Administrative Workflows

Elevate the patient experience.

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Eligibility and Benefits

$7.5 Billion in Potential Savings Annually for the Medical and Dental Industries Combined.

Prior Authorization

$417 Million in Potential Savings Annually for the Medical Industry

Claim Status Inquiry

$3.1 Billion in Potential Savings Annually for the Medical and Dental Industries Combined

Eligibility and Benefit Verification

Save time & reduce denials

A patient’s eligibility and benefits can change at any moment. Lack of follow up with insurance carriers prior to seeing a patient could lead to an increase in claim denials and a significant loss of revenue. Maintaining a consistent and accurate verification process is essential to maintaining a healthy revenue cycle. Our eligibility and benefit verification digital humans routinely follow up with the insurance carriers to ensure that patient information is up to date and accurate at the time of the visit.

Digital assistant verifies a wide range of data:

  • Effective date and coverage details
  • Individual patient eligibility
  • Type of plan
  • Payable benefits
  • Non-covered procedures
  • Co-pay
  • Deductibles
  • Co-insurance
  • Claims mailing address
  • Referrals 
  • Pre-existing clause
  • Max-daily benefits
  • Lifetime maximum
  • Other related information

Prior Authorization

Prior authorizations are a key pain point for healthcare providers as they work to best serve their patients and provide them the services they need, in a reasonable timeframe, to improve care outcomes. Often, before a procedure or new clinician referral can occur, a prior authorization needs to occur to ensure insurance coverage. These can be lengthy, fraught with one-off errors, and lead to frustration for a patient or member, provider, and healthcare payer alike, not to mention adversely affecting patient care.

This particular use case automates the prior authorization process for more immediate authorizations, leading to better outcomes and increased satisfaction for patients, providers, and payers.

Conversational Interface

Our virtual health agents help patients resolve issues conversationally with no need to navigate through complex phone menus.

healthcare Compliant

Call ai is fully compliant with HIPAA regulations to safeguard PHI and ensure patient privacy. Compliant with HITECH, GDPR, PCI and more.

EHR integration

Call ai integrates with all major EHR systems, in addition to your existing contact center infrastructure, to deliver an effortless patient experience.

Automate IVR Traversing

The sky is the limit. Our Virtual Agents are designed to mimic live agent functionality, no matter how complicated the task.

Claim Status Inquiry

Improve profitability and cash flow for healthcare providers.

Claim status inquiry automation presents a major opportunity for providers and payers to save money. Despite growing adoption and support for automated claim status inquiries, the per-transaction savings opportunity is among the highest reported for claims management processes. The industry could save an average of $9.22 per claim status inquiry by doing away with manual processes.

Instead of taking up valuable staff time, bots can now call up payor’s phone lines a couple of days after providers sends a claim and they run claim status checks on all claims. Once the bots identify if a claim is received, paid, pending, or denied, they send the status back to providers’s EHR system where a workflow can be triggered if the account needs additional work.

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