Patient access teams
manually sorting inbound requests and determining urgency
HEALTHCARE & LIFE SCIENCES
Referrals stall. Prior auths bounce back. Urgent requests wait behind routine ones.
Referrals stall in generic queues. Prior authorisations bounce back incomplete. Urgency is hard to spot when everything arrives the same way. Ortoo Orchestrator connects intake, triage, routing, and escalation into one consistent process inside Salesforce, so referrals reach the right specialist and prior auths do not restart at the beginning.
- Full audit trail on every step
- Route by urgency and licensing
- 100% Salesforce native
- Per work-item pricing
RequestReferral received
TriageCompleteness checked
RoutingSpecialist: licensed, in region
ActionPrior auth routed
OutcomeSLA met
Trusted by healthcare and life sciences teams running complex Salesforce operations
THE REALITY
The tools scaled. The workflows didn't.
Where the work gets stuck
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Utilisation management
chasing incomplete prior auth submissions through bounce-back loops
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Appeals and grievances operations
reconciling handoffs across teams without a traceable ownership record
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Life sciences field operations
managing territory coverage and OOO continuity by hand
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Compliance and audit functions
reconstructing case histories from disconnected Salesforce records
Healthcare and life sciences operations manage inbound work across multiple systems, specialist teams, and coverage models, all under strict service and compliance expectations. The processes worked at lower volume. The complexity grew around them.
Fragmented intake, incomplete submissions, and simplistic routing create delays, stalled handoffs, and limited visibility into service-level risk. The pressure does not show up on a single dashboard.
Every stalled referral is a patient waiting. Every missed SLA is a compliance exposure. Every out-of-office break is a risk that someone manages manually.
WHERE WORKFLOWS BREAK
The breakdowns are predictable. The costs are not small.
The tools are in place. Health Cloud, Service Cloud, Email-to-Case. The gaps appear in the spaces between them, where intake meets assignment, where assignment meets specialist routing, where specialist routing meets compliance.
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Referrals arrive from multiple sources: email, fax-to-email, portals, EHR.
None of them arrive in a consistent structure the next team can act on.
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Urgency is critical to route correctly.
“I need to reschedule” and “I’m having chest pain” land in the same inbox, formatted the same way.
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Prior authorisations need to be complete before routing.
Incomplete submissions reach the wrong team and bounce back, restarting the clock.
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Specialist routing depends on licensing, territory, language, and plan rules.
Native Salesforce routing handles one variable at a time, not all of them at once.
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Out-of-office events happen constantly across shift-based care teams.
Manual reassignment is how coverage is maintained, until it isn’t.
WHY HLS OPERATIONS ARE DIFFERENT
Clinical licensing, plan rules, territory, language, and urgency. Most routing tools handle one. HLS needs all five.
Clinical licensing, plan rules, territory, language, and urgency aren't the exception in HLS; they're the baseline. Shift schedules and compliance obligations layer on top. Native routing doesn't handle the combination. Orchestration does.
Regulatory audit trail requirements
HIPAA, GxP, prior-auth turnaround SLAs, and appeals timelines all require a complete record of what happened and when. Every routing decision, classification step, and handoff must log automatically, not manually.
Multi-source intake that fragments queues
Work arrives by email, fax-to-email, broker portal, patient portal, and EHR-driven referral. Each source has its own format. Structured intake normalises all of them before routing begins.
Routing complexity no single rule set handles
Clinical licensing, territory, language, plan rules, capacity, and urgency all affect who should receive a given request. Multi-factor routing handles the combination; native Salesforce assignment handles one factor at a time.
Shift coverage and OOO continuity at clinical risk
In healthcare, a broken handoff during a shift change is not just an operations inconvenience. When a coordinator is out or a shift changes, requests are reassigned automatically. Nothing waits for someone to notice.
HOW ORTOO FITS
Referrals, prior auths, and medical information requests: intake handled, routed, and escalated as defined steps.
Ortoo Orchestrator handles the processes that get referrals, prior authorisations, and patient access requests from intake to the right specialist, without manual reassignment at each step.
Care delivery operations
Standardise referral intake, validate required information, and route by service line, site, urgency, and capacity. Reduce admin overhead and improve access coordination across distributed care teams.
ExploreCare financing operations
Triage and assign prior authorisations, benefits checks, and determinations based on plan logic, specialist teams, and real-time capacity. Completeness checks before routing reduce bounce-backs and restarts.
