Workflow
Insurance verification and prior authorization are critical gatekeepers for interventional pain procedures. AI collects patient insurance info and coverage questions during booking, so your billing team has everything needed to start pre-auth before the patient's first visit.
Insurance details are collected during the booking call, not at check-in. Your billing team has all day to submit pre-auth, so authorization is likely back before the procedure date.
AI asks all required fields in one conversation. No back-and-forth with patients after booking. Complete data means complete pre-auth submissions.
If a patient says 'My insurance denied this procedure last year,' AI notes it. Your billing team can plan an appeal or reach out to the patient to discuss alternatives before appointment day.
Patient knows upfront whether they'll hit their deductible or max with this procedure. Reduces surprise bills and payment plan conversations.
By procedure day, authorization status is known. Cancellations due to denied pre-auth are rare because the issue is resolved during the pre-auth window.
Insurance details captured once
Carrier, plan, policy, coverage questions collected in booking call
Pre-auth turnaround starts immediately
Billing team receives complete insurance summary within minutes of booking
Prior denial flags surfaced early
Patient reports of previous denials noted for appeals review
Deductible and out-of-pocket clarity
Patient knows cost responsibility before arrival
Required procedure codes identified
AI notes which procedures require pre-auth vs. notification-only
Your office configures the procedure list during onboarding and tags each with pre-auth requirements. AI knows, for example, that 'nerve block' requires pre-auth but 'trigger point injection' does not. AI mentions the requirement when booking and alerts billing team.
No. AI collects the patient's insurance information and relevant coverage questions during the booking call. Your billing team uses that summary to call the insurance company or submit pre-auth through online portals.
Not directly. However, some insurance portals and eligibility verification systems integrate with your EMR or billing system. If that integration is active, your team can pull real-time status during the pre-auth process using the patient's info AI collected.
AI asks them to find their insurance card or policy document. If they can't locate it, AI collects their name and insurance carrier name, and your billing team can look up the account or call the patient back for the policy number.
Insurance details are captured during the call and returned as a structured summary for your billing team to review. Your team enters insurance into your billing system or EMR manually or via your existing eligibility verification workflow.
AI asks: 'Do you have primary and secondary insurance?' and collects both. Your billing team then verifies coverage under both policies and determines coordination of benefits before procedure day.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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