Agenda.

Step01

Welcome & Intros

Who’s in the room, on both sides

Step02

Patient Journey Overview

The self-pay journey, from statement to resolution

Step03

Phase I · Outreach Demo

Rose · self-pay outreach, from your Epic workqueue to resolution

Voice · Live

Step04

Phase II · Inbound Billing Demo

Aaron · the inbound billing line, payments taken on the call

Voice · Live

Step05

Q&A and Next Steps

Your questions, and what Phase 1 kickoff looks like

Introducing

Rose.

First AI Agent to join the Patient Financial Services team at

Legacy Health

The starting line

The workflow starts in your workqueue

Legacy’s revenue-cycle team already wrote the criteria that populate this queue. Rose doesn’t define the rules, and never touches them. Her job begins the moment a row lands on the queue.

Owned by Legacy Health

Workqueue criteria

patient balance > 0
payment method = null
insurance = null

Your rules, your queue.

HB Self-Pay Follow-Up WQ Financial Counselor View

WQ Score ▾Svc DatePatientCoverageBalancePayment

11005/12/2026ALVAREZ,MARIAnil$4,820nil

10006/02/2026NGUYEN,THANHnil$1,290nil

9005/21/2026HOFFMAN,GREGORYnil$3,218nil

Every row is a patient your counselors would otherwise have to dial by hand.

Real-time

The moment a row lands, a workqueue event notifies Rose. Outreach can start within seconds.

Batch

Or on your schedule: a sweep hands Rose the queue, nightly, hourly, you choose.

Rose picks it up from hereEither path starts the same workflow.

Enough slides

Rose.

is now online at

Legacy Health

Same data you just saw in the workqueue.

“Does the patient have insurance coverage not obtained during the visit?”
“If not, would the patient choose to participate in a screening process for Medicaid eligibility?”
“If not eligible for Medicaid, would the patient choose to apply for financial assistance with the help of Legacy’s staff?”

What Rose can do…

Reads the Epic Workqueue

Connects directly to the Patient Account Workqueue
Listens to real-time HL7 interfaces (ADT, SIU, ORU, MDM and more), including custom Bridges Z-segment feeds for workqueue-level triggers
Or reads the full queue as a scheduled batch: nightly, hourly, any interval Legacy sets
Pulls live account context (balance, coverage, workqueue status) through 600+ Epic APIs and 250+ HL7 interfaces

Automated Outreach

Initiates outreach automatically on workqueue entry, replacing manual dialing and voicemail follow-up
Delivers two-way SMS/RCS, Voice AI, and Email from a single platform
Supports campaign-based and trigger-based outreach through a unified rules engine
Re-validates eligibility before every touch; resolved accounts are automatically suppressed

SMS / RCS

Voice AI

Email

Financial Counselor Decision Tree

Identifies the patient first: phone, account, or DOB, before any PHI is discussed
“Does the patient have insurance coverage not obtained during the visit?”
If not: “Would the patient choose to participate in a screening process for Medicaid eligibility?”
If not eligible: “Would the patient choose to apply for financial assistance with the help of Legacy’s staff?”

Medicaid Eligibility Screening

Captures consent before any screening question is asked
Runs the eligibility / redetermination questions conversationally, in the patient’s language
Income, household size, and answers land as structured data, not transcripts
Not eligible? Rose initiates the financial assistance workflow on the same conversation

Medicaid / OHP

Documents & Warm Handoff

Document collection: patients submit forms and photos straight from their phone
One workflow across channels: Call → SMS follow-up, SMS → agent call-back
Warm handoff to a live counselor, with full context carried over

Voice AI

SMS / RCS

Secure File Transfer

Writes Back to Epic

Returns answers as Workqueue tasks for the Financial Counselor, routed to the correct queue with zero manual entry
Updates coverage, demographics, and account status directly through FHIR APIs and HL7
Manages consent and opt-out preferences automatically, with an end-to-end audit trail

Real-Time Campaign Analytics

Live campaign status: attempted, connected, in progress, completed
Response and connection rates by channel, language, and cohort
Financial outcomes: coverage found, screenings completed, applications started
Real-time dashboards that show the agent’s next move, not just what happened

