AI employees for pediatric primary care groups
Every pediatric location leaks the same revenue. You can't see it compounding across all of them.
You catch the leak at one office, but you cannot watch it compound across all of them at once.
Relay builds custom AI employees for multi-location pediatric primary care groups. They sit on top of the stack you already run, from PCC to Office Practicum to athenaOne to eClinicalWorks. They handle the high-volume back-office work at every handoff: intake, eligibility, referrals and prior auth, claims, denials, and scheduling. Each finished action goes to a staff member to finalize.
Healthcare-specific, human-in-the-loop, one monthly fee, one dashboard. The leak grows every month you add a location. In a free 30-minute call we show you exactly where it is leaking.
Where your pediatric primary care group is leaking revenue.
Six places the back office leaks at every location. Open the ones that sound like your group.
When the callback is slow, the family has usually already booked somewhere else. An AI employee monitors the inquiry queue across every location the moment a new-patient request lands. It sends an immediate structured intake sequence to collect demographics, insurance carrier, reason for visit, and preferred location and time. Then it surfaces a pre-qualified slot for the front desk to confirm in one click.
Once the visit is booked, it sends a digital intake packet and nudges the family until it is complete. It cross-checks for the missing fields that cause downstream denials: secondary insurer ID, referring-provider NPI for HMO panels, unsigned guardian consent. It flags only the exceptions that need a human call. Staff finalizes; the AI does the chasing.
Pediatric intake is heavier than adult intake and easier to leave incomplete. The packet requires guardian consent and HIPAA authorization for a minor, insurance verification for the dependent, immunization release, developmental history including age-appropriate screeners (M-CHAT-R, ASQ-3), and a referring-provider NPI for HMO panels. Many packets emailed out never come back. The first visit proceeds on an incomplete chart, and the claim cannot be submitted cleanly.
That means you stop losing new families to the practice that called back faster.
Checking eligibility on the day of the visit is too late to catch a plan that already changed. The AI employee runs an automated eligibility sweep 48 to 72 hours before each scheduled visit across every location, and again the morning of the visit for Medicaid accounts. It flags any patient whose coverage status, MCO, or co-pay structure has changed. It pre-populates the check-in record and queues exceptions (changed or inactive coverage, EPSDT documentation due) for a billing coordinator to work before the patient arrives. Staff reviews; the AI runs the sweep.
Pediatric primary care is uniquely Medicaid- and CHIP-heavy, and those plans churn faster than any adult panel. A child on Medicaid in January may have aged out of CHIP, switched to a parent's employer plan, or lost coverage entirely by March. Front-desk staff run eligibility the morning of the visit, or not at all, and discover at billing that the plan on file terminated 60 days ago. The claim bounces, the family is hard to reach, and the revenue is gone.
The layers are pediatric-specific: the child is the patient but the parent is the guarantor; Medicaid coverage often runs through a managed care organization with a separate card and formulary from base state Medicaid; dual coverage creates coordination-of-benefits work; and EPSDT benefits must be confirmed by visit type.
Day-of eligibility failures stop stalling check-in and generating denials.
The open-referral queue has no one tracking it end to end. The AI employee tracks every open referral and authorization by patient, payer, specialist, and status. It drafts the referral package (clinical summary, diagnosis codes, supporting notes) for the coordinator to review and send. It monitors for specialist confirmation and assembles the prior-auth packet against the payer's preferred channel, with a due date set to the CMS decision window. It surfaces an exception queue: auths approaching deadline, referrals with no specialist response, approved units nearing expiration, and denied PAs with an appeal opportunity. Staff submits with one click; the AI does the assembly and the watching.
A single well-child visit can generate referrals to audiology, developmental pediatrics, speech and occupational therapy, behavioral health, ENT, and GI. Each one needs chart notes, diagnosis codes, and a clinical rationale. Many payers, Medicaid MCOs especially, require a prior authorization number before the specialist can see the child.
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires impacted payers to send standard prior authorization decisions within 7 calendar days and expedited decisions within 72 hours, beginning January 1, 2026. The 2024 AMA Prior Authorization Physician Survey found physicians complete an average of about 40 prior authorizations per physician per week.
The expiration clock stays covered, and no auth silently lapses while the referral queue sits unworked.
Most pediatric denials share the same short list of root causes. The AI employee runs a pre-submission audit on every claim batch: modifier 25 application, vaccine code completeness with NDC and VFC status, age-banded preventive code accuracy (99381 to 99387 new patient, 99391 to 99397 established), EPSDT code pairing with developmental screening codes such as 96110, and Medicaid MCO versus state Medicaid routing. Only clean claims reach the clearinghouse.
