AI HEDIS Coordinator Meet your AI HEDIS
Coordinator. It works every open gap. You don't hire for that anymore.
Your team focuses on patients who need clinical care. Everything else - finding evidence across claims, faxes, labs, and PDFs, reconciling payor gap lists, generating submission-ready supplemental files - is handled automatically.
No commitment required · Typical demo: 20 min
Ingesting sources Claims data — Aetna Inbound fax — lab results HbA1c result — Quest AI Engine Reconciling across sources Gaps closed COL — Colorectal screening Closed CDC — HbA1c control Closed CBP — Blood pressure Closed
The Problem
Your EMR only sees part of the picture. Standard HEDIS tools extract data from your EMR - but the evidence coordinators need lives across claims, faxes, labs, and PDFs too. Reconciling those sources manually is where the hours go. Most of the time, the gap was already closed.
EMR Coverage0% Full Source Coverage0% 95% of measures don't need your team. A lab result buried in a fax gets the same coordinator time as a patient with uncontrolled hypertension who needs clinical intervention. Your best people are spending their day on work a machine should handle.
Machine work0% Needs clinical judgment0% Regulatory Shift NCQA is eliminating chart retrieval for key hybrid measures - COL, CIS, IMA, CCS - and requiring compliance to flow through prospective supplemental data instead. Organizations still running manual chart chase workflows are about to hit a wall.
The Difference What makes this different. "Other tools hand you a better flashlight. We turn on the lights."
VS Every other HEDIS tool Pulls EMR data, surfaces evidence Helps abstractors work faster Stops at dashboards and worklists Still requires manual payor reconciliation Single data source per submission DoctusTech AI HEDIS Coordinator Ingests EMR, claims, faxes, PDFs, labs Eliminates the abstractor workflow entirely Closes gaps autonomously where data allows Auto-generates payor-ready supplemental files Formatted to each payor's exact specs With DoctusTech, here's how those 15 gaps get handled 0 Total gaps → 0 Automated by AI + 0 For your team How It Works How your AI HEDIS Coordinator works "Not all HEDIS gaps need a human. The ones that do deserve your team's full attention."
Handled by AI Your clinical team Gap type Example What's required Who owns it ▾ Documentation gaps Screening done, not in EMR Cross-source reconciliation, supplemental submission AI AI handles this automatically
Scans EMR, labs, claims, and supplemental sources — reconciling records and submitting documentation without manual chart review. Zero coordinator time required.
▾ Administrative gaps Result in fax or PDF, unreconciled Multi-source evidence packaging, payor formatting AI AI handles this automatically
Faxes, PDFs, and unstructured results are ingested, parsed, and packaged into payor-ready evidence submissions — formatted to each payor's exact requirements.
▾ Outreach & scheduling gaps Lab draw or screening not yet done Outbound patient contact, scheduling, closure confirmation AI AI handles this automatically
AI reaches out to patients via their preferred channel, schedules the needed service, and confirms closure once results are received. Your team is notified only if outreach fails.
▾ Clinical improvement gaps HTN not at goal, HbA1c uncontrolled Clinical judgment, treatment decision, patient relationship Your team Your team owns this — AI prepares the context
These gaps require clinical judgment and a therapeutic relationship. AI surfaces the patient, preps the chart summary, and flags the gap — so your clinicians walk in fully briefed.
0 Gap types 0 Handled by AI 75% of volume 0 For your team Ready to Find Out By the time your coordinators arrive, HEDIS Agent has already closed the gaps the data supports. Most organizations find closed gaps hiding in sources their EMR never touched.
Request a demo
→ No commitment required · Typical demo: 20 min