Workflow
Interventional pain procedures often require prior authorization from insurance. New patients typically arrive unprepared, requiring front-desk staff to hunt for insurance info and chase payers. AI receptionist captures insurance, procedure indication, and clinical history during intake call, handing staff a complete summary and auth checklist before arrival.
Insurance information captured during booking call. Your auth team begins payer outreach immediately rather than waiting for patient check-in. Reduces delay-to-procedure and improves first-pass approval rates.
AI captures pain duration, prior failed treatments, imaging results, and current therapy. Structured summary handed to auth staff, making payer request complete and supporting medical necessity faster.
Insurance and patient history already in chart before arrival. Front-desk confirms contact info, collects co-pay, and reviews photo ID. No hunting for insurance cards or calling payers during busy clinic hours.
During intake, AI asks if recent MRI or imaging is on file. Records location is captured. Your staff proactively pulls films before procedure day rather than scrambling post-arrival.
If patient reports progressive neuropathy, bowel/bladder changes, or signs concerning for structural pathology, AI captures and flags for provider review before procedure.
Insurance captured on intake call
Member ID, carrier, plan type, and prior auth status documented before arrival
Prior auth checklist prepared
Medical necessity supporting info captured and handed to payer request team
Clinical history structured for review
Pain history, prior treatments, and red flags summarized for provider and staff
Imaging and records location known
Staff pulls films proactively before procedure rather than post-arrival scramble
AI asks for insurance carrier name, plan type (HMO, PPO, Medicare, etc.), member ID, and group number if available. AI also asks if the patient knows whether prior authorization is required and whether they've already initiated auth. All information is captured as structured data and returned to your team.
Insurance carrier, member ID, and plan type are captured during the call and write to your EMR as part of the patient demographics. Your staff reviews the structured summary, verifies the information, and uses it to initiate prior auth. Clinical details (symptoms, medical history, medications) are returned as a structured summary for your team to review and file, not auto-populated into the clinical chart.
AI captures the patient's reason for seeking the procedure (e.g., 'chronic low back pain, failed physical therapy and medication, considering lumbar epidural injection'), duration of symptoms, prior treatments tried, and current pain level. This clinical context is returned as a summary to your auth team, making the payer request complete and increasing approval likelihood.
AI asks if the patient has an insurance card at home or can provide info within 24 hours. If not available during the call, your staff follows up via phone or patient portal before the procedure. The appointment is still confirmed; auth and insurance verification happens pre-arrival.
During intake, AI asks: 'Do you have any recent MRI or X-ray imaging for your [spine/joint/etc.]? Where was it done?' Patient provides location and date. This information is returned to your chart team, who then retrieves images from the other facility before procedure day.
Yes. If an existing patient's appointment reminder includes a request to confirm insurance, AI asks if insurance has changed since last visit. Any changes are captured and flagged to staff for eligibility verification before the procedure.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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