It reads the daily ERA, classifies each denial by root cause and recovery path (auto-correctable, staff-correctable, appeal-required), and drafts the corrected claim or appeal with documentation pulled from the chart. It posts ERAs and works the AR aging report by exception so nothing ages past the filing window. The billing coordinator reviews and submits; the AI does the triage.
Vaccine administration is billed with CPT 90460 and 90461 tied to each antigen and the patient's VFC status and NDC. Same-day preventive and sick visits need modifier 25. EPSDT visits pair the preventive code with screening codes. Medicaid MCO rules and timely-filing windows vary state by state. A single misconfigured billing template propagates the same error across thousands of claims before anyone notices.
Unworked denials stop aging past the filing window before anyone catches them.
A well-visit slot that goes empty is revenue the day cannot give back. The AI employee runs a daily utilization view across all locations, identifies open slots by visit type, and matches them to the waitlist. It prioritizes patients overdue for a well-child visit or whose annual window is closing. When a cancellation lands it drafts the outreach and surfaces the top matches for a coordinator to approve.
It also drives the well-child recall cadence (2, 4, 6, 9, 12, 15, 18, and 24 months, then annually), flags overdue developmental screenings, and drafts outreach through the practice's existing communication tool. A staff member approves every send; the AI does not fill the schedule on its own.
No-shows run above average in Medicaid and CHIP populations because of transportation, work schedules, and child illness. They compound month over month. The waitlist exists, but filling a slot that opens with two hours notice means calling families and hoping someone answers fast enough on a lean front desk shared across sites.
The recall cadence runs across every location without relying on front-desk bandwidth to keep it moving.
A provider scheduled before credentialing is complete generates claims every payer will deny. The AI employee maintains a credentialing status matrix per provider, location, and payer contract with effective dates. Before any provider is scheduled at a location it checks the matrix and flags a credentialing gap to the operations coordinator.
It monitors CAQH attestation cycles, license, DEA, and malpractice renewals, sends advance reminders, drafts renewal packets from the existing CAQH record, and bridges enrollment status to the billing queue so the first claim to a newly credentialed payer goes out correctly. The coordinator approves; the AI tracks.
Multi-location pediatric groups carry a credentialing problem the vertical makes acute: providers rotate across sites, each location may bill under a different group NPI or hold payer contracts with different effective dates per provider. Locum coverage is the worst case: a locum sees a full panel for a week and the credentialing for that location's Medicaid managed-care contracts was never confirmed. Claims billed under an uncredentialed or out-of-network provider are denied in full and cannot be recovered under most payer agreements.
The credentialing gap gets flagged before the provider is scheduled, not after the ERA arrives and the write-off is already locked in.
See where your pediatric group is leaking revenue.
See where you're leakingWorks on top of the EHR your pediatric group already runs, never instead of it.
Relay is not an EHR. It does not replace any platform below. The AI employees read across your stack, act on it, and hand finalized actions to your staff. Each integration below names the gap the platform leaves to your team today.
PCC is pediatric-native, purpose-built for independent single-location practices. There is no public self-serve API, appointment-confirmation data is not integrated into appointment details, and multi-location reporting is not a documented strength. AI employees layer on top to consolidate eligibility, auth tracking, denial triage, and recall across locations. Integration via vendor-negotiated feed, clearinghouse, or screen-level automation.
OP is the other pediatric-native platform, with VacLogic forecasting and a Claim Scrubber, but the interface is dated, financial reporting can be hard to trust, and multi-location group reporting is not a marketed strength. AI employees add cross-location eligibility sweeps, EPSDT and modifier-25 pre-submission auditing on top of the scrubber, and denial triage. FHIR API available to contracted clients on Version 21, ONC 2015 Cures certified.
athenaOne has the richest documented API surface among these platforms (FHIR R4 plus 800-plus REST endpoints and event-driven webhooks) and is common in pediatric groups that outgrew pediatric-only platforms, but prior authorization is still a documented friction point and the platform is ambulatory-general, not pediatric-native. AI employees work the PA, eligibility, and denial queues athenaOne leaves to staff, with pediatric-specific rules layered on.
eCW is preferred by large multi-provider, multi-location groups, but charge-capture gaps let billable services disappear and prior-auth tracking is manual and fragmented, with auth denials surfacing 30 to 60 days after service. The FHIR endpoints do not expose insurance, claims, or authorization data, which requires HL7 v2 DFT/ADT messages. AI employees close the charge-capture and auth-tracking gaps on top. FHIR R4 plus SMART; billing and financial data via HL7 v2 DFT/ADT.
NextGen offers pediatric SOAP workflows and Ambient Assist, but PM and EHR data are hard to combine into unified reports, denial resolution is largely self-service, and manual prior-auth management is still a gap at scale. AI employees unify cross-location reporting and work the denial and PA queues. FHIR R4 plus HL7 v2 plus CCD/C-CDA; Mirth Connect on Enterprise tier.
