Concierge & DPC

AI receptionist capturing prior authorization and insurance data for concierge practices

Many concierge members still use insurance for specialist referrals and procedures. An AI receptionist can field insurance questions, capture prior auth needs, and gather insurance information on inbound calls—freeing your team to focus on care coordination.

Identifies insurance-related questions and prior authorization needs during inbound calls
Captures insurance details (member ID, group number, plan information) and returns them as a structured summary for your team to review and file
Creates structured insurance-inquiry summaries for your billing and care coordination team to action
Handles routine questions about member out-of-pocket responsibility and covered services
Escalates urgent authorization blockers to your care team for same-day resolution

How it pays back

Insurance Friction Doesn't Stall Care

When a member calls with an insurance question, the AI gathers the details and flags it for your billing or care coordination team. Your clinicians aren't interrupted with insurance inquiries, and your admin team has a clean summary to work from. Authorizations move faster.

Capture Insurance Data On Every Inbound Call

Insurance changes, coverage lapses, and plan updates happen frequently. Every inbound call is an opportunity to verify or update insurance information. The AI captures it (returned as a summary for your staff to review and file), so your care coordination team always has current data.

Reduce Back-and-Forth with Insurance Companies

Your team needs accurate insurance information to initiate prior authorizations. The AI captures member ID, group number, plan details, and authorization history on the first call. Your staff spends less time on follow-up calls and more time on actual authorization work.

Insurance details captured

Member ID, group number, plan type, and coverage details logged from inbound calls

Prior auth needs identified

AI recognizes authorization blockers and flags them for your care coordination team

Structured summaries returned

Insurance inquiry data formatted for your billing system and care team to action

No EMR write-back of insurance

Insurance data is captured and returned as a summary; your staff reviews and files according to your protocols

Frequently asked questions

Does the AI write insurance information directly into my EMR or practice management system?

No. The AI captures insurance details (member ID, group number, plan name, coverage questions) on the inbound call and returns it as a structured summary for your team. Your billing or care coordination staff reviews, verifies against your system, and updates as needed. This gives you control over accuracy and compliance.

Can the AI initiate a prior authorization directly with the insurance company?

No. The AI identifies authorization needs and captures the clinical details from your member, then returns that information to your care coordination or billing team. Your staff initiates the authorization with the payer using your established workflows.

What if a member has multiple insurance plans?

The AI can capture primary and secondary insurance details. If the member is unclear about coverage, the AI documents the uncertainty and your team follows up to clarify. This is especially useful for concierge members who may have supplemental insurance or family plans.

Can the AI explain what services are covered under a member's plan?

The AI can explain general coverage categories (e.g., 'Your plan covers preventive care in-network without a copay'), but cannot provide definitive coverage advice without access to your plan details. For specific questions, the AI escalates to your billing team or recommends the member contact their plan directly.