Compliance

Building the insurance question set: what the call asks, and which payer rules you configure behind it

The insurance questions on a pain intake call are a configuration decision, not a fixed script. Here is the field set worth capturing, how payer-specific flags are set up, and how carrier rules get applied while the patient is still on the phone.

Core field set: carrier, member ID, group number, and whether the patient knows their procedure needs authorization
Procedure type asked in the patient's own words (epidural injection, facet ablation, SI joint injection) and recorded for the authorization decision
Medication and allergy questions that bear on approval, such as anticoagulation or steroid response
Carrier rules you configure in advance, for example a payer that requires documented conservative treatment first
Flags for carriers you have marked as slow or high-denial, so the summary tells staff what they are dealing with
A path for the caller who reports an existing denial or a coverage exclusion, so it is captured rather than discovered later

How it pays back

The question set is yours to define

Which insurance fields are asked, in what order, and which are optional are all configured for your practice. The call asks what your authorization team actually needs rather than a generic set of insurance questions.

Payer rules are applied during the conversation

If you have recorded that a particular carrier requires documented conservative therapy first, that rule can be applied while the patient is talking, and the summary carries the flag to whoever picks it up.

Clinical detail that affects approval is asked alongside the insurance fields

Anticoagulation, allergy, and prior procedure history are captured in the same pass as carrier and member ID, so the authorization review is not missing the clinical half of the picture.

One standard format instead of a call recording

Answers come back in a consistent structure. Your authorization team reads fields rather than hunting through a voicemail or a recording for the group number.

Insurance details captured

Carrier, member ID, group number documented on intake call in structured format

Procedure type documented

Specific intervention (epidural, facet ablation, SI joint, etc.) recorded for PA determination

Clinical flags noted

Anticoagulation, allergy, prior procedure history documented to inform authorization review

Auth data ready same-day

Structured intake summary delivered to your authorization team hours after booking call, not days

Frequently asked questions

Which insurance questions belong on a pain intake call?

At minimum the carrier name, member ID, and group number where there is one, plus whether the patient already knows the procedure requires authorization. Practices that also capture the requested procedure type, anticoagulation status, and allergies give their authorization team a far more complete starting point.

How do we configure rules for specific carriers?

Carrier rules are set up with you during onboarding. You can flag high-denial carriers, carriers with long turnaround, or plan requirements such as documented physical therapy, and the flag appears in the summary your team receives.

What if the patient does not have the card in front of them?

Whatever the patient knows is captured, and the rest can be provided at the appointment or uploaded through the patient portal. The summary records what is missing rather than leaving a blank field.

Can we ask about procedure type without the AI making a clinical judgement?

Yes, and that distinction matters. The call records the procedure the patient says they were referred for or has had before. It does not decide what procedure is indicated. Your clinician makes that call, and your authorization team acts on it.

Do the insurance questions make the call noticeably longer?

They add roughly thirty seconds to a minute inside a natural conversation. The slot selection and confirmation take the same time either way, so a straightforward new patient booking runs about three to five minutes with the insurance questions included.

How do we handle self-pay and high-deductible callers in the same script?

Self-pay status or a high-deductible plan is recorded like any other answer, and your staff can raise cost estimates or payment plans during intake or a follow-up call rather than at the desk on procedure day.