Autonomous Revenue Cycle Intelligence for Epic Resolute

Revenue Cycle Perspective

(For CFOs, Revenue Cycle Directors, Billing Managers, and Executive Leadership)

LlamaPack_BillingGuard acts as a fully autonomous “24/7 revenue cycle co-pilot” that sits on top of your existing Epic Resolute (Professional Billing + Hospital Billing) workflows and owns the entire end-to-end process without replacing or disrupting anything your team already does in Epic.

Here’s exactly how it works in daily operations:

• Charge Capture & Coding: As soon as a provider finishes documentation in Hyperspace (or via voice/ambient notes), BillingGuard reads the clinical note in real time, applies ICD-10/CPT/HCPCS coding with >98% accuracy using your specific payer rules, charge description master (CDM), and facility contracts. It then auto-populates or updates the charge in Resolute’s Charge Router / Charge Capture workqueues.

• Claim Building & Submission: BillingGuard assembles clean, fully scrubbed claims directly inside Resolute (or via your clearinghouse feed). It performs pre-submission validation against every payer’s latest rules, flags anything that would be denied, and either auto-corrects or routes it to a human only when truly needed. Clean claims go out the same day — often within minutes of the encounter closing.

• Denial & Appeals Management: When a denial lands in Resolute’s Workqueues (or 835 remittance files), BillingGuard instantly pulls the full claim history, clinical documentation, and payer policy. It drafts a complete, evidence-based appeal letter (with citations), attaches the right documents, and submits the appeal back into Epic’s denial workflow or directly to the payer portal.

• Compliance & Continuous Monitoring: It runs constant audits for medical necessity, bundling/unbundling violations, modifier errors, and documentation gaps. It also monitors payer policy changes and proactively updates your charge rules inside Resolute.

Business outcomes you will see within 60–90 days:

• A/R days drop 30–45%
• First-pass acceptance rate climbs to 98%+
• Denial volume falls 50–70%
• Billing staff spend 70% less time on repetitive tasks and more time on complex exceptions
• Full audit trail and compliance reporting stays 100% inside Epic (no shadow systems)

Your revenue cycle team still works in the familiar Epic Resolute interface — they just get far fewer items in their workqueues and far higher collections.

Technical Perspective

(For IT, Integration, Epic Analysts, Security, and Implementation Teams)

LlamaPack_BillingGuard is built as a secure, read/write external agent that integrates with Epic Resolute using industry-standard, Epic-certified methods (no custom Bridges development required in most cases). It is designed for rapid, low-risk deployment.

Core Integration Architecture:

• Authentication & Security: Uses Epic’s OAuth 2.0 + SMART on FHIR (Backend Services flow) or standard Epic Interconnect credentials. All access is scoped to the minimum required resources (e.g., Claim, ExplanationOfBenefit, ChargeItem, Encounter, DocumentReference, etc.). SOC 2 Type II + HIPAA BAA in place; optional on-prem/air-gapped deployment available.

• Data Ingestion (Read):

  • Real-time or near-real-time via Epic on FHIR R4/R5 APIs (Encounter, DocumentReference for notes, ChargeItem, Claim resources).
  • HL7 v2 interfaces (ADT, ORU for clinical notes, DFT for charges) via your existing Epic Bridges engine if preferred.

• Action & Write-Back:

  • Writes corrected or new charges directly into Resolute Charge Router / Charge Capture using FHIR ChargeItem or HL7 DFT messages.
  • Creates or updates Claim resources in Resolute, then triggers outbound X12 837 submission.
  • Reads ExplanationOfBenefit (835/837 responses) and writes appeal notes and attachments back into Resolute Denial Workqueues.

• Orchestration & Autonomy:

  • Runs as an always-on agent swarm. Subscribes to Epic event notifications (via FHIR Subscriptions or HL7) for new encounters, charge events, or denials.
  • All actions are logged in Epic’s Audit Log + our immutable audit trail (visible to your compliance team).

Deployment & Go-Live:

• Typical timeline: 4–6 weeks (2 weeks for Epic analyst collaboration + testing in non-prod, 1–2 weeks parallel run, 1 week cutover).
• No Epic build required in most cases.
• Works with both Resolute PB and HB modules and Single Billing Office.
• Full regression testing against your payer rules and CDM before go-live.