Patient enrollment form processing, from fax to an open hub case in minutes
Every faxed or portal enrollment form becomes a cited patient-support case in minutes, the same day it arrives.
See one case, screen by screen ↓The prescriber's office faxes six pages: the enrollment form, the prescription, a demographic sheet, the insurance cards and a chart note. Until someone in intake splits that fax, keys the patient, prescriber, diagnosis and insurance fields into the hub system and checks every signature and box, the patient has no case, and benefits verification cannot start.
Most forms are not complete when they arrive. The patient authorization is unsigned, the prescriber did not sign the prescription, the cards are missing, the ICD-10 code does not match the box ticked, two digits of the member ID are swapped. Each gap means a call or a fax back to the office, a reply to match to the right patient hours or days later, and a patient who still cannot be contacted.
Estimated split for one enrollment form, in working hours, by hand and with the solution — not counting the wait for the office's reply.
Six specialist agents sort, read and check every packet and draft the note to the office; the intake specialist approves each request and case.
At 07:42 Lakeshore Gastroenterology in Chicago faxes six pages for Marisol Vega, a new Veltrimab patient of Dr. Elise Novak. Here is what happens next, screen by screen, in the working solution.
Dana opens the intake line for Northwind Patient Support: 412 forms received in the last 24 hours, 64 % of them by fax, 355 already open as cases. Four packets need her, 46 wait on offices, and the median from receipt to case is 38 minutes. Lakeshore's fax is at the top of the tray, marked Needs you.
“Patient outreach waits for a signed authorization.”
The Packet Sorter splits the six pages into an enrollment form, a prescription, a demographic sheet, the insurance card and a chart note. The Form Reader reads 31 fields, each with its page and box. The Insurance Card Reader reads the card front and back, and finds the member ID differs from the form. The privacy guard finds a Social Security number on page 4 and masks it.
“31 fields read, each with its page · 3 below 90%”
The Veltrimab form has 15 rules. Twelve pass. The programme authorization in section 2 is not signed: both lines are blank. That one goes straight into the office request, and patient outreach is locked until it comes back signed — the text-message consent box is ticked, but nobody contacts Marisol yet.
“Until it is signed, no health information goes to the programme and nobody contacts Marisol.”
Patient, consent, insurance, diagnosis, prescriber, clinical and prescription fields, each with a confidence and the page it came from. Click a row to see it on the faxed page. Three handwritten values were read below the 90 % threshold: the member ID at 78 %, the date of diagnosis at 88 % and the TB test at 84 %.
The ulcerative colitis box is ticked, but the code written, K50.90, is a Crohn's disease code; the prescription line ticked is the UC strength and the chart note describes ulcerative colitis. Dana chooses “Ask the office to confirm”. On the member ID, the form says NWH 4417 2093 and the printed card, read at 99 %, says NWH 4471 2093. She takes the card value.
“This is a form check, not a clinical call — the office confirms its own code.”
A fax to Rosa Diaz, office coordinator at Lakeshore, with exactly two items: the patient's signature and date on the authorization (page 1, section 2) and a confirmation of the ICD-10 code (page 2, section 4). It reminds the office to black out Social Security numbers before faxing. Page 1 is attached with the lines to complete marked.
“No insurance numbers or diagnosis codes beyond what is asked.”
Dana approves and the request is faxed to (312) 555-0148. The Case Opener opens the case in the hub system as Pending info and sets the follow-up timers: a call to the office at 24 hours, a second request at 48 hours, close as incomplete at day 10.
A one-page reply comes back from Lakeshore. The Packet Sorter matches it to ENR-24817: it comes from the office fax with an open request, and the patient's name and date of birth match. Marisol's signature is there, dated 10/07/2026, and Dr. Novak writes: “Confirmed: ulcerative colitis, K51.90. K50.90 was written in error.” All 15 checks now pass.
“Authorization signed — the hub may contact Marisol by phone and text.”
Before the case can open, Dana checks the date of diagnosis and the TB test against their boxes on the page and confirms them as read. She opens the case. The Case Opener writes the 31 cited fields to the hub system and assigns it to Sam Patel, case manager, who starts benefits verification with Harborline Health Plan.
Lakeshore sent 64 forms in 30 days and 48 % arrived complete; the patient authorization was unsigned on 21 of them. The solution drafts a coaching note to Rosa with three fixes and a one-page checklist, for Dana to approve and send.
“Most gaps come from the patient signature on page 1 — the form is often faxed before the patient signs at check-out.”
The same packet, seen by the four people who carry it — what their week looked like, and what it looks like now.
Six specialist agents sort, read and check every packet and draft the note to the office; the intake specialist approves each request and case.
Splits each inbound fax or upload into its documents — enrollment form, prescription, demographic sheet, insurance card, chart note — and matches replies to the open case.
Reads typed and handwritten fields from the enrollment and prescription form into the case, with the page and box for every value and a confidence.
Reads payer, member ID, group, Rx BIN, PCN and Rx group from the front and back card images and compares them with what the form says.
