Operations

Capture prior authorization requests from concierge members and route to your staff for processing

Members call requesting prior authorizations for specialists or procedures. An AI receptionist captures the request, confirms member coverage details, and delivers a structured summary to your staff for submission to insurers or third parties.

Identify when a caller is requesting a prior authorization vs. a routine appointment
Capture member insurance info, chief complaint, and requested procedure or specialist name
Confirm member eligibility and coverage tier in EMR before accepting request
Return a structured summary with all required details for staff to process
Route urgent prior auths to priority queue for same-day processing
Track prior auth requests in your system for follow-up and denial management

How it pays back

Staff receive complete context, not partial calls

Instead of scribbled voicemail or partial notes, your staff gets a clean summary with member ID, procedure code, requested provider, and chief complaint. Less back-and-forth to clarify what the member needs.

Members don't wait on hold while staff verifies coverage

The AI checks member eligibility and coverage tier upfront. By the time your staff reviews the request, they know the member is covered and where to send the prior auth—no delays due to manual verification.

Urgent prior auths prioritized

A member calling about a time-sensitive procedure (surgery next week, urgent MRI) is flagged for priority processing. Your staff sees it first in the queue and can process it immediately.

Fewer insurance delays and denials

Complete, accurate prior auth intake reduces back-and-forth with insurers. Staff have all the information they need to submit correctly the first time, speeding up approvals and reducing member frustration.

Prior auth requests captured fully

Procedure, specialist, member coverage, and clinical details captured on the call

Member eligibility verified upfront

Coverage tier and authorization requirements confirmed before handoff to staff

Structured summary for staff

All required fields populated and formatted for submission to insurer

Urgent requests prioritized

Time-sensitive prior auths flagged and routed to priority queue

Frequently asked questions

How does the AI know a call is about prior authorization vs. routine appointment?

The AI listens for keywords like 'prior auth,' 'approval,' 'insurance approval,' 'specialist visit,' or 'procedure.' You can also configure the AI to ask a question upfront: 'Are you calling to schedule an appointment, ask about a procedure, or request an insurance approval?' The AI routes based on the member's answer.

What insurance information does the AI capture?

The AI captures the member's primary insurer (from the EMR if available), the procedure or specialist being authorized, the requesting provider, and the clinical reason. The AI includes insurance details and clinical context in a structured call summary for your staff to review and submit to the insurer.

Can the AI verify insurance coverage on the call?

The AI can look up the member's coverage tier and authorization requirements from your EMR. For detailed coverage questions (copay, out-of-pocket max), the AI can note the question and pass it to your staff, or offer to have your team call the member back with specifics.

Does the AI submit prior authorizations to the insurer?

No. The AI captures and structures the request; your staff submits it to the insurer. You control whether staff use your EMR's prior auth module, a web portal, phone, or fax. The AI gives staff all the information they need in one organized summary.

How are urgent prior auth requests flagged?

The AI listens for urgency cues: 'surgery next week,' 'procedure scheduled for Monday,' 'need approval ASAP.' Urgent requests are tagged with priority status and sent to your prior auth queue at the top. Your staff sees them first thing in the morning or as soon as they log in.