Workflow

AI receptionist captures prior-auth requests and routes them to the right staff member—no authorization slip goes lost

Prior authorization requests for interventional pain procedures arrive by phone, fax, and patient inquiry. AI reception identifies and routes auth requests to clinical staff, ensuring no procedure is delayed by a missing authorization.

Patient calls asking about procedure authorization status or to submit prior-auth request
AI captures procedure type, insurance, diagnosis code, and provider name from caller or patient chart
System logs prior-auth request with full context and routes to clinical staff workqueue
Staff receive prioritized list of pending auths sorted by procedure date
Callback is scheduled if patient needs status update or insurance approval is pending
Appointment remains on calendar; escalation alert fires if auth deadline approaches

How it pays back

Prior-auth requests are logged instantly, not buried in voicemail

A patient calls: 'I need prior auth for my injection next Tuesday.' The AI logs the request, identifies the insurance requirement, and immediately adds it to your clinical team's queue. Your provider doesn't discover a missing auth 15 minutes before the procedure is scheduled.

Insurance company calls are routed to the right person

Aetna calls asking for clinical notes to support an RFA auth. Instead of playing phone tag or asking an admin to take a message, the call is routed (or logged for immediate callback) to the provider or clinical coordinator who can provide notes. Authorization moves faster.

Recurring patients don't repeat auth requests

A patient has had two prior lumbar epidurals; the second one was already authorized. The system recognizes the pattern and flags whether the new auth is truly needed or if the existing auth can be extended. Unnecessary pre-auth calls are eliminated.

Procedure delays due to auth gaps are prevented

Your clinical team sees a real-time dashboard of scheduled procedures and their auth status. If an auth deadline is approaching, the system triggers a reminder. No surprise cancellations.

Prior-auth requests logged instantly

No voicemail, no missed requests; clinical team gets a prioritized worklist

Insurance company calls routed correctly

Inbound auth requests go to the clinician who can answer, not a voicemail inbox

Auth status visible to staff in real time

Clinical team sees which procedures have pending, approved, or expired authorizations

Patient callbacks scheduled automatically

If auth is delayed, patient gets a callback notification; no surprise cancellations

Frequently asked questions

How does the AI know which insurance requires prior authorization?

Your practice loads insurance requirements into the system (e.g., 'Medicare requires auth for RFA; Blue Cross requires auth for epidural injections'). When a procedure is booked or an auth request arrives, the system checks the list and flags required auths.

Can the AI submit prior authorization on behalf of the practice?

The AI captures the request and routes it to your clinical staff with full patient and insurance details. Your provider or clinical coordinator then submits the auth using your practice's portal, phone, or fax system. The AI does not submit auth directly.

What happens if insurance denies the prior authorization?

Your clinical staff is notified immediately. The system logs the denial reason and flags the patient's appointment. You can then contact the patient to discuss appeals, alternative procedures, or out-of-pocket options.

How long does prior authorization typically take?

That depends on your insurance contracts and procedures. The AI simply ensures requests are logged and routed on the day they arrive, and your team can track timelines. We recommend submitting auth requests as soon as the procedure is booked.

Can the AI handle multiple insurance for one patient?

Yes. If a patient has primary and secondary insurance, the system captures both and flags which authorization is required. Staff review and submit accordingly.

Bring this to your practice

See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.

Book a Demo Contact Us

Want the numbers first? See plans and pricing