Workflow
After an interventional pain patient books a procedure, prior authorization often determines whether insurance covers it. Instead of your staff manually checking insurance portals daily, the AI monitors approval status and alerts the practice when a decision arrives.
Insurance approvals and denials are time-sensitive. The AI monitors for decisions and notifies your team within hours, so you can confirm appointments before the patient has second thoughts or the referrer escalates.
When staff learn of a denial on the morning of a scheduled procedure, the day is lost. Automated prior auth monitoring catches denials early, so your team has time to reach the patient, discuss appeals or alternatives, and reschedule.
Staff no longer spend time daily logging into insurance systems to check auth status. The AI handles that work and surfaces decisions in real time, so your team focuses on patient communication and clinical coordination.
The AI logs all auth decisions with dates and auth numbers. When the AI calls back with an approval, it captures auth details in a structured summary for staff review—staff have a timestamped audit trail.
Prior auth status monitored continuously
Insurance approvals and denials flagged automatically, not missed on manual checks
Callbacks placed when decisions arrive
Staff notified in real time, not at end-of-day or end-of-week
Auth numbers and details logged with callback
Compliance documentation complete; staff have audit trail and patient confirmation
Multi-auth tracking supported
For complex procedures requiring multiple prior auths, AI monitors all and alerts when reauth is needed
The AI integrates with common insurance EDI channels and uses web-monitoring for insurers without automated feeds. Your staff submits the auth request tracking number when the patient books; the AI checks that insurer's system daily for updates.
The AI alerts your staff with the modification details—e.g., 'approved for 1 injection, not 2' or 'approved for cervical, not lumbar.' Staff review the summary, contact the patient, and reschedule if the approved scope differs from what was booked.
The AI flags denials and alerts your clinical team, but appeal letters and medical documentation are handled by your staff. The AI logs the denial date and can remind your team of appeal deadlines if configured.
Yes. The AI can monitor prior auth for Medicare Advantage plans, Medicaid programs, and commercial insurers. Your staff configures which insurers and procedure codes the AI should track.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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