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.

Book a demo Map your workflow

  • Full audit trail on every step
  • Route by urgency and licensing
  • 100% Salesforce native
  • Per work-item pricing

LiveRequestReferral 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

  • Patient access teams

manually sorting inbound requests and determining urgency

  • Utilisation management

chasing incomplete prior auth submissions through bounce-back loops

  • Appeals and grievances operations

reconciling handoffs across teams without a traceable ownership record

  • Life sciences field operations

managing territory coverage and OOO continuity by hand

  • 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.

  • 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.

  • 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.

  • Prior authorisations need to be complete before routing.

Incomplete submissions reach the wrong team and bounce back, restarting the clock.

  • 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.

  • 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.\ Explore Care 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.\ Explore Life 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.\ Explore

EXAMPLE 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.

  1. 01 // STEP 01

Intake

  1. 02 // STEP 02

Validate

  1. 03 // STEP 03

Classify

  1. 04 // STEP 04

Route

  1. 05 // STEP 05

Audit

  1. 01

// STEP 01

Intake

  1. 02

// STEP 02

Validate

  1. 03

// STEP 03

Classify

  1. 04

// STEP 04

Route

  1. 05

// STEP 05

Audit

One sequence across intake, validation, classification, routing, and audit.

Referral intake→patient 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 submission→determination 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 email→escalated 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 request→specialist 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

  • Request classification

Classifies referrals, authorisations, and service requests in real time at intake.

  • Completeness checks

Validates submissions before routing to reduce bounce-backs and restarts.

  • Urgency detection

Identifies urgency signals in patient and member communications before assignment.

  • SLA risk flagging

Surfaces stalled handoffs and SLA risk before service levels slip.

  • 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.

Does Ortoo Orchestrator work with Salesforce Health Cloud?

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.

How does this handle the HIPAA audit trail requirement?

Can this handle the routing complexity in prior authorisation operations: plan rules, clinical licensing, territory, and urgency all at once?

How does out-of-office continuity work for shift-based teams?

Is this suitable for life sciences teams with pharmacovigilance and GCP compliance obligations?

What AI is included, and how is data residency handled?

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.

Book a demo Map your workflow

Installs natively into Salesforce·Start with one workflow·Pricing follows work, not tokens

RELATED

Use case Salesforce for healthcare and life sciences \ Detailed workflow patterns for HLS operations.\ Open Use case Intelligent case routing \ Multi-factor routing for high-complexity case environments.\ Open Use case Escalating high-priority cases automatically \ Urgency-aware escalation before SLA breach.\ Open Use case Salesforce email management for service teams \ Patient and member email intake at scale.\ Open Solution Service workflow orchestration \ The full service workflow orchestration solution.\ Open Industry Salesforce for insurance \ Adjacent industry; claims and member-servicing workflows.\ Open