Insurance Workflow
Radiculopathy cases often require prior authorization for specialist evaluation, imaging, or procedures. AI receptionist captures insurance information and asks about prior MRI, CT, or injections during intake. This context is returned to your staff as a structured summary for prior auth requests, helping include patient imaging history and avoid delays.
Instead of scheduling, then calling for insurance details, then calling for imaging history, your authorizations team has everything on the first intake. Prior auth goes out the same day.
By capturing prior conservative treatment (PT, anti-inflammatories, prior injection attempts) during intake, your prior auth shows medical necessity clearly. Fewer 'need more information' denials.
AI asks if imaging was done elsewhere and checks your system for prior MRI or CT. Your authorization request references prior images, reducing unnecessary repeat imaging and cost.
Your admin no longer spends 10–15 minutes per call chasing insurance info. All captured on intake and structured for the auth team.
Insurance details captured on first call
Member ID, group, plan type, and contact information available for prior auth immediately
Prior treatment history documented
Conservative therapy, prior injections, and imaging history recorded to support medical necessity
EMR-integrated imaging lookup
Prior imaging cross-referenced; duplicates flagged to avoid redundant testing
Structured for authorizations team
Insurance and clinical context returned as ready-to-use summary for prior auth submission
The AI uses a standard intake template that captures member ID, group number, plan type, and patient's insurance contact number. Your front office can customize these fields per your prior auth process.
No, the AI does not log into insurance portals. It captures the patient's insurance information and returns it to your staff. Your authorizations team uses this to verify coverage and submit prior auth through your standard channels.
The AI asks about primary and secondary coverage. Both are captured and returned so your authorizations team knows which payer to contact first and whether secondary coverage applies.
By submitting prior auth with complete patient history (prior imaging, prior injections, conservative therapy) on day 1, your request is less likely to be returned for additional information. Insurance reviewers have everything they need to make a decision.
Insurance details and clinical history are returned to your staff as a structured summary for review and filing. Appointment and demographic data (name, DOB, phone) sync to your EMR; insurance information and clinical context remain available as a pasteable summary for your team to file, so you control what enters the chart.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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