Workflow
Prior authorizations delay pain procedures and create administrative friction. An AI receptionist captures insurance details, procedure type, and clinical indication on the call—your billing team submits immediately, no phone tag.
Caller provides insurance and procedure details on the call. The AI structures it for your pre-cert team. They submit the same hour instead of waiting for a fax or message.
Your billing team gets the prior auth data same-day, submits it to the payer, and calls the patient with the result. If denied, there's time to appeal or reschedule before wasting a procedure slot.
Workers' comp, Medicare Advantage, Medicaid, and commercial plans all have different auth rules. The AI captures the payer ID and policy number; your team knows exactly what to do next.
Acute pain, post-injury nerve block, or cancer pain management can be flagged for priority pre-cert. Authorizations come back faster.
Insurance verified on the call
Active coverage and benefits confirmed before appointment booking
Prior auth request structured
Procedure type, indication, imaging status, and payer info formatted for your pre-cert team
Routed to billing immediately
Same-day submission to payer; no email ping-pong or lost messages
Patient notified of status
Approved, denied, or pending—patient knows before arriving for the procedure
No. The AI captures insurance information and procedure details on the call and structures them for your pre-cert team. Your staff submits the auth request to the payer via your normal channels (online portal, phone, fax).
The AI flags coverage gaps or known denials during the call. Your staff can contact the patient immediately to discuss alternatives, appeal, or reschedule. No surprises on procedure day.
Insurance details are captured during the call and returned as a structured summary for your staff to review. Your team enters insurance into your EMR and billing system. The data is not stored separately by the AI.
The AI captures the claims adjuster name, workers' comp carrier, and claim number. Your team submits the auth to the adjuster and manages appeals. The AI simply ensures no information is lost on the call.
Yes. If the AI detects urgent pain language or post-injury indication, it can flag the pre-cert request as expedited. Your team can then call the payer instead of submitting electronically for faster approval.
See how MedReception AI handles after-hours calls, scheduling, intake, and patient communication for medical practices like yours.
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