Compliance

Gather insurance details and authorization flags during patient intake—staff processes, not staff calls back to verify

Prior authorization holds up interventional pain procedures. MedReception captures insurance and prior auth needs during the booking call and returns a structured summary so your team can begin the authorization process immediately.

During intake, AI asks for insurance carrier, member ID, and group number; caller provides or consents to record lookup
AI identifies procedures that require prior auth (common for epidurals, blocks, injections) and flags them during the call
Caller is informed of authorization timeline (e.g., 'Your insurance typically approves this within 48 hours')
Insurance details and authorization flags returned to staff as structured summary; not scattered across voicemail or handwritten note
Staff begins prior auth submission immediately; no second call to the patient needed
Authorization status tracked and communicated to patient before the procedure date

How it pays back

Authorization process starts on day one

Insurance information captured on the call means your billing team can submit prior auth immediately, not after a second verification call.

Procedures don't get cancelled for missing authorization

Flagging authorization needs during intake means your staff has time to resolve it before the procedure date.

Patient knows what to expect

Caller is informed on the original call if authorization is required and how long it typically takes. No surprises at check-in.

Billing staff spends time authorizing, not re-verifying

All information is captured and structured; staff does not make additional calls to confirm insurance or authorization needs.

Insurance captured on call

Member ID, group number, and coverage details gathered during initial intake

Prior auth flags identified upfront

Procedures requiring authorization flagged during the booking call, not discovered later

Structured summary for staff

Insurance and auth needs returned as ready-to-action summary, not loose notes

No second verification call

Staff begins prior auth submission immediately; all needed information captured on first call

Frequently asked questions

How does the AI know which procedures require prior authorization?

The system is trained on common prior auth requirements for interventional pain procedures. You can also upload your payer-specific prior auth rules into the system. When a patient books an epidural steroid injection or medial branch block, the AI flags it based on the procedure type and the identified payer.

What if the patient doesn't have insurance information on hand?

The AI can ask if they'd like the office to look up their insurance using their date of birth and Social Security number (captured with consent). Alternatively, the patient can provide the information after the call via the patient portal, and staff updates the booking. The appointment is not delayed; authorization begins as soon as insurance details arrive.

Does the system submit prior authorization automatically?

No. The system captures insurance and authorization needs and returns them as a structured summary to your staff. Your billing or clinical team reviews the summary and submits the prior auth request through your standard process (payer portal, phone, EDI, or fax). This ensures compliance with your payer contracts and keeps your team in control of the authorization timeline.

Can the AI communicate authorization status back to the patient?

Yes. Once your staff updates the authorization status in the system (approved, pending, or denied), the AI can send the patient a proactive notification via SMS or email. This eliminates patient calls asking 'Is my procedure approved?'

What happens if insurance denies authorization?

Staff is notified immediately. If denial occurs, your team can contact the patient to discuss next steps (appeal, out-of-pocket, alternative procedure). The AI can also send a templated message to the patient explaining the denial and next steps, reducing back-and-forth calls.