nearly all for one of five reasons the desk knew by heart. A coder corrected the same laterality modifier on Monday and again on Thursday. One payer had changed its medical necessity form in the spring, and the assistant had cited the old one for six weeks before anyone noticed the pattern in the denials.

The cost was rework and delay. A bounced authorisation is a week added to a patient's wait and twenty minutes of a specialist's time. Claims came back for codes the desk had stopped using the quarter before. Letters went out at the wrong reading level and came back as phone calls. Every correction cost a reviewer's time and bought nothing for the next request, and the weekly coders' meeting existed mainly to repeat them.

02Day one

Day one

The desks' assistants were connected over MCP in a working week, most of it spent with the compliance lead on what may never be remembered. The practice management system and the clearinghouse were not touched.

  • Desk assistantsMCP connection for the Claude and ChatGPT assistants on the revenue cycle and patient access desks, knowledge-work domain, signed in through the group's identity provider.
  • ReviewersWhen a coder or an authorisation specialist corrects a draft, the assistant proposes the lesson it has drawn, with the patient removed, and the reviewer saves, edits or skips it.
  • Jira and ConfluencePayer bulletins, protocol pages and known clearinghouse issues link to the insights that cite them, with the page version and date.
  • PoliciesFourteen rules written by the compliance lead: what never enters memory, which decisions are always a clinician's, what every letter must contain. Served on every task and never decayed.
  • Claude Codememco plugin for the three platform engineers who maintain the integrations, so fixes to the clearinghouse scripts are recorded with the desk's lessons.
  • SparkSite networks, validation rules and the review queue set up by the revenue cycle manager with the compliance lead approving each rule.
  1. OrganisationPolicies: what never enters memory, the clinician boundary, letter standards, the group's coding conventions.Every assistant and every reviewer.
  2. Revenue cyclePayer habits: documentation each payer requires, forms in force, appeal conventions, codes retired this quarter.Authorisation specialists, coders and their assistants at every site.
  3. Patient accessScheduling rules, confirmation conventions, what the front desk may promise.Scheduling staff and their assistants.
  4. Site networks, one per clinicHours, rooms, the equipment a site has, the surgeons' preferences for their own lists.Staff and assistants at that site.
  5. PersonalA reviewer's own phrasing and shortcuts.That reviewer's assistant only.

fig. 01Scope map

Merriwether memory networksNested scopes: the organisation network holding the fourteen policies, the revenue cycle network inside it, site networks for the clinics inside that with the four pilot clinics marked, and personal networks per reviewer; any insight naming a payer waits for a named reviewer.ORGANISATIONfourteen policiesREVENUE CYCLEevery billing deskSITE NETWORKS, ONE PER CLINICRiversideLakesideHillcrestNorthgate+ nineteen clinicsPersonal · one per reviewerNAMED REVIEWERPAYER, CODE, LETTERReads inherit downward · Writes stay local · No patient in memory
Merriwether memory networksNested scopes: the organisation network holding the fourteen policies, the revenue cycle network inside it, site networks for the clinics inside that with the four pilot clinics marked, and personal networks per reviewer; any insight naming a payer waits for a named reviewer.ORGANISATIONfourteen policiesREVENUE CYCLEevery billing deskSITE NETWORKS, ONE PER CLINICRiversideLakesideHillcrestNorthgate+ nineteenclinicsPersonal · one per reviewerNAMED REVIEWERPAYER, CODE, LETTERReads inherit downward · Writes stay local · No patient inmemory
Policies, including the clinician boundary and what never enters memory, are served on every task. Site facts stay at the site. The dashed route is the hold: any insight naming a payer, a code or a letter standard waits for a named reviewer.

