Concierge & DPC

AI Receptionist for Concierge Prior Authorization — Capture Insurance Details and Route Efficiently

Concierge members expect fast approvals. An AI receptionist captures insurance information and prior authorization requests on inbound calls, returning structured data for your staff to submit quickly.

Members call with authorization questions; the AI gathers insurance details during intake
Insurance information is captured on the call and returned as a structured summary—not auto-populated to your EMR
Prior authorization requests are flagged and routed to your insurance coordinator immediately
AI documents member medical history and reason for the requested service
Reduces insurance hold times and gets authorizations moving faster
Members see faster approvals and feel their care is prioritized

How it pays back

Insurance Data Is Captured Efficiently

Instead of your staff asking members for insurance details, the AI gathers it during intake. Members are prompted for insurance carrier, group number, member ID, and coverage details. Your staff gets clean, organized data to work with.

Prior Auth Requests Move to Your Coordinator Instantly

When a member calls to request authorization for a procedure or specialist referral, the AI flags the request and routes it to your authorization team with full context—member history, reason for service, and insurance details—ready to submit.

Members Avoid Repeated Phone Calls

Concierge members expect seamless service. One call, and their insurance request is captured and routed. No 'call back when you have a chance' or repeated insurance verification.

Your Team Focuses on Approval, Not Data Collection

Your insurance coordinator receives a complete prior auth packet from the AI: member insurance, procedure requested, clinical justification, and provider notes. They submit the request immediately, not chase down information.

Insurance data captured on call

Complete insurance details without back-and-forth

Prior auth requests flagged instantly

Routed to your authorization team with full context

Structured intake summaries

Your staff gets organized data, ready to submit

Member history documented

Reason for service and clinical context included

Frequently asked questions

Does the AI's captured insurance information sync to our EMR?

No. Insurance details and photo ID/driver's license information are captured on the call and returned to your staff as a structured summary. Your insurance coordinator reviews them and files them appropriately. This keeps sensitive data under your control and maintains audit compliance.

Can the AI determine if a service needs prior authorization?

The AI can ask for the procedure or service, document it, and flag it for your team. Your authorization specialist reviews and determines if prior auth is required based on the member's coverage. Some carriers require certain procedures to be pre-approved; the AI doesn't make that determination but captures all needed context for your team.

What if the member's insurance is out of network?

The AI captures all insurance information and flags it for your staff. Your team reviews coverage and communicates with the member if needed. For concierge members, insurance handling is often managed differently; your staff makes those calls.

Can the AI document the clinical reason for the prior authorization request?

Yes. The AI asks why the member is requesting the procedure or referral—e.g., 'chronic knee pain' or 'annual preventive colonoscopy'—and documents it. Your authorization team uses this context when submitting the prior auth request.

How quickly can prior auth requests be submitted after a call?

The AI's summary is delivered to your authorization coordinator in real time. If they have the member's chart and insurance details, they can submit the request immediately—minutes, not hours or days.