Epic runs large hospital-affiliated pediatric health systems and has a deep FHIR surface, but implementation is enterprise-contracted and prior auth and denial management still require manual intervention at the payer boundary. Where a group is on Epic, AI employees add the autonomous follow-through Epic's rules engine leaves to staff. FHIR R4, 750-plus no-cost APIs on open.epic.com; integration via Epic Vendor Services.
Elation is cloud-native with expanding pediatrics capabilities, but prior-auth tracking is basic, with auth numbers stored manually per chart and no expiration alerting, and multi-location group features are less mature. AI employees add auth expiration alerting and cross-location visibility. FHIR-first REST developer API; SMART on FHIR and HL7 standards.
AI employees also sit on top of the non-EHR tools a pediatric group runs: Phreesia, Yosi Health, and Develo for intake and pre-visit eligibility; Availity and pVerify for eligibility and PA submission and tracking; Myndshft and Cohere Health for PA determination and packet assembly; Waystar and Office Ally for clearinghouse, claim editing, and denials; Updox, Doximity DocFax, and SRFax for referral and PA fax; Luma Health, Klara, Weave, Solutionreach, and OhMD for patient comms, recall, and no-show recovery; CAQH ProView, Medallion, Modio Health, and MedTrainer for credentialing. The AI reads across all of them; your staff finalizes.
Layer on vs rip-and-replace vs hire more staff.
Multi-location pediatric groups comparing their options usually land on three alternatives. A new EHR or RCM platform, hiring more staff, or an AI employee layer on top of the existing stack.
| Approach | What it means in practice | The tradeoff |
|---|---|---|
| Rip-and-replace (a new all-in-one platform) | Implementation runs 6 to 18 months, staff re-trains from scratch, new vendor to onboard | The problems that live at the edge of every platform remain; you add a second migration |
| Hire more staff | A biller, prior-auth coordinator, or front-desk float to absorb volume | Solves for one location, not three or five; turns over; scales linearly with every location you add |
| AI employee layer on top of your stack | Works on top of PCC, Office Practicum, athenaOne, eCW, or another platform you already run | Additive, no rip-and-replace, a staff member finalizes every action, covers every location from one dashboard |
Rip-and-replace (a new all-in-one platform)
What it means in practice
Implementation runs 6 to 18 months, staff re-trains from scratch, new vendor to onboard
The tradeoff
The problems that live at the edge of every platform remain; you add a second migration
Hire more staff
What it means in practice
A biller, prior-auth coordinator, or front-desk float to absorb volume
The tradeoff
Solves for one location, not three or five; turns over; scales linearly with every location you add
AI employee layer on top of your stack
What it means in practice
Works on top of PCC, Office Practicum, athenaOne, eCW, or another platform you already run
The tradeoff
Additive, no rip-and-replace, a staff member finalizes every action, covers every location from one dashboard
What sets Relay apart is that every build is custom to your operation, healthcare-specific, human-in-the-loop with staff finalizing each action, and billed monthly. It is not a point tool you bolt on, a platform you migrate to, or a generic automation tool with the vertical swapped in. The AI employees cover every location from a single dashboard. The first 2 to 3 weeks are discovery; full builds run 8 to 12 weeks.
How we build it.
We start from the problem you feel, then build the fix on the systems you already run. Discovery and your first working AI employee take 2 to 3 weeks. The full build runs 8 to 12 weeks.
Start with a free 30-minute call
A short call about where the work is piling up and what that is costing you while it stays manual. No commitment, and you leave knowing where you would start.
Discovery and your first AI employee (weeks 1 to 3)
A few working sessions with your team. We map your operation end to end, every workflow across your locations, and find where the money leaks and what closing it is worth. You do not walk away with just a document. By the end of discovery we have built your first working AI employee on top of the systems you already run, so you see it pay off in your real setup before the full build starts.
The full build (8 to 12 weeks, start to finish)
We build the rest of the AI employees you mapped and wire them across every location. Nothing goes out until your team approves it, so you stay in control the whole way. One pediatric therapy client had all seven locations live within 90 days.
Proof of the model: Sensory Speech & Occupational Therapy.
Relay first built for Sensory Speech and Occupational Therapy, a multi-location pediatric speech and OT group. Two AI employees, both running on top of the group's existing EHR and Drive, with staff finalizing every action.
The intake AI employee ran the full new-client lifecycle: it scheduled clinic tours, got ROIs signed, requested records from schools and prior clinics, requested IEPs, sent medical orders to the child's PCP and followed up until signed, started authorization renewals about a month out, and sent three-month progress reports and evaluations to PCPs for signature.