ExploreLife sciences, medtech, and diagnostics
Support medical information requests, patient access programmes, and device support with structured intake, consistent handoffs, and audit-ready tracking across global teams and regulated workflows.
ExploreEXAMPLE WORKFLOWS
Referrals that route correctly. Prior auths that don't bounce back. Urgent cases that don't wait in line.
Every referral, prior authorisation, and patient access request follows a consistent process, from intake to the right specialist, with every step logged.
- 01
// STEP 01
Intake
- 02
// STEP 02
Validate
- 03
// STEP 03
Classify
- 04
// STEP 04
Route
- 05
// STEP 05
Audit
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01
// STEP 01
Intake
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02
// STEP 02
Validate
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03
// STEP 03
Classify
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04
// STEP 04
Route
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05
// STEP 05
Audit
One sequence across intake, validation, classification, routing, and audit.
Referral intakepatient access assignment
A referral arrives by email or portal. Structured intake validates required fields; missing information triggers a completeness request before routing begins. The request routes to the correct service line, site, and capacity-available specialist. Access coordinators stop sorting by hand.
IntakeValidateRoute
Prior auth submissiondetermination routing
An authorisation request is checked for completeness at intake. Incomplete submissions request the missing fields before reaching the team. Complete submissions route to the correct specialist by plan rules, line of business, and urgency. Bounce-backs and restarts stop.
SubmissionCheckAssign
Urgency-flagged emailescalated response
An inbound patient email is classified at intake. AI identifies urgency signals in message content. High-urgency messages route to the priority queue immediately; routine messages follow the standard path. Urgent cases no longer wait behind routine requests.
InboxClassifyEscalate
Medical information requestspecialist response
An HCP enquiry arrives and is captured as a structured Salesforce record. It routes to the correct MedInfo specialist by product line, territory, and language. Response timelines are visible. Every action logs to the record for pharmacovigilance and GxP compliance.
EnquiryMatchRespond
AI IN HEALTHCARE
AI makes intake and triage faster. Patient workflows need every decision on the record.
Healthcare and life sciences operations carry compliance obligations that make AI governance a practical requirement, not a preference. Ortoo Orchestrator applies AI selectively where interpretation adds value: classification, completeness checking, urgency detection, with deterministic logic controlling routing, escalation, and ownership.
Where AI runs in HLS workflows
AI capability
What it does
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Request classification
Classifies referrals, authorisations, and service requests in real time at intake.
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Completeness checks
Validates submissions before routing to reduce bounce-backs and restarts.
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Urgency detection
Identifies urgency signals in patient and member communications before assignment.
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SLA risk flagging
Surfaces stalled handoffs and SLA risk before service levels slip.
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Audit logging
Logs every AI decision to the Salesforce record; every step is traceable and explainable.
Ortoo Orchestrator supports any LLM provider. Workflows can be configured to comply with strict data residency requirements.
AI identifies urgency, extracts context, and flags completeness gaps. The gaps between them are where patient and compliance risk lives.
ARCHITECTURE CONTEXT
Salesforce-native. Audit trail on every step. Data stays where it belongs.
Ortoo Orchestrator runs natively inside Salesforce on the existing data model, security model, and automation layer. No external workflow engine. No data duplication. Every intake record, routing decision, classification step, and handoff logs to the Salesforce record automatically.
Where workflows reach external systems, EHR integrations, prior-auth portals, AI providers, or data warehouses, Ortoo Orchestrator handles those callouts inside the same workflow definition, with the same audit logging.
Coordination layer
Ortoo Orchestrator defines and runs HLS workflows
Salesforce platform
Health Cloud, Service Cloud, cases, queues, Email-to-Case, Omni-Channel, Flows
External stack
EHR integrations, prior-auth portals, AI providers, data warehouses, partner systems
FAQ
What HLS operations teams ask before committing.
Yes. Ortoo Orchestrator runs natively inside Salesforce on the existing data model and security model. It works with Health Cloud objects and custom objects without requiring data migration, external systems, or separate infrastructure. Routing, intake, and workflow logic all execute inside the Salesforce environment.
Get started
Map the HLS workflow that is carrying the most operational risk.
Book a 30-minute session. We will walk through one workflow, referral intake, prior auth routing, medical information request handling, or wherever the coordination cost is highest, and identify where orchestration changes the outcome.
Installs natively into SalesforceStart with one workflowPricing follows work, not tokens
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