Workflow
Interventional procedures require prior authorization. Capture insurance carrier, member ID, and procedure codes during intake so your authorizations team can verify coverage in real time without calling the patient back.
Your authorizations team receives complete insurance details on the intake call. They can verify coverage, request prior authorization, and resolve issues before the patient arrives—eliminating appointment-day surprises.
The AI collects insurance on the first call. Your team no longer has to reach out to patients a day or two before the appointment asking for insurance cards or member IDs.
The AI documents the specific procedure (e.g., facet joint injection, radiofrequency ablation) so your authorizations team can submit the request with the correct CPT code the first time, not multiple times with corrections.
If the AI identifies red flags—patient age, procedure frequency, known denial patterns—your team can proactively reach out to the insurance carrier or patient to address coverage questions before the appointment.
Insurance captured during intake
Carrier, member ID, group number, and plan type collected on the first call
Procedure codes documented for authorization
Specific intervention and CPT codes included in authorization request
Authorization delays reduced
Complete insurance data submitted to carriers immediately, not after call-backs
Denial risk identified early
Flagged cases reviewed by authorizations staff before appointment
Your practice configures the AI with a list of procedures and the insurance carriers that typically require pre-authorization for each. The AI tailors questions based on the procedure and insurance plan identified during intake.
The AI can collect name and date of birth and ask the patient to look up their member ID online or via patient portal after the call. Your team can also verify coverage using the patient's demographic information. The appointment is booked; insurance follow-up happens in parallel.
The AI captures insurance information and returns it to your authorizations team, who can then check the carrier's authorization system. Direct real-time carrier API integration is not part of the standard service, but insurance data collected by the AI is formatted for your team's use.
Your authorizations team reviews the flagged case and contacts the patient proactively to discuss coverage, out-of-pocket costs, or alternative options. This conversation happens before the appointment, not after.
Insurance information is captured during the call and returned as a structured summary for your staff to review and file into the patient record. Appointment booking and patient demographics (name, DOB, phone) sync directly to the EMR; insurance is handled separately by your authorizations workflow.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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