Ohtari Workflows

Unpublished changes

Chat

Manual

Ohtari

Workflow builder

Build a voice agent that answers our main line. Ohtari should identify the patient via Athena, figure out what they're calling about, and use the right Skill to handle it — Pre-op questions, Post-op issues, Prior auth status, Billing. Each Skill has its own knowledge base and conversation flow. If the question is too complex or sensitive, transfer to staff with the full call context.

+ Add SMS follow-up after call

⚙ Lower transfer-confidence threshold

+ Add appointment-booking skill

+ Add after-hours on-call routing

Trigger

Patient calls the practice main line

Type:

Inbound voice call

Access:

Anyone — patient-facing line

Where:

Twilio · main line

Approval required

default

Approved by: Clinical lead · Billing lead (skill-dependent)

Human sign-off required before any patient, chart, claim, or financial action runs.

Athena · Read

Identify patient via caller ID + verify via DOB

Reading from chart (6 fields)

patient.phone_match

patient.dob

patient.episodes.active

patient.surgery.next_scheduled

patient.pa.in_flight

patient.balances.outstanding

Cache: 30 sec

Latency: ~620ms

+ Active episode list

+ Open balance flag

Survey · Voice

Greet patient and classify intent

Questions (3)

Channel: Voice (live)

Intent: what are you calling about?

single-select

ambiguous → reprompt

Sentiment / urgency

single-select

distressed → staff transfer

Verbal consent for AI assistant

single-select

no → staff transfer

Conditional

Route to the right Skill based on intent

Expression

intent IN { pre_op, prior_auth, post_op, billing, other }

TRUE

→ Invoke matching Skill (next step)

FALSE

→ Transfer to front office staff with intent unclassified

Skill

Invoke skill: Spine PA Criteria

Spine PA Criteria

/skills/spine-pa-criteria

Open skill →

Knowledge sources (5)

UHC clinical policy 2024.06.B

Aetna spine PA criteria

BCBS conservative care thresholds

Cigna peer-to-peer patterns

Practice's last 12 months of PA outcomes

Can handle (5)

“

What's the status of my prior auth?

“

Why was I denied?

“

What evidence is missing?

“

When is my peer-to-peer scheduled?

“

What does my payer require?

Transfer

Patient asks for clinical advice · Patient asks to change surgery date · Patient is distressed

Conditional

Did Skill resolve, or is staff transfer needed?

Expression

skill.confidence >= 0.85 AND NOT skill.transfer_signal_raised

TRUE

→ Close call with summary + Athena write

FALSE

→ Transfer to staff with full call context

Survey · Voice

Transfer to staff with full context

Front Office lane

Actions (3)

Warm transfer to live agent

Pre-populate context card on agent screen

Tag call with Skill used + intent classified

Writes

Call transcript

Intent label

Skill used

Transfer reason

Integrations

Twilio Flex

Athena (call note)

Athena · Write

Write call summary to chart and close

Field mapping (6)

call.intent

encounter.intent

call.skill_used

encounter.skill_ref

call.transcript_url

encounter.attachments

call.resolution

encounter.outcome

call.next_action

episode.followups

call.duration_sec

encounter.duration

Idempotent

Event: Patient phone encounter

Applied Skills (4)

Spine PA criteria — payer-specific medical necessity

How Ohtari assembles spine prior auth packets per payer, what counts as conservative care evidence, and when to escalate.

Joint replacement pre-op pathway

12-step pre-op coordination protocol used for THA, TKA, and UKA cases. Defines clearance windows, anesthesia handoff, DME timing, and patient prep cadence.

Post-op outcomes & escalation thresholds

Subspecialty-specific check-in questions and escalation thresholds for the post-op pathway.

Peer-to-peer prep & appeal strategy

Playbook for handling payer denials and peer-to-peer requests. Evidence assembly, surgeon talking points, escalation contacts.