Concierge Medicine
Concierge practices differentiate on specialist network access. An AI receptionist fields member referral requests, verifies insurance prior-auth status, coordinates with specialists, and schedules appointments—all without member or staff involvement in the back-and-forth.
Concierge member calls requesting a rheumatology referral. AI schedules the appointment, confirms insurance, obtains pre-auth, and texts the time and location. Member's only job is to show up. This is the concierge experience members pay for.
Staff no longer field angry calls from members blindsided by denied specialist visits. The AI verifies authorization before booking and communicates any denials or requirements upfront, giving members time to appeal or choose alternatives.
Every referral, authorization code, and appointment is logged in the EMR with timestamps. Complete audit trails support billing accuracy and compliance.
Referral request handled end-to-end
Member requests, AI coordinates insurance and scheduling, member receives confirmation
Prior-auth verified before appointment
Authorization status checked upfront to prevent denied-claim surprises
Specialist coordination automated
AI contacts offices, checks availability, obtains authorization codes
Yes, if your EMR integrates insurance verification data or you use a prior-auth service like Change Healthcare. The AI queries whether the referral (e.g., cardiology, MRI) requires pre-authorization for the member's plan. If required, the AI initiates the authorization request with the member's insurance and specialist office.
The AI attempts contact during normal business hours and retries if busy. If contact fails, it alerts your staff to handle manually. For urgent referrals, staff can intervene directly. The system surfaces blockers so you can escalate appropriately.
The system integrates with specialty-office scheduling systems where available (Epic, Athena, AdvancedMD, and others). Direct integration books the appointment automatically. If the specialist uses a different system, the AI calls and manually schedules, then logs the confirmation in your EMR.
The AI informs the member immediately, explains the reason (not medically necessary per plan, requires specialist pre-screening, etc.), and offers options: appeal the denial, pay out-of-pocket, or try a different specialist. Staff are alerted to help with appeals if the member chooses to challenge the decision.
Related Specialty
AI receptionist for concierge and DPC practices
Concierge and direct primary care models, member access workflows, and specialist coordination.
Next step
Automated patient scheduling
Booking, rescheduling and calendar rules the receptionist applies on every call.
Next step
Front desk workload
Where front-desk time actually goes.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
Want the numbers first? See plans and pricing