Runs the brand form rules — required fields, signatures, consent, the ICD-10 code belongs to the box ticked, NPI check digit, form version — and gives a verdict with reasons.
Drafts the missing-information fax to the office in plain words, lists exactly what is missing and attaches the page to sign.
Opens or updates the case in the hub system with the cited fields, sets follow-up timers and hands complete cases to a case manager for benefits verification.
Confirms and approves. The agents propose; a named person decides.
The intake team can ask in plain words — or tell it what to change. Answers point to the page they rest on.
Why is ENR-24817 not complete?
One thing blocks it and two need you. The programme authorization on page 1 is not signed or dated; until it is, no health information goes to the programme and nobody contacts Marisol. The form ticks ulcerative colitis but the code written, K50.90, is a Crohn's disease code. The member ID on the form has two digits swapped against the card. A request to Rosa Diaz at Lakeshore is drafted and waits for your approval.
Which offices send the most incomplete forms?
Four offices are below 65 % complete on arrival this month: Riverbend Arthritis Center (42 %, old form version), Lakeshore Gastroenterology (48 %, patient authorization unsigned), Summit Rheumatology (51 %, prescriber signature missing) and Hill Country Digestive Health (64 %, representative relationship missing). Lakeshore's gap is almost always the patient signature — 21 of its 33 incomplete forms.
Add a rule: flag prescriptions signed more than 30 days before the fax
Added to all three brand forms as A person checks: “The prescriber signed the prescription within 30 days of the fax.” Tested on the last 500 forms: 11 would have been flagged, none of them blocked. Omar Haddad is notified as the rule owner and can retire it from Form rules.
What does the confidence threshold do?
Every field the Form Reader reads below 90 % goes to a person with its box highlighted on the page — mostly handwritten member IDs and dates. You can change it in Settings.
13 screens from the working solution, on its sample data. Pick one to see it large.
Thresholds, approvers and follow-up timing are settings. Changes apply to new packets at once.
| Setting | Default | Choose from |
|---|---|---|
| Confidence threshold — below it, a person confirms | 90 % | 85 · 90 · 95 % |
| Open complete forms automatically | Off — a person opens every case | On · Off |
| Who approves requests to offices | Dana Okafor | Dana Okafor · Lena Ortiz · Any intake specialist |
| Who answers consent questions | Omar Haddad | Omar Haddad · Dana Okafor |
| Who approves form rule changes | Omar Haddad | Omar Haddad · Priya Raman |
| Call the office if no reply after | 24 hours | Set in hours |
| Fax and e-signature link again after | 48 hours | Set in hours |
| Close as incomplete, and tell the office and the prescriber, after | 10 days | Set in days |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample hub data · “estimated” = our estimate · Patient authorization requirements: 45 CFR 164.508. People, offices, brands and payers named on this page are fictional characters and data in the working solution.
It is the first step of a patient's support journey: the enrollment form, prescription and insurance cards the prescriber's office sends are read, checked and turned into a case in the hub system. Enrollment Intake does that with six agents — they sort the packet, read the fields with a citation on each, check it against the brand form rules and draft the request for anything missing.
The Form Reader reads typed and handwritten fields with the page and box for every value and a confidence. Any value read below the threshold — 90 % by default — goes to a person, with its box highlighted on the faxed page, before the case can open.
The brand's own form rules, 12–15 per form: patient details, contact details, the programme authorization signed and dated, a representative's relationship, insurance cards attached, member ID against the card, the ICD-10 code against the diagnosis box, the prescriber NPI check digit, the prescriber's signature, the form version and more. Each rule says whether a failure blocks the case, goes to the office or goes to a person.
No. The Completeness Checker tests that the code belongs to the box ticked; it does not judge the diagnosis. When they disagree, the office is asked to confirm its own code. Quick-start eligibility is checked by the case manager during benefits verification, never by the agents.
Social Security numbers are masked on arrival and never stored, nobody contacts the patient until the authorization is signed, and texts need the text-consent box ticked as well. Requests to offices carry the minimum patient detail, and lists can show patient names as initials only.
Yes. A named person approves every missing-information request before it is faxed, decides every flagged item and confirms low-confidence fields, and a person opens each case unless you switch on automatic opening for complete forms. Every agent step and decision is on the packet's activity trail.
Your inbound fax lines, eForm and portal submissions, your e-signature service for patient and prescriber signing links, and your hub system, where it writes cases, timers and assignments. It checks prescribers against the NPI registry and codes against ICD-10-CM.
The Agentic Solution Engine builds and deploys it from your requirements — your brand enrollment forms, form rules, letter wording and a sample of past packets — and it goes live once every quality gate has passed. We will walk you through it on your own enrollment forms first.
Every patient-programme call, email, chat and note is read in full, and each side effect reaches safety inside the 24-hour window.
1-min filmPrior AuthorizationEvery request reaches the payer with each criterion proven from the chart, so patients start treatment in days.
1-min filmPatient AssistanceEvery free-medicine application is checked against every rule, each figure cited, and most are decided within a day.
1-min filmWe’ll run Enrollment Intake on a sample of your own faxed enrollment packets.