Workflow
Pain procedures often require prior authorization. Capturing insurance details, procedure codes, and treatment history on the initial call—rather than at check-in—lets your staff start the auth process before the appointment and reduces delays.
Instead of staff requesting insurance information at check-in, the AI captures it on the phone. Your authorization team can submit the request immediately, allowing time for insurer approval before the procedure date instead of rushing the auth after the patient books.
The AI asks about prior imaging, conservative care attempts, and previous interventions—all required for prior auth. This information is captured and returned as a structured, EMR-pasteable summary for your auth staff to review and file, giving them the clinical narrative they need without a second patient interaction.
When insurance information is already in the EMR and the auth has been initiated, check-in is faster. Patients aren't delayed by staff hunting for insurance cards or discovering auth gaps on the day of the procedure.
Workers' comp, Medicare Advantage, and out-of-network plans require different auth pathways. The AI can flag these during intake, allowing your staff to prepare special workflows before the patient arrives.
Insurance captured on call
Member ID, group, plan type, and eligibility questions asked during intake
Clinical auth data structured
Prior imaging, conservative care, and intervention history returned for auth team review
Patient demographics written to EMR
Name, DOB, phone, member ID, and group number recorded in your chart
Auth process starts early
Information ready for submission before appointment booking confirmation
No. The AI captures insurance details and clinical history on the phone and returns a structured summary for your prior authorization staff to review and submit. Your team retains full control over auth submissions and payer communication.
The AI asks about prior imaging (MRI, X-ray, CT), prior interventions, conservative treatments (physical therapy, medication), pain duration, and any imaging or notes the patient has. This information is returned in a structured format so your auth team can complete the clinical attestation.
The AI can capture workers' comp claim number, employer details, and injury date during intake. This information is highlighted in the summary so your staff knows to follow workers' comp authorization workflows and carrier requirements.
The AI can capture eligibility questions during the call. If your EMR supports real-time eligibility checks, results are documented in the call summary for your staff to review and act on.
The AI can ask about cash-pay options, financial assistance programs, or payment plan preferences during intake. This information is captured and flagged for your billing team to follow up with cost estimates before the appointment.
Yes. By capturing insurance and clinical details on the phone rather than waiting for check-in or a callback, your auth team can submit requests within hours of the patient booking, rather than days. This improves approval timing and reduces procedure reschedules due to auth delays.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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