Specialty Care

Capture prior-authorization and prescription refill requests on the call: zero patient callbacks, staff handles auth with full context

CGRP inhibitors, triptans, and preventive migraine treatments often require prior authorization. AI reception captures refill and auth requests with patient consent and full clinical context during the call—eliminating patient callbacks and giving your staff complete information for rapid authorization.

Patient calls requesting a refill or prior auth; AI captures medication name, indication, current insurance, and patient consent on the call
All prior-auth details (medication, dose, indication, patient and provider demographics) returned as structured summary for authorization staff to review and file
Insurance information captured during call and handed to staff; no data loss between call and authorization workflow
Refill requests routed to provider with full patient history and current medication list pulled from EMR
Patient never called back to confirm insurance or provide details already captured on intake call
Appointments for follow-up visits and medication reviews booked during the same call

How it pays back

Prior auth processed in one call contact

Patient calls, provides medication and insurance details, and consent is captured on the call. Your authorization staff receives a complete request with all required information—no need to reach back out to the patient for insurance details or clinical history.

Zero patient callbacks for missing information

All prior-auth and refill data is collected during the initial call: medication name, dose, indication, insurance type and group number, and patient signature/consent. Your staff can begin the authorization workflow immediately without follow-up calls.

Authorization staff has full clinical context

The structured summary includes patient's prior responses to treatments, current regimen, and indication for the requested medication. Your authorization team can defend the request to the insurance company with complete clinical reasoning, not fragments.

Faster turnaround on prior-auth approvals

By eliminating one call loop (patient callback for missing info), your authorization staff can submit requests to insurance sooner. Complete requests process faster than incomplete ones.

Insurance and authorization details captured in one call

Patient provides consent and all required info during initial intake; no follow-up call needed

Structured prior-auth request returned to staff

Medication, dose, indication, insurance, and clinical context packaged for authorization workflow

Clinical history linked to every auth request

Patient's prior migraine treatments and current regimen pulled from EMR and included in summary for staff review

Patient consent and compliance audit trail

Every prior-auth call logged with patient consent and timestamp for compliance and insurance follow-up

Frequently asked questions

How does the AI capture insurance information during the call?

The AI asks for insurance carrier, member ID, group number, and patient date of birth. This information is captured on the call and returned to your staff in the structured summary. Insurance details are handed to your authorization team for processing and filed per your compliance policy.

What if a patient's insurance has changed since their last visit?

The AI asks for current insurance at the start of every call. If a change is detected, the new information is captured and flagged for your staff to update the patient record before submitting the prior-auth request. This prevents claim denials due to outdated insurance information.

Can the AI handle refill requests for multiple medications?

Yes. If a patient requests multiple refills or prior auths, the AI captures all of them on a single call—medication names, doses, indications, and consent for each. Your provider and authorization staff receive a complete summary and can batch-process the requests.

How is patient consent documented for prior-auth requests?

The AI confirms patient intent and consent verbally during the call ("I'm requesting a prior authorization for [medication] with your permission"), and the call recording captures this. The structured summary includes a consent flag and call timestamp. This satisfies HIPAA requirements for verbal authorization.

What happens if the insurance company denies the prior auth?

Your authorization staff manages the denial as usual. Because the initial request included full clinical context and patient history from the call, staff can respond to denials with the complete justification. In many cases, the first request has all the information needed to support an appeal.

Do refill requests go straight to the provider or to your staff first?

Refill requests are routed based on your clinic's workflow. Most practices send them to the provider with a summary of current medications and patient history. The AI call captures the refill request and patient consent; your provider approves or denies the refill and your staff handles the pharmacy notification.