Agentic AI for primary care
Your AI partner for Medicare revenue, prior authorization and patient access, working inside the EHR you already use.
Works inside the EHR you already use
Zealthix reads the chart, runs your practice's rules and writes the results back as notes, tasks and alerts. Your staff never retype data, switch screens or learn a new login.
Care-plan update drafted for hypertension
Awaiting clinician sign-offPost-discharge check-in call scheduled
Within 7 days of dischargeAPCM enrollment task added (G0557)
Consent call queuedPrior-auth packet built from chart notes
Ready for staff reviewChart data drives the workflows
Problem lists, vitals, meds, visits, orders, ADT events and non-clinical data such as coverage and consent status all trigger your rules.
Actions happen inside the EHR
Notes, care plans, tasks and alerts are written back to the patient chart, always under clinical supervision.
Standards-based, light IT lift
We use FHIR R4, HL7 v2 and ADT feeds plus EHR marketplace APIs. We handle setup, so your IT team doesn't need a project.
Four policy shifts are changing primary care economics
New Medicare revenue is available, prior-auth rules are tightening and fees are going down, all at the same time.
APCM pays every month
Medicare has paid for Advanced Primary Care Management since January 2025. There are no time thresholds, and the codes are billed once a month when the service elements are in place.
Source: CMSPayer prior-auth APIs go live
CMS-0057-F requires Medicare Advantage, Medicaid, CHIP and exchange plans to run FHIR prior-auth APIs. Most commercial payers stay portal-only.
Source: CMS-0057-FWISeR adds prior auth to Original Medicare
From 2026 to 2031, the WISeR model requires prior auth for some services in AZ, NJ, OH, OK, TX and WA.
Source: KFF, CRSThe 2027 conversion factor drops
The proposed 2027 Physician Fee Schedule cuts the conversion factor 1.68% for most clinicians. Practices need new revenue and lower labor costs.
Source: CY2027 PFS proposed ruleThree agents, one platform
Start with one product, usually ZenCare. Each agent shares the same EHR connection, patient communication engine and audit-ready evidence store.
Turns all 10 CMS APCM service elements into tracked workflows inside the EHR. It assigns the right G-code each month, blocks CCM/APCM double-billing and keeps a one-click audit binder for every patient.
Checks whether an order needs prior auth, builds the clinical packet against payer criteria and submits it by FHIR API or payer portal. It also verifies eligibility, scrubs claims and drafts appeals.
Handles scheduling, refills and billing calls, and runs reminders, recall and APCM enrollment outreach. It covers your after-hours line, and every call is transcribed and written back to the EHR.
Each agent makes the others work better
Point solutions solve one problem. Our products share data, so the whole suite gives you more than three separate tools would.
Voice AI enrolls APCM patients
Outbound calls explain APCM, capture consent and book initiating visits. The after-hours line covers APCM's 24/7 access element.
Care plans strengthen auth packets
APCM care plans, risk scores and medication reconciliation feed straight into prior-auth packets, so submissions arrive complete.
Eligibility data guides booking
Real-time eligibility stops ZenVoice from booking patients into visits their plan will not cover.
Built for independent primary care
Our core customer is a family or internal medicine group with 3 to 25 providers and a large Medicare panel. We also serve the organizations that support those groups.
Independent Primary Care
Owner-led family and internal medicine groups that feel the fee cut directly and have no in-house care-management team.
Learn more →Geriatric & Medicare-Heavy Practices
Large APCM-eligible panels where most chronic patients qualify for G0557.
Learn more →FQHCs & Rural Health Clinics
Clinics that can bill APCM and have many QMB patients but run with thin front-office staffing.
Learn more →MSOs, IPAs & ACOs
One contract and one platform for every member practice, with ACO reporting that already meets APCM's performance element.
Learn more →What is APCM worth to your practice?
Enter your Medicare panel size to estimate the monthly APCM billing it could support.
Start with one product, then grow as it proves its value
We start with a free revenue assessment, launch one product, and only add the next once you see results.
-
1
Week 0 · Free
Free panel assessment
From a de-identified EHR export, we show how many Medicare patients qualify for each APCM level and your current prior-auth and phone volume.
-
2
Go-live
Go live with ZenCare
We connect to your EHR, configure consent and care-plan templates, and start billing monthly with audit-ready evidence. Practices with mostly Medicare Advantage patients can start with ZenAuth instead.
-
3
Day 60
Add ZenVoice for enrollment
Voice AI handles APCM enrollment and consent calls, which grows your enrolled panel without adding staff.
-
4
Day 90 to 180
Move to the full suite
Add prior auth, claims and front-office calls at bundle pricing.
Compliance is built into every workflow
Every agent action is logged, reviewable and tied to the person who approved it.
HIPAA & BAAs
We sign a Business Associate Agreement with every customer and every sub-processor, and we access only the minimum necessary data.
US-hosted PHI
PHI stays in US data centers. Support staff can reach it only through monitored virtual desktops.
Clinicians stay in charge
Agents draft. Licensed staff approve care plans, auth submissions and anything clinical.
AI disclosure
ZenVoice tells every caller it is an AI, and we follow each state's disclosure and call-recording rules.
Billing integrity
Every billed APCM month is backed by documentation. CCM and APCM are never billed for the same patient in the same month.
TCPA-ready outreach
Automated calls and texts go out only with documented consent, and we collect all-party recording consent where state law requires it.
Common questions
What is APCM and how is it different from CCM?
Advanced Primary Care Management (G0556, G0557, G0558) is a monthly Medicare payment that started on January 1, 2025. Unlike Chronic Care Management, it has no minimum minutes. You bill it once a month when the 10 required service elements are in place. A patient cannot be billed for both CCM and APCM in the same month.
Do we need to hire care coordinators?
No. ZenCare automates the documentation and tracking, and ZenVoice handles enrollment calls and after-hours access. Your existing MAs and nurses review and approve the work. If you would rather not run the program yourself, we will also offer a managed tier in which our care coordinators deliver the monthly touches.
Which EHRs do you work with?
We work with eClinicalWorks, athenahealth, Practice Fusion, Elation, NextGen, Qualifacts InSync and Edvak, among others. If your EHR isn't listed, tell us when you book a demo.
Does the AI submit anything without our approval?
Not by default. A staff member approves every prior-auth submission and every clinical document. You can turn on auto-submit for low-risk categories once you trust the results.
How is pricing structured?
ZenCare is priced per enrolled patient per month, never as a percentage of collections. ZenAuth is priced per provider and ZenVoice per location. The full suite comes at a bundle discount. We share exact pricing after your free assessment.
See your practice's APCM number before you sign
Get a free panel assessment and a walkthrough of the suite inside your own EHR.
Book a Demo →