Workflow

Capture insurance and pre-authorization flags on first call; let your billing team handle approval workflows

Insurance pre-authorization is a major roadblock for interventional pain procedures. An AI receptionist captures insurance info, identifies prior-auth requirements, and flags common blockers—leaving your billing team with a clear roadmap instead of incomplete paperwork.

Ask for insurance carrier, group number, and member ID during scheduling call; validate real-time against clearinghouse
Identify procedures requiring prior authorization (e.g., sacroiliac joint injection, spinal cord stimulator implant) and flag for your billing team
Ask standard pre-auth questions (physician name, procedure code, medical necessity statement) and return structured summary
Alert callers to common delays (e.g., 'Auth typically takes 3–5 business days'; 'Your plan requires step therapy') so expectations are set
Capture insurance information on the call and return it as a structured summary for your billing team to review, validate, and file in the chart
Handle workers' comp and auto insurance claims with specialized question logic

How it pays back

Insurance Captured on First Call

Callers provide insurance details during appointment booking. No second call chasing coverage. Your billing team receives a structured summary with member ID, group number, and policy highlights—ready to request auth.

Prior-Auth Flags Visible Before Booking

The AI knows which procedures require pre-auth. If a caller wants a cervical facet injection, the system flags 'Prior auth typically needed' and your staff begins approval workflow immediately, not after the patient is already scheduled.

Billing Team Saves Hours of Follow-Up

Insurance details, procedure codes, and prior-auth flags are returned as a ready-to-process summary. Your billing staff doesn't hunt for member IDs or call the carrier blind; they're armed with complete caller info.

Patient Expectations Set Early

Callers are informed if auth delays are expected or if their plan has step-therapy requirements. This reduces surprise cancellations and call-backs.

Insurance captured on first call

Member ID, group, and carrier validated real-time

Prior-auth requirements flagged at booking

Your billing team starts auth workflow immediately

Structured insurance summary for your team

All caller info in one paste-ready format

Insurance data captured but reviewed by staff

Your team validates and enters into chart for compliance

Frequently asked questions

How does the AI validate insurance information?

The system asks for carrier name, group number, and member ID, then performs a real-time eligibility check against the clearinghouse (if you have integration set up). It returns a basic verification: active/inactive, coverage dates, deductible status. Your staff always reviews and confirms before submitting for auth.

Does the system automatically submit prior-authorization requests?

No. The AI captures the information and flags procedures that typically require auth (e.g., advanced interventional techniques, spinal procedures). Your billing team uses this flag to initiate your standard prior-auth workflow with the insurance company.

What if a caller's insurance is inactive or has lapsed?

The system alerts you during the call. Your staff can ask the caller to verify coverage, suggest they contact their employer, or offer to wait for updated insurance info before finalizing the appointment. The call is logged so your billing team follows up.

How do you handle workers' comp and auto insurance?

The AI asks specialized questions for workers' comp (claim number, employer name, date of injury) and auto claims (accident date, police report number, defendant carrier). This info is captured and returned to your billing team, who then routes the claim appropriately.

How is insurance info handled after the call?

Insurance data is captured during the call and returned as a structured summary. Your staff reviews it and enters it into the chart manually or via your EMR's import workflow, ensuring compliance and accuracy before the appointment.

Can the system handle multi-carrier or secondary insurance?

Yes. The AI asks for primary insurance first, then asks if there is secondary coverage. Both are captured and flagged for your billing team to handle coordination-of-benefits logic.