Workflow

Reduce staff time on insurance callbacks and prior authorization management

Pain clinics spend hours on hold with insurance companies and follow-up calls. AI-powered prior auth workflows capture authorization requests, route insurance status updates to staff, and remove routine callbacks from the front desk.

Capture prior authorization requests from patient calls and route to staff with full context
Insurance status update callbacks handled after hours without staff involvement
Refill authorization requests logged and queued for provider review
Patient notified of approval or denial status via SMS or phone callback
Prior auth history and insurance notes captured in structured summary for your staff to file into the patient chart
Reduce callback queue and let staff focus on urgent authorizations

How it pays back

Insurance holds don't block scheduling

When a prior auth is pending, the AI captures the request and flags it. Your staff prioritizes the insurance call; patient can still book a conditional appointment that confirms once auth arrives.

Routine status update calls don't tie up staff

Insurance carriers often call back with approval or denial status. The AI can take these calls after hours and route the information to your staff inbox with full context.

Patients hear back about their authorization quickly

Once insurance approves, the patient is notified via SMS or phone. No more patients calling to ask 'Is my injection approved yet?'

Prior auth becomes a trackable workflow, not a mystery

Every prior auth request, status update, and provider signature is logged in one place. Your compliance and revenue cycle teams can see exactly where each auth stands.

Prior auth requests captured

Full context logged and routed to staff for rapid insurance follow-up

Insurance callbacks handled

After-hours status updates routed without staff intervention

Patient authorization status tracked

Approval/denial notification sent automatically via SMS or callback

Staff time freed

Routine authorization callbacks automated, freeing staff for complex cases

Frequently asked questions

How does the AI request a prior authorization from insurance?

The AI captures the patient's request to schedule a procedure, checks your EMR for insurance carrier, and logs the prior auth request with full clinical detail (procedure type, patient history, clinical justification). Your staff then contacts the insurance company with all information compiled. The AI doesn't contact insurance directly; it ensures your team has everything ready to make the call.

What if insurance calls back with a denial or requirement for additional information?

The AI logs the insurance callback (if it comes after hours or on a weekend), captures the reason for denial, and alerts your staff with the details. Your provider can then review and either rebut or suggest an alternative procedure.

Can the AI notify the patient when their prior auth is approved?

Yes. Once your staff updates the authorization status in the EMR, MedReception can send an SMS or make a phone notification to the patient confirming approval and next steps.

What if a patient needs a refill authorization—how does that work?

Refill requests are captured on patient calls and routed to your staff with a flag for provider review. Your provider approves or denies the refill, and the AI (or staff) notifies the patient. Routine refills can be approved by staff standing orders; complex cases are escalated to the provider.

Does prior auth history sync to my EMR?

Prior auth requests, approval dates, denial reasons, and insurance notes are captured in MedReception and returned as a structured summary your staff files into the patient's chart. This creates a complete audit trail.