Workflow
Prior auth calls from insurers and patient insurance verification calls are answered by AI, documented, and flagged for your insurance staff. Procedures stay on schedule; authorization holds don't create patient cancellations.
By MedReception AI, physician-built by Paul Toomey, MDPublished
Patient calls day before procedure: 'Did insurance approve my injection?' AI checks your EMR for auth status, tells patient 'pending' or 'approved,' and flags your insurance coordinator if pending. Staff has a full day to chase authorization, not an hours-before-procedure panic.
Instead of live staff calling insurers one by one, AI documents all incoming prior auth requests and patient insurance calls. Staff batches these into organized callback lists, calls insurers in bulk, and closes multiple authorizations per call. Hold times vanish.
Prior auth gaps are surfaced days early, not found morning-of-procedure. Staff has time to secure authorization or discuss with patient and provider. Cancellations due to auth drop; patient satisfaction improves.
One AI line handles insurance verifications, prior auth questions, and authorization status inquiries from patients and insurers. All communication is logged and available to your insurance team in one inbox. No scattered voicemail, no lost requests.
Insurance calls answered live
Verification and prior auth questions handled without transferring to staff
Prior auth data structured and logged
Incoming requests and patient inquiries consolidated in one documented list for staff
Authorization status checked in real time
AI pulls EMR data to answer patient prior auth questions; patient doesn't wait for callback
Urgent requests flagged
Same-week and same-day procedures flagged for immediate staff follow-up
No. The AI checks your EMR for cached authorization status (if you've already received approval). For real-time status checks, the AI documents the patient's request and insurance info; your insurance coordinator calls the insurer and provides an answer. All inquiries are logged so staff can batch calls.
The AI explains that authorization is pending and offers to transfer the patient to your insurance coordinator immediately, or notes the patient's contact info and priority level. Your insurance team calls back with status the same day.
The AI asks for the procedure type, patient name, insurance claim number, and what documentation is needed. This information is logged in your patient portal as a structured summary for staff review. Your insurance coordinator receives a notification and responds to the insurer with the required documents.
No. Prior auth requests must be submitted by the practice, usually by your insurance coordinator. The AI captures incoming authorization requests and routes them to your staff. Your staff submits authorization to the insurer using your existing process.
The AI flags the patient's call as urgent. Your insurance coordinator is notified and prioritizes that authorization. If approval is unlikely, your coordinator can discuss alternative timing or procedures with the patient and provider.
Yes. The AI pulls authorization status from your EMR (if stored there) and logs all incoming prior auth inquiries as structured summaries in your patient portal for staff review and action. Your insurance staff reviews and closes these requests in your existing system.
Next step
Workflow playbooks
Step-by-step workflows for the calls a practice actually gets.
Next step
How appointments get booked on the call
Booking, rescheduling and calendar rules the receptionist applies on every call.
Next step
Pain management practices
How call handling differs for pain management practices.
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See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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