Chapter 01 · PlatformArchitecture & layers

An operating layer you can hear, read, and trust.

Four coordinated layers — voice, vision, orchestration, and integration — built around the operating rhythm of a medical practice, primary care or specialty.

LayersThe architecture

Layer · 01Inbound

Voice

Conversations that feel like reception, not an IVR.

Inbound calls are triaged, scheduled, and routed with the nuance of a trained front desk. Multi-lingual, context-aware, always logged.

Layer · 02Ambient

Vision & documents

Faxes, referrals, and PDFs, read once.

Intake forms, outside records, insurance cards, ECG strips — ingested, structured, and routed to the right human or the right chart in seconds.

Layer · 03Runtime

Orchestration

The runtime that makes the rest of it feel like one team.

A policy-aware runtime that sequences tasks, respects clinician preferences, and escalates to a human the moment a signal looks ambiguous.

Layer · 04Systems

Integration

Plugs into the stack you already run.

Native connectors for Epic, Athenahealth, Elation, and eClinicalWorks, plus HL7, FHIR, and X12 rails for everything else.

WorkflowsWhere the layers meet the day

Phase 01 · Before the visit

Intake, scheduling, and prep.

Patients reach a real answer on the first call. Charts arrive warmed up, with records requested, insurance verified, and the right questions pre-populated.

Inbound triage on voice and messaging

Records and imaging chased from referring providers

Benefits verified, copays quoted, prior auth queued

Pre-visit questionnaires sent in the patient's language

Phase 02 · In the room

Ambient documentation, no keyboard.

Clinicians talk with patients. Sarthi produces the note, the problem list update, the orders, and the follow-up plan — ready for review before the next visit starts.

Specialty-tuned ambient scribe for cardiology and pulmonology

Structured findings, not generic SOAP templates

Orders and referrals drafted for signature

Patient summary generated in parallel

Phase 03 · Care coordination

Nothing falls through the cracks.

Care plans become actions. Cohorts are monitored between visits, medication refills are handled quietly, and clinicians are paged only when the data warrants it.

Longitudinal follow-up for chronic cohorts

Refill and lab-ordering workflows on autopilot

Priority inbox that surfaces only human-scale decisions

Closed-loop referrals across specialists

Phase 04 · Revenue & compliance

Billing as a quiet background process.

Coding, claim preparation, denials, and documentation for payers — done as the note is finalized, not weeks later.

Code suggestions with payer-specific nuance

Clean claim preparation and electronic submission

Denials worked as they arrive, not monthly

Audit trails that satisfy compliance by default

Revenue cycleThe loop, closed end-to-end

The revenue cycle,
run on the layer.

Most AI healthcare vendors stop at the note. The operating layer was always going to close the revenue loop — charge capture through final payment, denials and all. Here’s what that actually looks like inside Sarthi.

Stage 01

Charge capture and coding.

Sarthi codes from the finalized note — E/M, procedure, HCC-relevant diagnoses, modifiers, time-based codes for AWV / CCM / RPM — with the documentation evidence linked to each code. Coder review surfaces only the cases that actually need a human; the rest move.

Stage 02

Clean claim preparation.

Payer-specific edits applied before submission. Modifier rules, bundling logic, medical-necessity attachments, prior-authorization references — checked against the payer’s current policy, not last year’s. The claim arrives at the clearinghouse already clean.

Stage 03

Clearinghouse routing and submission.

X12 837 generation, electronic submission, acknowledgment ingest. Practice-level visibility into what’s in flight, what’s acknowledged, what’s pending payer review — without staff opening a clearinghouse portal.

Stage 04

ERA ingest and posting.

X12 835 remittances parsed automatically. Payments posted to the right encounter, adjustments applied per contract, secondary claims generated where appropriate. The end-of-day reconciliation that used to take a coordinator two hours runs in the background.

Stage 05

Denial management and appeals.

Denials routed by reason code with the supporting clinical history already pulled from the chart. First-pass appeals drafted by the system; complex denials staged for a human with everything they need attached. The denial backlog stays at zero, not at thirty days.

Stage 06

A/R follow-up and aging.

Aged claims worked on a payer-specific cadence. Calls to payers for status, escalation triggers when claims age past threshold, structured documentation of every contact. A/R aging surfaces in the Monday standup, not the quarterly board deck.

Stage 07

Patient billing and collections.

Patient responsibility surfaced clearly the first time. Statement generation, payment plans, online-portal payment reconciliation. The collections conversation happens once, with full context, instead of three rounds of confused phone tag.

Operates standalone or alongside an existing RCM vendor — clean claims into your existing pipeline if you’d rather not switch. The walkthrough is where we decide which model fits your practice.

Infrastructure sheetWhat it runs on

Runtime

Multi-region runtime

US-only PHI residency

Isolated tenants

Per-practice boundaries

Graceful failover

99.9% uptime target

Models

Specialty-tuned

Cardio + pulmo primaries

Human-in-loop

Clinician review by design

Evaluations

Live error surface, weekly

Integrations

Epic · Athena

Native EHR connectors

HL7 · FHIR · X12

Standards for everything else

Payer rails

Clean claim + remit ingest

Security

HIPAA Business Assoc.

BAA on request

SOC 2 in progress

Type II, 2026

AES-256 · TLS 1.3

At rest and in transit

The best way to understand Sarthi is to watch it handle a morning of your clinic.

We set up a shadow of your practice, run Sarthi against de-identified traffic, and walk you through every decision the system made.

Request a working session