Workflow
Prior authorization is a pain clinic workflow blocker. Patients book procedures, but pre-auth requests lag. AI reception can field payer questions, log authorization requirements, and queue them for your billing staff to resolve.
When a patient books a pain procedure, the AI asks what pre-authorizations they know are needed and confirms insurance info. Your billing team walks in to a queue of pre-auth tasks already sorted by procedure type and payer, not a pile of voicemails to sort.
If a payer calls asking about a patient's procedure, imaging, or prior treatments, the AI captures the information and routes it to billing as a structured task. Your staff isn't on hold with an automated payer system; they review a summary and callback number.
Carrier, member ID, group number, and policy type are captured during the call and presented as a structured summary. Your staff reviews, confirms accuracy, and enters verified information into your EHR—no manual phone tag or patient callbacks for verification.
An alert fires 48 hours before a scheduled procedure if pre-auth is still pending. Your provider knows whether they're doing the procedure as planned, need to delay pending approval, or should discuss alternative options with the patient.
Pre-auth requirements captured
Payer name, procedure code, medical necessity criteria, and imaging requirements logged
Insurance data structured for review
Member ID, group number, and carrier info captured and presented as EMR-pasteable summary for staff verification
Payer calls tracked
Insurance verification inquiries logged and routed to billing with context
The AI is configured with common pre-auth requirements by procedure and major payers. During booking, it asks: 'Does your insurance require pre-authorization for [procedure type]?' If the patient is unsure, your billing staff can call the payer. The AI logs the answer and adds it to your pre-auth queue.
The AI captures the payer's name, the patient they're calling about, and their specific question (imaging requirements, prior conservative treatment documentation, etc.). Your billing or clinical staff gets a summary and can call the payer back with the relevant clinical or records information.
The AI captures what the patient provides and flags any discrepancies for staff review. If the member ID doesn't match your record, staff follow up before the appointment to confirm current coverage and avoid claim denials.
Yes. Pain procedures that are time-sensitive (acute radiculopathy, failed conservative therapy, urgent pain exacerbation) are flagged for expedited pre-auth. Your billing team knows to call the payer same-day for these approvals rather than waiting for standard turnaround.
Yes. A pre-visit summary is generated for each scheduled pain procedure showing pre-auth status (approved, pending, denied), payer case number, any conditions the payer imposed (prior imaging required, specific provider credentials, etc.), and next steps for the clinical team.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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