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The Biggest Mistake in Healthcare Infrastructure Right Now

Jeffrey Morelli
Jeffrey Morelli
Published 18 March 2026

The biggest mistake happening in healthcare infrastructure right now is confusing automation with orchestration.

They sound alike. They get lumped together in pitch decks and vendor proposals constantly. But they are fundamentally different things, and that difference is why so many "solutions" to prior authorization and insurance verification workflows continue to fall short.

Automation performs a task. Orchestration coordinates multiple systems, channels, and decision layers to deliver an outcome.

Prior authorization is not a task. It's a dynamic, multi-step, multi-channel workflow. And the outcome providers actually care about isn't faster data or fewer clicks, it's confidence that a patient is financially cleared, correctly authorized, and safe to schedule.

Why Service-Based and Ambulatory Care Is Still Broken

In pharmaceutical workflows, the infrastructure has matured considerably. Medication-based prior auth has deep integrations and real rails that standardize much of the process. That doesn't exist in services-based healthcare.

For providers in service-based and ambulatory care settings (think ABA therapy, physical and occupational therapy, senior living, cardiac rehab, and beyond), even the most organized teams are stitching together a patchwork: clearinghouses, insurance portals, fax workflows, call centers, internal spreadsheets, payor emails, and tribal knowledge locked in SOPs. Each of those systems was built independently and was never designed to work together.

That fragmentation isn't a technology gap. It's a structural one. And patching it with point solutions makes it worse, not better.

The Two Incomplete Approaches on the Market

Most vendors take one of two approaches. Neither works.

Approach #1: Tools/wrappers not solutions.

Raw eligibility responses get handed back to your team to interpret and act on. An active coverage indicator isn't an answer; it's the beginning of more questions. What does this patient owe? Are there visit limits? Is authorization required? What documentation does the payor need? Returning raw data outsources interpretation to already-overloaded staff. That's not a solution. That's a slower version of the problem.

Approach #2: Automate a single channel.

Some tools automate web portal submissions. Others automate outbound phone calls. These work until the portal changes, or the payor calls back asking for more information, or a human reviewer sends an email mid-workflow or calls to ask for additional information, or the specific plan routes authorizations through a third-party administrator that requires fax submission. Single-channel automation assumes linear workflows. Healthcare workflows are not linear. Payors don't behave consistently. Variability is the rule, not the exception.

Benefits Verification Workflow:

Before Silna: No Orchestration TOOL WHAT STAFF GETS OUTCOME EDI 270/271 Raw benefits returned Multiple copays/coins listed. No visit limits. No auth reqs. Staff must call payer to fill gaps. Time lost from core patient work. Payer portal Partial benefit snapshot Accumulations missing. Auth reqs ambiguous. Wrong quote risk Erroneous charges. Claim denials. Phone call 15-45 min hold times Human error. No paper trail. Contradicts portal data. Errors and no audit trail Claim denials. Certainty never guaranteed. EHR / tracking tools Siloed, stale data No real-time visibility across patients. No complete picture before first appointment. Revenue at risk. The problem: tools deliver fragmented, ambiguous data — certainty is never guaranteed.
With Silna CHANNELS SILNA ORCHESTRATION OUTCOME EDI 270/271 Portal agent Phone agent SBC review Fax + email Silna orchestration aggregates · enriches fills gaps · confirms Complete benefits No guesswork. Copay · deductible · OOP Visit limits · auth reqs Accumulations confirmed 100% accurate quote before care begins Patient cleared Zero staff phone calls No interpretation needed Zero revenue leakage The solution: Silna aggregates across all channels in real time, filling gaps automatically.

What Actually Solves This: Multimodal Orchestration

The infrastructure required to drive outcomes needs to operate across every channel a payor uses and to coordinate intelligently among them.

That means:

  • Electronic integrations via EDI 270/271 for eligibility, and emerging 277/278 transactions for prior authorizations, where structured data exists
  • Web portal automation to both read and write data: submitting authorizations, checking statuses, capturing information that only lives in a portal and nowhere else
  • Phone agents for outbound and inbound call workflows: because network status, CPT-level benefits, and many specialized service authorizations can only be confirmed over the phone, and some payors call inbound to request additional information or provide updates
  • Document intelligence to scan clinical documentation against payor-specific medical necessity guidelines, generate and OCR authorization forms, and identify the true payor from insurance cards
  • Fax and email as first-class channels (not afterthoughts) for both outbound submissions and inbound payor communications

But the channels alone aren't enough. What ties them together is the orchestration layer.

The Brain Behind the Workflow

An orchestration layer isn't just a workflow tool. It's the system that knows which channel to use, when to use it, and what to do when the first approach fails.

For verifications, it translates raw eligibility data into service- and provider-specific requirements, accounting for specialty, network status, contract tier, place of service, and negotiated rates. A benefit check that doesn't answer what this patient actually owes and what's needed to treat them isn't a benefit check. It's noise.

For authorizations: it knows which form to use, where and how to submit, how to follow up, how third-party carve-outs work, and any payor- or specialty-specific quirks that would derail a manual workflow.

And critically, once a requirement is surfaced, the system doesn't flag it for your team to chase down. It automatically initiates and tracks the authorization.

Prior Authorization Workflow:

Before Silna: No Orchestration
A single authorization touches 7+ manual steps — each one a chance to stall, error, or lose the approval. Check if auth is required Identify required documentation per payer + CPT Coordinate with clinical team to collect supporting documentation Package + submit authorization Fax Email Portal Phone Follow up to confirm auth was received Staff calls payer or checks portal manually Wait for payer decision 1–14 business days Approved or denied? Approved Care can begin Appeal + resubmit Coordinate with clinical team Peer-to-peer review Physician call with payer MD Restart the entire loop Weeks of additional delay The problem: every step is manual, reactive, and dependent on tribal knowledge. When anything goes wrong — a missed fax, a changed portal, a payer callback — staff absorbs the cost.
With Silna
TRIGGER SILNA ORCHESTRATION SILNA EXECUTION IMPACT New patient auth needed Existing patient auth needed Detects auth requirement per payer, plan + CPT code Flags required documentation tells provider exactly what's needed Predictive doc intelligence validates docs before submission Routes to correct channel portal · fax · email per payer Payor intelligence follow-up cadence tuned per payer + specialty Auth submitted right channel, first time Status tracked zero staff chasing Payer callbacks handled inbound + outbound Auto-appeal if denied resubmits immediately Peer-to-peer facilitated Silna coordinates the call No denied care or claims due to missing prior authorization Fewer denials Predictive doc intelligence catches issues before submission Payment certainty Auth confirmed before care is delivered The solution: Silna orchestrates every step — from auth detection to appeal — with no staff intervention required.

The Real Goal: Patient Clearance and Revenue Protection

Providers don't want automation for its own sake. They want to know, with confidence, that a patient is cleared to be seen, financially, operationally, and clinically.

The only way to achieve that is a layered, multimodal system designed to handle variability, not ignore it. Prior authorization isn't a web scraping problem. It isn't a call center problem. It isn't a data problem.

It's an orchestration problem, across a highly variable, multi-channel, payor-specific set of workflows.

Until the infrastructure is built to coordinate every channel (structured and unstructured, digital and human), providers will keep stitching together systems that were never designed to work together.

—
 Jeffrey Morelli
 Co-Founder & CEO, Silna