Workflow
Prior authorization holds up procedure scheduling for weeks. Capture insurance details, procedure history, and clinical justification on the first call—deliver structured summaries to your billing team so pre-auth submissions are accurate and complete.
Insurance documentation is captured upfront. Your billing team receives a structured summary with all required clinical history and previous treatment attempts—no back-and-forth for missing data.
The AI captures insurance details. Your practice management system can check real-time eligibility flags. Patients understand coverage and prior authorization timelines before booking.
Complete pre-auth packages are submitted quickly, so approvals come back faster and your procedure schedule fills predictably.
No time wasted chasing patient callbacks for missing insurance info. Your billing staff focus on appeals, denial management, and payer relationship work.
Insurance intake structured upfront
Member ID, group number, prior authorizations, and eligibility captured on first call
Clinical history documented
Prior procedures, failed conservative treatment, imaging results, and pain severity recorded
Pre-auth packages complete
Billing team receives all required documentation without follow-up calls
Insurer requirements flagged
AI notes which payers commonly request imaging, appeals, or additional clinical notes
The AI is trained on common insurance pre-auth requirements for pain procedures—epidural injections, radiofrequency ablation, spinal cord stimulation placement, etc. It captures standard fields and flags when a patient mentions a specific payer so your team can reference payer-specific rules.
The AI captures the insurance details and eligibility questions during the call. Your practice management system can display real-time eligibility in your back office. Your team verifies and notifies the patient.
The AI captures the patient's name, date of birth, employer or insurance company name, and asks them to check their insurance card or policy. It logs a note for your staff to follow up and retrieve the full details before submitting pre-auth.
The AI asks targeted questions: 'Have you had a prior epidural injection?' 'What did the MRI show?' 'Was there a trial spinal cord stimulator?' It documents the patient's answers and flags if imaging reports or previous procedure notes should be retrieved from outside systems.
The AI is trained on common denial reasons—missing prior conservative treatment documentation, imaging that doesn't support medical necessity, or procedure frequency limits. It prompts patients to discuss failed prior treatments so your team can build a stronger pre-auth narrative.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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