03The first weeks

The first weeks

The first lessons were the five reasons authorisations bounced. The memory was sparse for a week and the first reuse came on day seven, when a specialist at the second clinic read a rule the first had written.

fig. 02Deployment timeline

Merriwether: baseline fortnight to readoutTimeline from the baseline fortnight through a working week of connection, the first reuse at a second clinic on day seven, the plan-scope mistake on day thirteen, the payer form change on day nineteen and the readout on day thirty.BASELINE FORTNIGHTCONNECTION WEEKPILOT, FOUR CLINICSDAY 7First reuse, secondclinicDAY -14Baseline at fourclinicsDAY 0Assistants connectedover MCPDAY 2Conservative-treatmentruleDAY 13Plan-scope mistake;rule addedDAY 19Payer form changes;old form retiredDAY 24Letter policyDAY 30Readout: all 23clinics
Merriwether: baseline fortnight to readoutTimeline from the baseline fortnight through a working week of connection, the first reuse at a second clinic on day seven, the plan-scope mistake on day thirteen, the payer form change on day nineteen and the readout on day thirty.Baseline fortnightConnection weekPilot, four clinicsDAY -14Baseline at four clinicsDAY 0Assistants connected over MCPDAY 2Conservative-treatment ruleDAY 7First reuse, second clinicDAY 13Plan-scope mistake; rule addedDAY 19Payer form changes; old form retiredDAY 24Letter policyDAY 30Readout: all 23 clinics
Spacing is proportional to elapsed days. The filled mark is the first reuse: a payer rule one specialist saved, applied by the assistant at a different clinic.
  • Day 2. A payer returns an MRI request for missing conservative treatment records, the third that week.This payer requires six weeks of documented conservative treatment attached to any advanced imaging request. Attach the physiotherapy notes and the medication history.Saved by the specialist who had corrected it three times. Day seven: the assistant at a different clinic attaches the records unprompted and cites the rule. First reuse. Bounces for that reason stop at the four clinics within a fortnight.
  • Day 5. A coder corrects the bilateral modifier on a procedure for the fourth time in a month.Bilateral procedures at this group are coded one line per side with the laterality modifier, not the bilateral modifier.The correction does not recur. The coder who saved it says the weekly meeting lost its first agenda item.
  • Day 9. The scheduling assistant offers a Friday 4.15pm slot at the riverside clinic, which closes at four on Fridays.The riverside clinic closes at 4pm on Fridays. Offer nothing after 3.30pm.Saved in the riverside site network, readable only there. A fact no other clinic needs and the practice management system had never been told.
  • Day 13. A documentation rule for one payer's Medicare Advantage plan is applied to the same payer's commercial plan, and a request is delayed by a week.Payer rules are scoped by plan. A lesson that names a payer must name the plan it applies to.The insight is split and scoped. The compliance lead adds a validation rule: any insight naming a payer waits for a human. The specialist who caught it approves the next week's payer insights herself.
  • Day 19. A payer changes its medical necessity form. Two requests go out on the old form before the bulletin is read.Advanced imaging requests to this payer use the form dated 1 October. The spring form is superseded.The revenue cycle manager updates the insight the morning the bulletin is read; memco retires the old one with the bulletin as provenance. In the spring, the same change had gone unnoticed for six weeks.
  • Day 24. A clinician sends back a patient letter that restates the diagnosis in the assistant's own words.Letters quote the clinician's documented wording for anything clinical. The assistant drafts the appointment, the directions and the contact details, at a reading age of eleven, with the next appointment in the first paragraph.Written as a policy by the compliance lead after the clinician's note. Served on every letter at every site.

04Governance

Governance

  • Never a clinical decisionDiagnosis, treatment and medical necessity are clinicians' decisions and nothing in memory bears on them. The assistants draft the paperwork around a decision already made. This is a policy, served on every task, owned by the medical director.
  • No patient in memoryThe assistants read the chart summary where it lives. What reaches memory is the lesson: the payer, the plan, the form, the site rule. Names, dates of birth, record numbers and anything that could identify a patient are stripped before a lesson is proposed, and the compliance lead reviews a sample weekly.
  • Human approval on payer and policy insightsAny insight naming a payer, a code or a letter standard waits for a named reviewer. Scheduling and site insights serve automatically once they have held on five reviewed tasks.
  • Scopes follow the organisationRevenue cycle lessons are read by every billing desk. Site facts stay at the site. Personal networks never leave the reviewer. Nothing is promoted sideways between sites.
  • Provenance, audit and currencyEvery insight links to the bulletin, protocol page version, ticket or correction it came from, with the date. Every read, write, approval and retirement is logged. Any insight citing a payer form is reviewed when the payer publishes a change.

