Concierge & DPC
Members call for prior auth status, specialty referrals, or procedure approvals. AI reception captures the request, routes to your clinical staff, and follows up with the member—ensuring no auth request gets lost.
AI reception captures the request, staff processes it, and AI proactively notifies the member when approved. No 'call back in 3 days' runaround.
Instead of answering repeat calls about prior auth status, staff receive a prioritized list of pending requests with member contact info and request details already captured.
If an authorization is denied, staff can contact the member and physician to discuss appeals or alternative treatments before the member shows up expecting approval.
Call timestamps, member request, staff action, and approval date all logged in EMR. Supports compliance and dispute resolution with insurers.
Prior auth requests captured
Member request, insurance, service, and urgency recorded during call
Staff notified immediately
Clinical team receives prioritized alert with full request context
Insurance details structured
Plan name, member ID, group, authorization type returned as structured summary for staff review
Member follow-up automated
AI proactively notifies member when auth completes or flags delay
If your practice has a real-time eligibility tool (Availity, Surescripts, etc.), the AI can query it during the call and relay basic status to the member. Complex denials or appeals still route to staff for resolution.
The AI flags urgency ('appointment next week') and routes to your clinical staff with priority flag. Staff can expedite the authorization or contact the member if denial is likely.
AI captures the specialty, reason for referral, and requested provider/facility. If your practice has preferred specialists, the AI can suggest them; otherwise, the request routes to your referral coordinator for processing.
Staff are notified of the denial. The AI can help schedule a callback with the member and provider to discuss appeals, alternative treatments, or out-of-pocket options.
Yes, if your practice uses a member portal. But many members prefer calling. The AI ensures those calls are captured and routed efficiently—it's not either/or.
Related
AI receptionist for concierge and dpc practices
How concierge and DPC practices use AI reception for authorization and referral workflows.
Workflow
Patient intake
Structured capture of clinical and insurance information during member calls.
Integration
EMR and EHR integrations
How prior auth requests and member data are returned as structured summaries for staff review and filing.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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