Workflow

Capture prior auth requests on intake calls and route to billing without administrative bottlenecks

Insurance approval delays block procedure scheduling. MedReception AI asks about coverage and prior auth needs during intake, flags payer-specific requirements, and routes to your billing team—so approvals are tracked from day one.

How it pays back

Authorization requests queued immediately after intake

Billing team doesn't wait for appointment confirmation to start prior auth. They have complete intake data and payer details on the same day the call comes in.

High-risk payers flagged automatically

Callers with workers' comp or Medicare Advantage plans trigger a workflow alert so billing prioritizes their authorization. No surprises the day before surgery.

Insurance details never lost in transition

Payer name, member ID, plan type, and special requirements are captured once during intake and passed to billing, scheduling, and clinical staff. No re-verification needed.

Compliance documentation for denial appeals

Structured intake shows exactly when authorization was requested, what was asked, and when it was documented. Supports appeal letters and regulatory inquiries.

Insurance details captured on first contact

Payer name, member ID, plan type, and authorization requirements collected during intake call

Prior auth routed to billing queue

Authorization requests sent to billing team with complete intake summary for immediate payer contact

High-risk payers auto-flagged

Workers' comp and Medicare Advantage plans trigger workflow alerts for billing priority

Structured summary for staff review

Insurance details and authorization flags returned for clinical and scheduling team coordination

Frequently asked questions

Does the AI ask about insurance on every call?

The AI asks about insurance coverage and prior auth needs during new patient intake and pre-procedure calls. For established patients with known coverage, the question is skipped unless a procedure or plan change is noted.

What happens if a caller doesn't have their insurance card?

The AI captures the caller's name, date of birth, and any plan information they remember. This is returned to billing as a partial summary, and your team follows up for complete details before contacting the payer.

Can the AI contact the insurance company directly for prior auth?

No. The AI captures all required information and routes it to your billing team, who contact the payer. This ensures compliance with your payer agreements and maintains relationship continuity with insurers.

How does the system handle workers' comp claims?

The AI identifies workers' comp claims during intake and flags them for immediate routing to your billing team. Workers' comp often has unique authorization timelines and requirements, so early flagging prevents procedure delays.

Is the insurance information stored in the EMR?

Insurance details are captured during the call and returned as a structured summary for your staff to review and file. Your staff enters insurance into your practice management system; the AI does not write insurance data directly to the EMR to maintain data integrity and compliance.

Related reading

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Prior Authorization Tracking for Interventional Pain Procedures | Medreception AI