fig. 03The write path

From a specialist's correction to the assistant at another clinicSwimlane showing an authorisation specialist attaching missing records for the third time, the assistant proposing the lesson with the patient removed, the specialist saving it, memco holding it for the compliance lead because it names a payer, then serving it to every authorisation desk where another clinic's assistant attaches the records unprompted on day seven.AUTHORISATIONSPECIALISTASSISTANT, CLINIC AmemcoASSISTANT, CLINIC BAttaches themissing recordsday 2, third timeProposes thelesson, patientremovedSaves itVALIDATION RULEHeld: names apayer; complianceapprovesServed to everyauthorisationdeskAttaches therecordsunpromptedday 7
From a specialist's correction to the assistant at another clinicSwimlane showing an authorisation specialist attaching missing records for the third time, the assistant proposing the lesson with the patient removed, the specialist saving it, memco holding it for the compliance lead because it names a payer, then serving it to every authorisation desk where another clinic's assistant attaches the records unprompted on day seven.AUTHORISATION SPECIALISTAttaches the missing recordsday 2, third timeASSISTANT, CLINIC AProposes the lesson, patient removedAUTHORISATION SPECIALISTSaves itmemco · VALIDATION RULEHeld: names a payer; compliance approvesmemcoServed to every authorisation deskASSISTANT, CLINIC BAttaches the records unpromptedday 7
The lesson carries the payer, the plan and the rule, never the patient. The dashed node is the hold: insights naming a payer wait for a named reviewer.

05What compounded

What compounded

The thirty-day readout compared the four pilot clinics with their own baseline and with the nineteen that were not connected. The decision was to connect every site in month two and to extend memory to coding and scheduling in month three.

MetricMovementWhy
First-pass acceptance77% to 91%Imaging authorisations accepted first time at the four pilot clinics by day thirty. The unconnected clinics stayed at 76 to 78 percent.
Repeat-error rateFive bounce reasons to oneThe one that remained was a payer that changed its rules twice in the month and was flagged both times.
Adaptation speedSix weeks to a morningA payer form change. The old form was retired the day the bulletin was read, with the bulletin as provenance. In the spring the same change had gone unnoticed for six weeks.
Cross-person or agent learning gain4 clinics to 23The nineteen clinics connected in month two started from 140 approved payer insights rather than from nothing.
Safe autonomous completionZero clinical; 40% confirmationsZero on anything clinical. Forty percent of appointment confirmations by month four: only the category the compliance lead listed, with every message logged and the patient access lead sampling weekly.
Improvement with experienceStill climbing, month fourThe assistants moved to a new model in month three. Nothing was retuned, because the desk's lessons were never in the prompt.

fig. 04Connected and unconnected

Imaging authorisations accepted first time, baseline to day thirtySlopegraph: the four pilot clinics rise from 77 to 91 percent of imaging authorisations accepted first time, while the nineteen unconnected clinics move from 77 to 78.BASELINEDAY 3077%77%91%78%Four pilot clinicsNineteen unconnected clinics
Advanced imaging authorisations accepted without a resubmission. Baseline fortnight and day thirty.

fig. 05Costs before it pays

Authorisations bounced per hundred, week by weekLine chart: bounced imaging authorisations fall from 23 per hundred at baseline to 9 by week four, with week one almost unchanged.0103023BASELINE227WK 1WK 2WK 3WK 4MO 2MO 4Bounced authorisations per 100, pilot clinics
Imaging authorisations returned for missing documentation, per hundred, at the four pilot clinics. Week one barely moved.

06What it cost

What it cost

  • Setup timeA fortnight of baseline at the four pilot clinics. One working week to connect the assistants, sign the desks in and set the networks, most of it spent with the compliance lead on the fourteen policies. No change to the practice management system or the clearinghouse.
  • Who ran itThe revenue cycle manager, the compliance lead and one platform engineer. Reviewers spent about ten minutes a day on proposed lessons in month one. The weekly coders' meeting shrank to fifteen minutes.
  • Licence and tokensAn enterprise agreement with a dedicated US tenant and audit export. The assistants' token use rose six percent from reads. The saving that mattered was specialist time: about 30 hours a week across the four pilot clinics by day thirty, before the resubmissions that no longer happen.
  • What it replacedDesk cheat sheets in shared drives, payer knowledge that lived with nine people, and the weekly meeting where coders repeated the same corrections.

Turn your desks' corrections into rules every clinic reads.

Join the waitlist

More deployments.

All use cases