Workflow
Insurance verification and prior authorization are common pain practice bottlenecks. The AI captures authorization requests and payer questions during intake, returns them as structured notes for staff review, and keeps your EHR clean.
When a patient calls about prior authorization, the AI gathers insurer details, member ID, group number, procedure requested, and payer-specific questions. This is returned as a clean summary—not buried in clinical notes or appointment fields. Your team reviews once and decides what goes where.
Insurance staff get a pre-populated summary: payer name, contact info, requirements, and the patient's stated medical necessity. They can call the payer with context already in hand. No forwarding the patient back to clinical staff; no rehashing the same questions.
A new patient calls and mentions their insurance may require pre-auth. The AI documents this on the call. The new patient record is created in your EHR with name, DOB, phone, and demographics. The prior auth question is captured in a structured summary for your insurance team to pursue offline.
Prior auth requests go into a tracked queue with payer contact info, member ID, and deadline noted. Your insurance staff can batch payer calls and avoid duplicate authorization requests. Follow-ups are logged and visible to the practice.
Prior auth captured
Insurance questions documented and summarized during intake
Chart stays clean
Insurance data handed to staff, not auto-written to EMR
New patients created instantly
Demographics synced while authorization questions are queued separately
Authorization tracked
Payer callbacks and deadlines flagged for follow-up
Prior authorization requests and insurance questions are captured as a structured intake note and returned to your team. Your insurance coordinator or administrative staff review the summary and decide what to file, call the payer on, or flag for the provider. This keeps the clinical chart focused on medical information and prevents insurance clutter.
The AI syncs name, date of birth, phone number, and basic demographics to the EMR for new patients. Insurance information (policy numbers, member IDs, payer details) is captured in the structured intake summary and handed to your staff to manage separately—not written to the patient record.
The AI can book a tentative appointment for after the expected authorization window. The booking note includes a flag: 'pending prior auth.' Your team confirms with the payer, then sends a final confirmation to the patient. Or, the AI can book a follow-up callback for your insurance team once auth is received.
Yes. You can configure payer-specific requirements (e.g., 'Aetna requires 72-hour notice for interventional procedures'). The AI mentions these requirements during intake so the patient knows what to expect, and your staff can prioritize accordingly.
When prior auth status is clear at booking (or flagged as pending), patients don't show up expecting to proceed, only to learn authorization was denied. The AI documents the status upfront, your team confirms authorization before the appointment, and cancellations are minimized.
Yes. If a patient calls with a prior auth question, the AI recognizes them via caller ID or name verification, pulls their record summary, and uses it as context for the new authorization request. This avoids re-collecting demographics and speeds the insurance conversation.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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