Healthcare · Referral Leakage & Network Integrity

Cut out-of-network leakage from primary care to specialty by ≥ 40% in 12 weeks while preserving documented patient choice and closing the loop on every referral.

Frequently asked questions

What does the Healthcare · Referral Leakage & Network Integrity blueprint do?

Cut out-of-network leakage from primary care to specialty by ≥ 40% in 12 weeks while preserving documented patient choice and closing the loop on every referral.

What KPIs does the Healthcare blueprint target?

Referral Capture Rate (EHR-logged vs. claims-observed) from 55 to ≥ 95 (weekly). Leakage Latency (days to attribution) from 75 to ≤ 7 (weekly). Out-of-Network Leakage Rate from 42 to ≤ 18 (monthly).

How long does the Healthcare · Referral Leakage & Network Integrity deployment take?

12 weeks.

What systems does the Healthcare blueprint integrate with?

Integrates with EHR referral module (Epic Referrals / Cerner Message Center), Provider directory / search (Kyruus / Press Ganey ProviderMatch), Closed-loop referral platform (e.g. CarePort / Outcomes4Me), Claims feed for out-of-network leakage attribution through the AEROSS Execution Mesh. All writes are credit-metered, CAPS-gated, and audit-stamped.

What regulatory requirements does this blueprint address?

Stark Law (42 USC §1395nn) — patient-choice affirmation required on every referral; Anti-Kickback Statute (42 USC §1320a-7b) — no value exchange for referral volume; HIPAA 164.506 — referral PHI shared under treatment exception; HL7 FHIR R4 ServiceRequest / Task for closed-loop standard All agent actions inherit AEROSS CAPS governance — autonomy ceilings, human approval gates, and a tamper-evident audit log.