Workflow
Prior authorizations delay pain procedures. An AI receptionist captures insurance and clinical history during intake. Your admin team has complete prior auth packages ready before the patient arrives.
A patient calls to book a cervical epidural steroid injection. The AI captures insurance, asks about prior physical therapy or injections, and notes the supporting clinical data. Your admin team receives a structured summary and files authorization that afternoon. Procedure day is not delayed by authorization calls.
If a patient's plan excludes epidural injections or requires pre-procedure imaging, your team knows during the booking call. You can educate the patient on out-of-pocket costs or route to alternative procedures. No surprises on procedure day.
The AI captures prior treatments that support medical necessity: 'Failed conservative treatment for 3 months,' 'MRI shows herniated disc at L4-L5,' 'Pain interferes with work.' This evidence is returned in your prior auth summary for your team to review and file.
If you treat patients across Medicare, Medicaid, and commercial plans, the AI learns each plan's auth rules. It prompts for the right questions, flags high-risk denials, and routes authorizations to the correct internal workflow.
Insurance verified during the call
Coverage and auth requirements captured for your team to verify
Clinical history captured for medical necessity
Prior treatments, imaging, and failed conservative care logged for summary
Prior auth package ready before appointment
Insurance, clinical summary, and supporting documentation assembled for filing
Denial risk flagged upfront
Excluded procedures or coverage gaps identified during booking
No. The AI captures and organizes the data. Your administrative team or prior auth vendor submits the formal authorization request using your EMR or prior auth portal. The AI provides a clean, structured summary that speeds up submission.
The AI notes the missing documentation in the summary (e.g., 'Patient reports no recent MRI'). Your admin team flags the gap and either requests imaging from the patient or notifies the patient that authorization is pending additional clinical data. No surprises after the procedure is scheduled.
Yes. The AI is configured with rules for common payors and procedure types. It knows that epidural injections typically require auth but consultations do not. When a patient books, the AI alerts your team if authorization is likely required.
For self-pay patients, the AI verifies no insurance coverage and notes the patient as self-pay. Your scheduler can then discuss cost and payment options. For out-of-network patients, the AI captures their insurance information and routes to your billing team for rate negotiation or patient education.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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