Workflow
Pain procedures require insurance pre-authorization. An AI receptionist captures insurance details, pre-auth status, and authorization blocks during the initial call. Insurance info and pre-auth flags are logged for your admin team to start processing before the appointment.
Insurance details are captured during the initial call. Your admin team begins authorization processing immediately — not after the patient arrives for check-in. Denials or issues are caught early; you reach the patient before the visit to explain coverage gaps.
Calls are answered and scheduled without waiting for insurance verification. The AI collects the data; your admin team confirms coverage in parallel. If pre-auth is missing, the appointment is held pending authorization — not canceled.
Patients don't show up for an appointment only to learn their insurance won't cover it. Pre-authorization issues are resolved before the visit. Patient calls back to confirm? You already know insurance is active.
Insurance verification is complete before the patient arrives. Front desk does final confirmation, not initial discovery. If a pre-auth was denied, you've already discussed alternative payment plans with the patient.
Insurance details captured on every call
Member ID, group number, and carrier logged without caller friction
Pre-auth status logged and escalated
Missing pre-auth or denials flagged for immediate admin review
Authorization processing begins in parallel
Admin team starts pre-auth before appointment scheduling is complete
Insurance data returned as structured summary
Your team reviews and files insurance and pre-auth status in the patient record
You configure pre-auth requirements by procedure type and insurance carrier during setup. The AI asks for insurance details, looks up the procedure, and flags if pre-auth is required. If required, the call is routed to your admin team for immediate authorization processing.
The AI captures the patient's name, date of birth, and any partial insurance details (e.g., employer name). The call summary is marked 'insurance pending.' Your admin team searches the patient's employer records or calls the patient back to collect full details before the appointment.
Yes, if your EMR or insurance portal is integrated. The AI can check prior pre-authorizations for that patient and procedure. If a current pre-auth exists, the AI confirms it; if it's expired or missing, the call is routed to your admin team immediately.
The AI flags the denial in the call summary and escalates it to your admin team. Your staff contacts the patient to discuss the denial, explain alternative payment options, and determine next steps before the appointment.
Insurance carrier, member ID, group number, and pre-auth status are captured and returned as a structured summary for your team to review and file in the new patient record. This ensures your clinical staff sees insurance and authorization details from the chart before the visit.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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