Avaamo’s Conversational Intelligence

Where the events land

The Avaamo Outreach Platform

Avaamo Outreach Platform LIVE FEED

Campaign Recipients Rules Engine Guardrails

Patient	WQ Score	Source	FYI Flag	Location	Channel	Language	Status
ALVAREZ,MARIA	110	WQ EVENTreal-time	nil	Legacy Emanuel	SMS / RCS	Spanish	Queued
NGUYEN,THANH	100	WQ EVENTreal-time	nil	Good Samaritan	Voice	Vietnamese	In cadence · step 1
HOFFMAN,GREGORY	90	BATCHnightly sweep	nil	Mount Hood	Voice	English	Callback booked
PETROV,IRINA	70	WQ EVENTreal-time	nil	Salmon Creek	SMS / RCS	Russian	Suppressed · resolved

Campaign nameSelf-Pay Follow-Up Outreach

DescriptionFinancial counseling outreach, self-pay cohort, Phase 1

TriggerEpic WQ event (Bridges feed) + nightly batch

Linked agent Rose

RoseVoice AISMS / RCSEmailTwo-way

Outbound number+1 (503) 555-0142 · Legacy Health caller ID

10DLC registered · trusted sender: calls and texts display as Legacy Health, never as spam

Verified RCS sender · branded name and logo in the patient’s messaging app

Who qualifies, who is excluded, who goes first

Eligibility

BalanceNumberGreater than$0Eligible

Payment methodFieldIs empty-Eligible

Active payment planFlagIsYesExclude

Opted out / resolvedFlagIsYesExclude

Prioritization

WQ ScoreNumberSortHighest firstPriority

CohortListIsFA pendingBoost

BalanceNumberGreater than$5,000Boost

✚ Add New Condition

Activate

When outreach goes out

Send on activation · first touch goes out the moment a patient qualifies

Recurring campaign · follow-ups on specific days of the week

TimezoneAmerica / Los_Angeles (Pacific) ▾

Start time8:00 AM ▾

RepeatDaily ▾

Repeat onSunMonTueWedThuFriSat

Attempts4 ▾

Channel per attempt 1SMS / RCS ▾ 2Voice AI ▾ 3SMS / RCS ▾ 4Voice AI ▾

EndsAfter attempt 4 → account moves to the human workqueue

Transactional · enforced by the platform

The system cannot break these

Quiet hours · 8 PM–8 AM, patient-local

Preferred language · informed by the patient’s Epic record

SMS consent & opt-out · synced back to Epic automatically

Re-validate eligibility before every touch · paid or resolved stops instantly

Exhausted → warm handoff · full context to a live counselor

Conversational · enforced in every exchange

Rose cannot be talked out of these

Compliance · Oregon

FA screening before any collections talk, alwaysORS 646A.677

Identity verified before any PHI is spokenHIPAA

Discloses she is a virtual agent and that calls are recordedORS 165.540

Contact frequency caps on top of quiet hoursReg F · 7-in-7

The money conversation

Never pressures, never threatens, help-first framing onlyFDCPA-aligned

No card numbers in-channel, secure link or billing specialistPCI DSS

No legal or financial advice, options only, complex → counselor

Clinical & crisis

No medical advice, ever, clinical questions route to care

Crisis escalation: self-harm or emergency → 911 / 988 script, outreach abandoned988 protocol

Financial-distress empathy: hardship pivots to assistance, never persists on paymentIRS 501(r)

Conduct & scope

Strict scope refusal: off-topic, political, competitors, prompt-extraction, all declined

Minors & third parties: account discussed only with the verified guarantorHIPAA

Click a patient

RULE TRACE · EVALUATING select a patient →

Every row arrived on its own: real-time WQ events and the nightly batch, no manual imports, no spreadsheets
The feed brings the event; Avaamo enriches the rest from Epic EHR: WQ score, FYI flags, location, channel, language, by patient ID
Status is live: queued, in cadence, callback booked, updating as Rose works
Suppression is automatic: eligibility re-validated before every touch, resolved patients are never contacted

One campaign per use case: named, described, and owned by Legacy
Wired to an agent: Rose answers this campaign on Voice AI and SMS/RCS, two-way
A trusted number: 10DLC-registered caller ID, outreach displays as Legacy Health, never as spam
The trigger is yours: the WQ event or the nightly batch, nothing else starts outreach

How it’s wired

One architecture, two ways in

Avaamo × Epic · Phase 1 reference architecture Click to walk the flow

1

Your workqueue

An account lands on your Epic workqueue.

