Referrals and Prior Auth
Membership practices order labs, imaging and specialist care they do not bill. Capture referral and prior authorization calls off the front desk.
A membership practice sends members outward constantly, to imaging, to specialists, to labs, and the coordination work follows even though no claim does. These calls do not appear in any billing workflow, which is exactly why they tend to land on the physician or the single staff member.
Members generally keep their own coverage, so an insurer may still require authorization for an imaging study or specialty referral your practice ordered. The status calls that generates are administrative, repetitive, and time-sensitive, and they are among the easiest to capture in structured form.
Inbound calls from specialist schedulers and imaging centers are frequently the ones that stall, because they arrive during clinic and need a specific document rather than a conversation. Capturing precisely who called, for which member, and what they need turns an interruption into a task with an owner.
Membership practices often hold negotiated cash rates that are only relevant if the member is not going through their plan. When the phone records which route the member intends, the conversation with the imaging centre starts from the right premise instead of unwinding a wrong assumption.
Unlimited concurrent calls
Outside offices and members reach you simultaneously without a hold queue
Under 1 second to answer
Specialist schedulers with a narrow calling window are not sent to voicemail
HIPAA BAA included
Referral, imaging and authorization details encrypted with AES-256 at rest and TLS in transit
It handles the phone side: capturing the inquiry, the plan, the reference number, and what the member or the outside office was told, then routing it to your workflow. Submission and payer follow-up remain with the people who hold your credentials and clinical documentation.
By your records-release process, which usually means verifying the requesting organization and routing the request rather than confirming any clinical detail on the call. Nothing about a member's chart is disclosed to a caller outside the rules your practice has written down.
Only where a read-back interface exists and your practice has authorised it. Otherwise it captures the question and routes it, because a confident wrong answer sends a member to an appointment that was never booked. Integration depth is confirmed during setup.
Yes. Inquiries from another physician's office about referring a patient in are captured with the referring practice, the reason as stated, and contact details, then routed to whoever handles new members. Whether that becomes an enrollment conversation is your call, not the system's.
No. Tasks can arrive as structured summaries in a shared inbox, by secure message, or written back through API or FHIR where an interface exists, with custom integration available otherwise. The referral workflow itself is EMR-neutral and portable if you change systems.
Those calls are captured with the same structure and flagged by the urgency category your practice defines for time-critical outside calls, so they reach a person quickly rather than sitting in a general message list while the member waits in a waiting room.
Related
Insurance Questions at Cash-Pay Membership Practices
Why members still ask about coverage at a practice that never sends a claim.
Related
Front-Desk Phone Coverage in Small Membership Practices
Outside offices call during clinic, which is exactly when a two-person practice has nobody free.
Related
Member Communication and Follow-Up for Concierge Practices
Keeping members informed between visits, including while an outside referral is in flight.
Pillar guide
AI Receptionist for Concierge, DPC and Membership Practices
The full membership-practice phone layer: member and prospect calls, access, after-hours, enrollment questions, and operations.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
