Medication Calls

Capture Prior Auth and Formulary Calls Without a Runaround

The pharmacy rejected it, the plan wants a different drug, the patient is out. Capture plan, drug, pharmacy and days left so your PA queue can act.

Three callers describe the same problem three different ways: the pharmacy said it needs prior auth, the plan wants something else tried first, or the copay jumped to a number the patient will not pay
Captures what a prior authorization actually needs to move: exact drug and strength, the plan and member identifier, the pharmacy and location, the prescriber, and whether a previous request was already submitted
Asks how many days of supply are left, which is what sets queue order in most practices and is the single field a handwritten phone message almost never contains
Handles the pharmacy's own call and the plan's callback on the same main line, routing both to your prior authorization staff instead of into the general message pool
Never states whether a drug is covered, what a copay will be, whether an appeal will succeed, or how long a determination will take beyond timelines your practice or the plan already publishes
For Medicare Part D, the published process is that a plan decides a standard coverage determination within 72 hours and an expedited request within 24 hours, with the clock starting once the plan has the prescriber's supporting statement

How it pays back

These Calls Do Not Belong in the General Queue

A prior authorization call is long, detail-heavy and easy to get wrong, and it arrives in the same minute as a scheduling call. Routing it to the staff member who owns authorizations, with the plan, drug and pharmacy already captured, is the difference between one call and four.

The Patient Hears What Happens Next, Not a Guess

Front desks under pressure invent timelines. The system quotes only what your practice publishes and what the plan itself states, and tells the patient who will follow up. It never predicts an approval, a denial, a copay or a date, because a wrong promise turns into an angry second call.

Pharmacy and Plan Callers Get Their Own Path

A pharmacy technician calling about a rejection and a plan representative returning a call are not patients, and treating them as patients wastes both sides' time. Your rules route them directly, with the patient and drug identified before anyone picks up.

Volume Without Hold Time

Formulary changes land in batches, especially at the turn of a plan year, and every affected patient calls in the same two weeks. Every line answers at once, so the surge does not close your phones to everything else the practice does that day.

Unlimited concurrent calls

Plan-year formulary change surges do not close the line to the rest of the practice

Under 1 second to answer

Pharmacy technicians and plan representatives are not put on hold behind patient calls

HIPAA BAA included

Plan identifiers and medication detail encrypted with AES-256 at rest and TLS in transit

Frequently asked questions

Does the AI submit the prior authorization?

No. It captures a complete, structured request and routes it to your authorization staff. Submission and any clinical justification stay with your team. Delivery into an existing queue is available through secure workflow automation, and custom integration is available where no direct interface exists.

Can it tell a patient whether a drug is covered?

No. It has no view of a patient's benefit and does not speculate. It records the question, notes what the pharmacy told the patient, and routes it. Quoting a coverage status or a copay that turns out to be wrong costs more calls than saying it will be checked.

What if the patient is completely out of medication?

Days of supply remaining is asked on every call and travels with the request, so your staff can order the queue the way your protocol says. The system applies your routing rules, it does not make a clinical judgement about how urgent the gap is.

Does it handle the pharmacy calling us?

Yes. Pharmacy callers are identified up front and routed to the destination your rules name, with the patient, drug and reason captured before the message is delivered. They no longer sit in the same hold queue as patients booking appointments.

How is this different from the refill workflow?

A refill is a request to send more of a prescription you already agree with. A prior authorization call is a payer problem attached to a prescription that has already been written, and it needs the plan, member identifier and rejection reason that a refill message never carries.

Can it repeat plan timelines to patients?

It can repeat published timelines, such as the Medicare Part D standard 72-hour and expedited 24-hour coverage determination windows, framed as the plan's process and not as a prediction about this request. It will not estimate a turnaround your practice has not published.

Bring this to your practice

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

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Prior Authorization Call Handling for Primary Care | Medreception AI