u/rahuliitk

I keep running into this while building software for healthcare, and i’m curious how other founders have handled it.

on paper, things like eligibility checks, prior auth, claim follow-ups and denials all seem pretty repeatable.

then you talk to five clinics and somehow discover eight different workflows.

one clinic handles eligibility inside its EHR. another has someone manually checking multiple payer portals. home health prior auth is completely different from cardiology or dental. some customers want the whole process automated, while others just want one painful step fixed.

then there are all the random exceptions.

half the time, the real workflow isn’t documented anywhere. it just lives in the head of one employee who has been doing it for years and knows what to do when something breaks.

my first reaction was basically, fine, we’ll add more settings, integrations and rules.

but i’m starting to wonder whether “highly configurable SaaS” eventually just becomes custom software wearing a SaaS hat.

every new customer needs discovery, workflow mapping, setup, integrations and some special thing that apparently nobody else needs.

so i guess the options are:

1. go very narrow and make customers adapt to the product
2. accept that software plus services is the actual business model
3. build reusable workflow blocks and configure them differently for each customer

the third option sounds best in theory, but also feels like the easiest way to build something insanely complicated.

for anyone who has built vertical SaaS, where did you draw the line?

when did customization become a real moat, and when was it just your SaaS company slowly turning into an agency?

been working on automating stuff like prior auth, claim follow-ups, payer calls, and medical documents lately.

i genuinely thought the main challenge would be getting the AI accurate enough.

nope.

the real challenge is that healthcare workflows make almost no sense.

one insurance company wants a portal submission. another wants a fax. another wants you to call. sometimes the portal says the request is pending, the phone rep says they never received it, and somehow both are considered valid answers.

then you start building automation around it and realize there isn’t really one workflow. there are hundreds of slightly different workflows held together by people who just know what to do from experience.

we’ve had cases where the AI completed most of the task correctly, but the last 10% still needed a human because the payer gave a vague answer or asked something unexpected.

and honestly, that’s probably fine.

i used to think the goal was full automation. now i think the better goal is removing the repetitive work without making the human lose control of what’s happening.

anyone else building in healthcare, insurance, finance, or another messy industry finding the same thing?

sometimes understanding the broken process takes longer than building the product lol.

i honestly thought we’d put QuickVoice on GitHub, get a few stars, and go back to fixing bugs, but the repo took off way faster than we expected and now we’re trying not to mess up what comes next.

We built it because connecting real-time voice, telephony, tools, knowledge bases, outbound campaigns, and call logs across a bunch of different services was getting exhausting. The goal is to keep it open, self-hostable, and flexible enough that people aren’t locked into one provider.

It’s still early, the setup isn’t exactly one click, and there are definitely rough edges. Full disclosure, I’m the founder behind it, but I’d genuinely like blunt feedback from people building voice agents: what should we fix first, easier setup, lower latency, better docs, observability, or more integrations?

Repo: https://github.com/allgpt-co/QuickVoice

Hey everyone,

Healthcare is supposed to be digital now, but somehow a lot of work still means leaving the EHR, logging into another portal, sending a fax, downloading a PDF, or updating some random spreadsheet.

what workflow is the worst for this?

eligibility, prior auth, outside records, referrals, claim status, denials, scheduling, coding, anything really.

has anyone seen a tool that actually removed the manual work, or did it just become another dashboard staff had to check?

curious what people are still doing manually even though the technology is technically already there.

Does anyone else deal with this?

we keep seeing the same types of denials come back even after they get fixed and resubmitted. at some point it stops feeling like a one-off billing mistake and starts feeling like something is broken earlier in the process.

like maybe eligibility wasn’t checked properly, auth was missed, documentation didn’t support the code, or someone assumed another person was handling the next step.

by the time it reaches AR, everyone is just trying to fix that one claim, but it feels like nobody has time to ask why it keeps happening in the first place.

for people doing billing/coding, what denial do you see that always makes you think “we should have caught this before it went out”?

hey everyone,

i’m trying to understand something from people actually working in healthcare / healthtech.

why do some tools actually get adopted by clinicians and staff, while others look great in the demo and then basically disappear after week one?

i’ve seen this happen a lot. leadership gets excited, vendor says it will save hours, everyone does training, and then doctors or staff quietly go back to the old way because the new thing adds clicks or feels like another thing to babysit.

what healthcare software have you seen people actually keep using?

could be an AI scribe, EHR shortcut, note template, coding tool, intake form, patient messaging, inbox automation, billing tool, or even something boring that just removed a small daily headache.

why did it work?

was it because it fit inside the EHR, saved typing, reduced clicks, solved one specific problem, or because clinicians were involved before rollout?

i’m working around this space and trying to understand what makes a tool useful after the demo hype is gone.

would love honest examples, even boring ones.

Hey everyone, i’m working on an AI tool for healthcare admin/RCM stuff like eligibility, prior auth, coding support, claim follow-up, denials, etc.

i’m not here to say AI is going to replace billers or coders, because honestly the more i talk to people in this space, the more obvious it is that the hard part is judgment, payer weirdness, documentation gaps, and knowing when something looks off even if the system says it’s fine.

what i’m trying to figure out is what would actually make you trust a tool like this in your day-to-day work?

like, if it suggested codes, flagged missing documentation, caught auth/eligibility issues earlier, or warned that a claim might deny before it goes out, what would you need to see before you’d take it seriously?

audit trail? source notes from the chart? confidence score? payer-specific rules? coder review before anything gets submitted?

or would it still just feel like one more thing to babysit?

would really appreciate honest thoughts from people actually doing billing/coding every day.

I’m working on QuickIntell, an AI workflow tool for healthcare teams, mostly around eligibility, prior auth, denials, billing follow-up, coding support, and other RCM/admin stuff that eats up staff time.

The hard part is that healthcare has so many broken workflows that almost everything sounds painful when you ask about it.

People will say:

“yeah prior auth sucks”

“yeah denials are annoying”

“yeah eligibility mistakes waste time”

“yeah our staff is overloaded”

But I’m trying to figure out what is actually painful enough that a clinic, billing team, RCM company, or MSO would change how they work and maybe pay for a tool.

Because “that sounds useful” and “we need this now” are very different things.

And in healthcare, even if the workflow is painful, teams may still avoid new software because implementation, training, EHR integration, compliance, and staff adoption can feel like another problem on top of the original problem.

So for people who work in healthcare ops, billing, coding, prior auth, front desk, RCM, or practice management:

which admin pain would actually make you consider using a new tool?

Eligibility mistakes before the visit?

Prior auth tracking?

Denial prevention?

Coding/documentation checks?

Claim follow-up?

Patient balance confusion?

Payer policy changes?

Staff jumping between portals all day?

I’m not trying to pitch. I’m trying to understand where the real pain is vs where people are just politely agreeing.

For anyone who has bought, sold, or implemented healthcare SaaS, how do you tell if something is a real painkiller and not just another nice-to-have dashboard??