Workflow

Capture insurance and prior auth data on the phone call: structured handoff to billing, no manual re-entry

Insurance verification and prior authorization are manual bottlenecks in pain practices. An AI receptionist captures payer details, procedure codes, and clinical indication on the first call, returns structured data to billing, and eliminates re-entry—so your team submits requests faster and reduces denials.

Insurance provider, policy number, and group ID captured during new patient call
AI asks for specific prior auth requirement—procedure code, clinical justification, date of service
Structured summary returned to billing team with all required fields for submission
Follow-up calls from payers routed to billing department without repeating intake
Denial appeals and resubmissions logged for trend analysis
Appointment and patient demographics (name, DOB, phone) write to your EMR; insurance information and prior auth details are returned as a structured, EMR-pasteable summary for your billing team to review and file

How it pays back

Prior auth data captured once, used many times

Insurance information is collected during the patient's first call. Billing team has structured data immediately and can submit to the payer without calling the patient back or digging through notes.

Faster authorization turnaround

Complete payer information reduces submission delays. Cleaner, structured requests are processed faster than hand-written or incomplete forms.

Fewer appeal cycles and denials

AI captures clinical justification and procedure specifics on the call. That context is included in the authorization request, reducing payer requests for clarification or additional info.

Billing team spends less time on phone calls

Calls from patients asking 'Did my insurance approve my procedure?' are answered during intake. Billing focuses on payer communication and submission, not patient callbacks.

Insurance data captured on first contact

Payer, policy, group, and clinical justification documented before patient hangs up

Structured handoff to billing

All required prior auth fields populated and ready for submission

No re-entry, no delays

Billing team moves directly from AI summary to payer submission

Compliance-ready documentation

All calls and data captured logged for audit and appeal purposes

Frequently asked questions

What prior auth data does the AI collect?

Insurance provider name, policy number, group ID, member ID, phone number, authorization department extension, procedure code, clinical diagnosis, date of service, and any special requirements (e.g., 'requires 3 injections before surgery').

Can the AI verify coverage in real time?

The AI captures the insurance information and passes it to your billing team. Coverage verification is done by your staff using your existing payer portals or phone lines—the AI streamlines data capture so you have everything needed for that check.

What if a patient calls back asking about their prior auth status?

The AI recognizes the patient from caller ID or phone number, retrieves the captured prior auth record, and can provide status updates or route the call to billing if authorization details have changed.

Does this data flow into the EMR?

Insurance information is captured on the call and returned as a structured summary for your billing team to review and file into the patient record. Appointment bookings and demographics (name, DOB, phone) write directly to the chart.

Can the AI track denials and resubmissions?

Yes. All prior auth requests, payer responses, and denials are logged in your practice management system. Your billing team and clinical staff can review trends, identify problematic codes or payers, and refine your submission process.