● The instant it lands ● Or nightly batch

2

Secure Connection

Epic → Avaamo

Avaamo hears about it instantly, over the secure Epic interfaces already in place.

HL7FHIREncrypted

3

Outreach Engine

Your rules

Your rules decide who to reach, when, and on which channel.

EligibilityCadenceQuiet hours

4

Rose

The conversation

Rose has the conversation, with the account details in front of her, and a counselor one step away.

5

The Patient

Their channel

Reached on the channel they actually answer, from a number they can trust.

VoiceSMS / RCSEmail

7

Write-back to Epic

The loop closes

Everything lands back in Epic automatically · payments, answers, documents, dispositions. No manual entry.

6

Analytics Open live dashboard

You watch it live

Every attempt, every outcome, every next move · live on one dashboard.

The channel advantage

What RCS unlocks

Plain SMS is 160 characters and an unknown number. RCS turns the same thread into a branded, interactive experience, in the patient’s native messaging app. Click a feature.

1

Branded, verified sender

Legacy Health’s name and logo, verified checkmark, no unknown number, no spam gamble

2

Rich cards

Payment plans presented as visual cards with buttons, not a wall of text

3

Dynamic carousels

Patients swipe between options and pick, choosing feels effortless

4

Suggested replies & actions

One tap to confirm, call Rose, or open a secure upload, no typing required

5

High-res media, both ways

Patients send photos of insurance cards and pay stubs right in the thread

6

Read receipts & typing

Rose knows what was seen, and times the next touch accordingly

2:25▮▮ ⚲ ▯

←

Rose · Legacy Health Verified business · Legacy Health · RCS ⋮

Today · 2:25 PM

Hi Maria, this is Rose from Legacy Health. I’m reaching out about your recent visit to Legacy Emanuel. This is a secure line, reply anytime.

Oh good, I was worried this would be spam

Read 2:26 PM

Today · 2:31 PM

There’s a zero-interest plan for your balance:

Payment plan

12 months · $402 / month

Zero interest · no fees · cancel anytime

View planTalk to Rose

Today · 2:32 PM

Here are your options, swipe to compare:

3 mo

$1,607 / mo

Paid off fastest

Choose

6 mo

$803 / mo

Balanced

Choose

12 mo

$402 / mo

Lowest monthly

Choose

Today · 2:34 PM

Would you like help adding your insurance to the account?

✓ Yes, add insurance📞 Call me instead

🔗 Secure upload📅 Book a callbackNot now

Today · 2:36 PM

Snap a photo of the front of your insurance card, it attaches straight to your account.

OREGON HEALTH PLAN

ALVAREZ, MARIA T

ID 4X8 821 0512 · GRP OHP-PLUS

Delivered · attached to HAR 88214005

Today · 2:38 PM

Can I start next month instead?

Read 2:38 PM

Rose is typing…

⊕RCS message☺▣

◀●■

Phase 2 · Inbound

Aaron.

Inbound billing agent at

Legacy Health

Verifies the caller across independent confirmation points, before any PHI

Checks outstanding balance in real time, straight from Epic

Takes payment on the call, full or partial, through your existing gateway · PCI DSS

Posts instantly to Epic, no manual reconciliation · 69% faster

Sets up payment arrangements and pre-screens financial assistance, materials via MyChart

Explains charges, coverage, and denials, plus the COB action the patient must take

Takes new insurance verbally, uploads to Epic, and files disputes for nurse or coding review

Warm, contextual handoff to billing or insurance staff · 82% fewer calls reach humans

Agenda.

Rose.

The workflow starts in your workqueue

Workqueue criteria

Rose.

What Rose can do…

Reads the Epic Workqueue

Automated Outreach

Financial Counselor Decision Tree

Medicaid Eligibility Screening

Documents & Warm Handoff

Writes Back to Epic

Real-Time Campaign Analytics

The Avaamo Outreach Platform

Who qualifies, who is excluded, who goes first

Activate

When outreach goes out

Transactional · enforced by the platform

The system cannot break these

Conversational · enforced in every exchange

Rose cannot be talked out of these

One architecture, two ways in

Secure Connection

Outreach Engine

Rose

The Patient

Write-back to Epic

Analytics Open live dashboard

What RCS unlocks

Branded, verified sender

Rich cards

Dynamic carousels

Suggested replies & actions

High-res media, both ways

Read receipts & typing

Aaron.

Aaron.

What you just saw.

Thank you.