Gastroenterology

From fax to
booked procedure.

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01 Referral Intake

Every referral classified the moment it arrives.

Urgent, symptomatic, and screening cases land in separate queues immediately, with no manual sorting required.

Urgency routing

Stat cases (rectal bleeding, anemia) are separated from symptomatic and screening referrals automatically so urgent patients never sit in the same queue as routine colonoscopies.

Continuous monitoring

Batch processing runs three times daily. No referral waits until someone gets to it.

Inbound Referral Queue Auto-classified
STATRectal bleeding, anemia
SymptomaticChronic diarrhea, IBS workup
ScreeningRoutine colonoscopy, age 50
Checked every 10 seconds · batch processed 3×/day
Clinical Criteria Check
✓ Labs within 60 days
✓ Imaging report attached
✗ 8-week PPI trial documentedFax-back sent
✗ Stool studies (diarrhea referral)Pending
✓ Service area confirmed
Incomplete referrals returned before staff review
02 Referral Validation

Every gap caught before it reaches your queue.

Incomplete referrals are flagged and returned to the referring provider specifying exactly what is missing, before any staff member touches the file.

Documentation completeness

Labs older than 60 days, missing imaging reports, incomplete hospital records: flagged automatically, with a fax-back sent to the referring provider.

Clinic-specific clinical criteria

GERD cases require a documented 8-week PPI trial with dates. Diarrhea referrals require current labs and stool studies. Cases that don't clear are rejected before any staff touches them.

Frequency and geography

Patients with a colonoscopy in the last year and addresses outside your service area are filtered at intake, not after a scheduler has already spent time on the file.

03 Eligibility

Every patient verified before a slot is offered.

Carrier rules are applied automatically. Ineligible cases are excluded before they consume any scheduling capacity.

Payer-specific routing

Carrier rules are applied automatically. Certain payers route to specific physicians, require end-of-day slots, or have facility restrictions. No staff lookup required.

Ineligible cases filtered early

Referrals that don't meet insurance criteria are excluded before they consume any scheduling capacity.

Payer Routing Engine
Cigna PPO
→ Dr. Patel · Morning slot
Eligible
Medicare
→ Dr. Kim · End-of-day slot
Eligible
Out-of-networkFiltered
Ineligible cases excluded before scheduling
Prior Authorization Tracker Same-day submission
Aetna
Colonoscopy (45378)
Approved
UnitedHealth
Upper endoscopy (43239)
Submitted
Cigna
Colonoscopy (45380)
Denied → Appeal filed
Denial docs staged automatically · No staff rebuild required
04 Prior Authorization

Submitted same-day. Tracked automatically.

Colonoscopies, upper endoscopies, and capsule studies frequently require payer authorization before they can be scheduled. TriFetch identifies the requirement, populates the request, and submits it without staff involvement.

Automatic identification and submission

Authorization requirements identified by payer and procedure code at intake. Requests populated from the referral and submitted same-day for qualifying procedures.

Denial management

Denied authorizations are flagged with supporting documentation staged for appeal. Staff do not need to rebuild the case from scratch.

05 Patient Scheduling

Booked and confirmed. No coordinator required.

Linda contacts the patient after eligibility clears, schedules the procedure, and completes a structured pre-procedure intake, all logged directly to your EHR.

AI phone outreach

Linda contacts the patient, schedules the procedure, and completes a structured pre-procedure intake: BMI, cardiac history, diabetic status, driver confirmation, high-risk medications.

Every interaction is logged directly to the EHR

Every call, every outcome, and every patient response is written to the chart automatically. Nothing falls through.

Linda · AI Outreach Call Live
LindaHi, this is Linda calling from GI Associates. I'm reaching out to schedule your colonoscopy referral.
Oh yes, I was expecting a call.
Great. I have a few quick intake questions: do you have any cardiac history or high-risk medications?
No, I'm healthy otherwise.
Perfect. I've booked you for Thursday at 9 AM. You'll need a driver. Is that confirmed?
Procedure booked Pre-screening done
Chart Creation · Patient #4 of 5
✓ Referral parsed
✓ Patient demographics
✓ Insurance & auth
✓ Labs filed
✓ Clinical notes sorted
Awaiting staff approvalIn progress
Up to 5 charts created in parallel · 15–20 min total
06 EHR Integration

Charts built. Documents filed. Ready for approval.

Up to 5 patient charts created in parallel in 15 to 20 minutes. Staff approve each chart before it is finalized. Oversight without data entry.

Automated chart creation

Up to 5 patient charts created in parallel in 15 to 20 minutes, with all required fields populated from the referral and documents sorted into pathology, labs, insurance, and clinical notes.

Human in loop

Staff approve each chart before it is finalized. Oversight without data entry.

Ready to get started?

See how TriFetch works for your gastroenterology practice.

Book a Demo → Call Linda · (240) 981-5499