Workflow
Interventional pain practices spend staff hours chasing insurance pre-certifications. This page shows how AI captures prior auth requests on intake, routes them to billing in real time, and stops patients from waiting for callbacks.
Patient calls in, AI verifies coverage and captures authorization needs, billing team handles the request with complete context. No patient callback loops, no 'we'll check and get back to you.'
If authorization is pending, the patient hears a clear timeframe ('we'll know by Wednesday') and the appointment is held conditionally. When approval comes through, confirmation is automatic. No double-booking or cancellations.
MRI, CT, or imaging that requires pre-cert is captured and routed alongside procedure authorization. One call captures all insurance needs; staff handle all certifications in parallel.
The prior auth routing includes procedure type, patient insurance, and clinical urgency. Staff can triage urgent procedures and follow up with insurers knowing the full picture.
Referrals from referring physicians are verified at intake and routed to staff. No separate 'call the referral line' step later.
Prior authorization requests captured at intake
Insurance verification and pre-certification needs identified on the first call
Routed to billing with full clinical context
Procedure type, patient urgency, and insurance details passed to staff immediately
Patient receives authorization status or timeline on the call
No voicemail callbacks for insurance questions
Imaging pre-certification included in workflow
MRI, CT, and other imaging certifications handled alongside procedure authorization
Referral verification automated
Incoming referrals from referring physicians verified at call time
The AI asks about the procedure type, patient's insurance plan, and any imaging or testing already done. Based on the procedure and payer, it identifies standard pre-cert requirements and asks targeted questions. This logic is configured to your common procedures and insurers.
The AI captures the plan details (carrier name, member ID, group number) and returns them to billing. Staff verify coverage and authorization requirements, then contact the patient with a timeline. The next call, that carrier is in the system for faster routing.
If the authorization is already approved and in your system, the AI can confirm it on the call. If it's pending or needs to be submitted, the AI tells the patient the expected timeline and routes the request to billing immediately. Staff follow up when approval is confirmed.
The prior auth request and insurance details are captured by AI and returned as a structured summary for staff to review and file. Appointment bookings and new patient demographics sync to your EMR; prior auth tracking is managed in your billing system.
The AI captures the denial reason when it's communicated to your office. This is routed to billing and clinical staff. The patient is contacted with the denial reason and next steps (appeal, alternative procedure, out-of-pocket options) on a timeline you set.
Workflow
Patient intake
Insurance verification and clinical history captured together in structured intake.
Business Impact
The cost of missed calls
Missed insurance calls and prior auth delays result in lost procedure volume.
Governance
HIPAA and compliance
Prior auth data handling and insurance verification comply with all privacy rules.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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