Workflow
Prior authorization holds up procedure scheduling in pain practices. An AI receptionist fields patient calls about insurance approval status, logs updates, and flags denials or holds for your billing or clinical team to resolve.
Patient calls once asking for status; the AI logs the answer and notifies your staff. No need for the patient to call back every 2 days or for your staff to chase the insurance company repeatedly.
When a patient reports a denial, the AI immediately alerts your clinical or billing team with the denial reason and insurance contact info. Your team has days to appeal, not weeks after the patient discovers it on procedure day.
Prior auth status is confirmed before the appointment. Patients whose approvals are pending are rescheduled to a date after expected approval, not cancelled the morning of.
The AI gathers patient-reported status and escalates; your staff focus on insurance company calls, appeals, and policy review—not fielding dozens of patient status checks.
Insurance status calls answered by AI
No voicemail for prior auth questions
Insurance verifications completed on first contact
Member ID, procedure code, and coverage level captured during intake
Denials escalated to staff immediately
Appeal window tracked; denial reason and insurer contact logged
Follow-up calls proactively scheduled
AI calls patient on expected approval date to confirm and re-book if needed
The AI collects patient-reported information on the call (member ID, procedure name, coverage status as they understand it). For full verification, your billing staff or the AI can call the insurance company directly. The AI logs what the patient reported as a structured summary for your team to review and validate with the insurer.
The AI captures the denial code, reason, and patient's explanation. This escalates immediately to your clinical or billing team, who can reach out to the insurance company to dispute or request reconsideration. The AI logs the escalation so no action is lost.
The AI asks: 'When should we expect approval?' If the patient says 5-7 business days, the AI schedules a callback for day 7. If approval hasn't arrived by then, the AI calls the patient to check status and offer to reschedule the procedure or escalate to billing.
Yes. Your practice can configure the AI to handle workers' comp and no-fault cases differently—asking for claim number, attorney info, or employer details as needed. These calls are flagged and routed to your workers' comp team if not handled by the AI.
The AI captures the denial, escalates it immediately to your clinical team, and offers to reschedule once appeals are submitted or an alternative procedure is authorized. The patient doesn't show up on procedure day to discover the insurance won't cover.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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