The internal auditing AI employee reviewed every note nightly against the clinic's clinical requirements, confirmed the billing code matched the note, and after billing found and appealed denied claims (pulling from the EHR and Drive) and reconciled remittances against the EHR notes.
The group saw 100% claim accuracy, staff 33% more productive, claim denials down 12%, and faster documentation turnaround. Every result is attributed to the client's own reporting, and results vary by clinic. That is a pediatric therapy group, not a primary care group. The vertical differs; the two-AI-employee pattern (intake plus auditing, working on top of the existing stack, human in the loop) applies directly. No entry point requires a build commitment; it starts with a free 30-minute call.
AI employees for pediatric primary care groups: frequently asked questions.
They work on top of the EHR and tools you already run. AI employees handle high-volume back-office work at every handoff (intake, eligibility, referrals and prior auth, claims, denials, scheduling) and route each finished action to a staff member who finalizes it. You keep your existing stack and your team; the AI handles the volume between handoffs across every location.
No. Relay is not an EHR and never replaces one. The AI employees layer on top of the platform you already run, reading and acting across it. Nothing is ripped out, and no staff re-training on a new system is required. Works on top of PCC, Office Practicum, athenaOne, eClinicalWorks, NextGen, Epic, and Elation, among others.
Every action is routed to a staff member before it goes to a patient, a payer, or a claim. The AI does the drafting, the tracking, and the watching. A staff member reviews and approves before anything is sent. The AI never submits autonomously, whether that is confirming an intake slot, approving a denial correction, or sending a recall message.
They sweep eligibility 48 to 72 hours before each visit, and again the morning of the visit for Medicaid accounts. Pediatric Medicaid and CHIP coverage churns month to month. The AI flags changed or inactive coverage, the correct MCO, and EPSDT documentation due, and queues exceptions for staff before the patient arrives, which means day-of eligibility failures stop stalling check-in and generating denials.
Yes. They track every open referral and authorization by patient, payer, and status. They assemble the PA packet against the CMS 7-day standard decision window (CMS-0057-F, effective January 1, 2026) and surface auths approaching deadline and approved units nearing expiration for staff to submit. Expirations stop turning into denials because nothing ages unnoticed.
They pre-audit every claim for the pediatric failure modes before it leaves the clearinghouse: modifier 25 application, vaccine codes 90460 and 90461 with NDC and VFC status, age-banded preventive codes (99381 to 99387 new patient, 99391 to 99397 established), EPSDT code pairing such as 96110 with the well-visit code, and Medicaid MCO versus state Medicaid routing. Denials that do land are classified by root cause and a corrected claim or appeal is drafted for a coordinator to submit.
Yes. They check developmental-screening code pairing (96110 with the well-visit code) and vaccine administration completeness (NDC, lot, VFC status) on every claim before submission. These are the two pediatric areas where claims fail most predictably and where audits most commonly recoup. This is part of the standard pre-submission claim audit run on every batch.
They run a daily cross-location utilization view, match open slots to the waitlist (prioritizing patients overdue for a well-child visit or whose annual window is closing), draft the outreach, and drive the well-child recall cadence (2, 4, 6, 9, 12, 15, 18, and 24 months, then annually). A staff member approves every message before it sends. No messages go out without staff review.
No. Relay is not an AI scribe and does not author clinical documentation. It works the back office. After a note is signed it can flag a note missing a billing-relevant element before the claim is built, but it does not write, edit, or finalize clinical notes.
Yes. Both pediatric-native platforms have limited public APIs, so Relay integrates via vendor-negotiated feeds, the clearinghouse, or screen-level automation. It then layers cross-location eligibility, auth tracking, and denial triage on top of the workflows those platforms leave to your staff.
Pricing is a recurring monthly fee; there is no one-time build fee and no pay-in-installments structure. The entry point is a free 30-minute call where we show you exactly where your operation is leaking before any build is scoped or any fee is discussed.
The first 2 to 3 weeks are discovery: working sessions to map your operation and build the first AI employee. Full builds run 8 to 12 weeks. The timeline depends on the complexity of your stack and the number of locations, not on a fixed onboarding schedule.
It is custom-built for multi-location pediatric primary care groups. The AI employees are healthcare-specific and aware of Medicaid and CHIP churn, EPSDT requirements, modifier 25, vaccine administration codes, and the CMS prior-auth decision windows. This is not a generic automation platform with the vertical swapped in; each AI employee is built for the specific workflows, payers, and stack your group runs.
See where your pediatric group is leaking revenue.
It's a free 30-minute call, no commitment. We map your operation: intake, eligibility, referrals, billing, scheduling, credentialing, across every location. We show you exactly where it is leaking before any build is scoped. The work is built for healthcare, and a staff member at your clinic stays in the loop on every action.