Workflow
Prior authorization delays block pain clinic schedules. AI captures insurance, diagnosis, imaging, and prior treatment history on intake calls. Staff receive structured summaries to submit to payers immediately, without re-calling patients.
All required insurance and clinical data is captured on the initial call. Staff review the structured summary and submit to the payer the same day or next morning, not after manual phone tag with the patient.
Patient provides insurance and clinical history once, on the booking call. Staff use the AI-captured summary throughout the patient journey—no front desk re-verification calls.
The AI knows common prior auth rules: 'This payer requires X-ray before epidural' or 'Diagnosis code requires specialist referral.' If missing data is detected during the call, AI can ask for it immediately instead of staff discovering the gap after submitting to insurance.
Complete, accurate data on the first submission reduces back-and-forth with payers. Staff spend less time chasing missing documentation.
Insurance data captured on call
Carrier, member ID, group number, phone number, and plan type all collected during intake
Clinical history for prior auth
Diagnosis, pain duration, imaging dates and location, prior treatments, and referral source logged in structured format
Medication and allergy history gathered
Contraindications and medication interactions noted in structured summary for provider review before procedure approval
Payer-specific rules recognized
Common prior auth requirements (imaging prerequisites, specialist referral, diagnosis code rules) flagged during intake
Carrier name, member ID, group number, plan type (PPO, HMO, HDHP), insurance phone number, and subscriber relationship. This is returned in a structured summary for your insurance verification staff to confirm against your contracted payers.
The system can be trained on common rules by payer—for example, 'Blue Cross requires imaging before epidural' or 'Aetna requires specialist referral for sacroiliac joint injection.' When these rules are met, the AI flags the intake as complete. If missing, it notes the gap for staff to address before submission.
Diagnosis or chief complaint, pain duration and location, severity level, prior imaging (MRI/CT/X-ray dates), prior pain treatments or injections, current medications, and referring provider or specialist name. All structured and returned as a summary ready for your prior auth forms.
No. The AI captures and structures the data. Your staff or billing team submit the prior auth to the payer using your insurance portal, clearinghouse, or phone. The AI-structured summary reduces time spent gathering information from the patient.
If a patient calls to update insurance before their appointment, the AI captures the new information and flags the appointment for billing staff to verify and re-file prior auth if needed. Your billing team manages the payer contact.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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