Patient referral form for Michael Thompson with orthopedic rehab instructions, physician Dr. Sarah Chen, and BlueCross BlueShield insurance details including MRI pre-authorization steps.

Automate eligibility verification and prior auth across 1500+ payers

95% reduction in verification time
80% lower processing costs
8x more verification per hour

Unified automation for all payer-facing tasks

Susan, our bespoke AI agent, handles all manual tasks for your insurance discovery and eligibility needs.

BlueCross BlueShield insurance card showing name Kevin Paulsen and insurance ID 272819183733 with a green button indicating coverage verified.

STEP 1

Patient Coverage Check

Susan starts by checking if insurance information is present in the patient's records, including member ID & provider details. If any crucial information is missing, Susan automatically notifies the intake team.

List titled 'Applicable insurance' showing Medicaid, Medicare, BCBS with red exclamation marks, and Premera Blue Cross with a green checkmark.

STEP 2

Insurance Discovery

When member ID isn't available, Susan automatically searches across insurance databases to find active coverage. Sam checks multiple sources including Medicare and Medicaid to ensure no coverage is missed.

Error message stating 'Insurance coverage will expire before the service' above a call status showing Susan calling Michael Thompson.

STEP 3

Real-time Eligibility Verification

Susan verifies insurance coverage in real-time, checking if the specific services are covered under the patient's plan. This includes confirming the provider network status and service type coverage.

Health insurance card for Sophia Parker from Premera Blue Cross with insurer BCBS, valid until 10-04-2026, requiring a 20% co-pay.

STEP 4

Benefits Summary

Susan generates a comprehensive benefits summary showing copays, deductibles, out-of-pocket maximums, and covered services. If multiple insurance policies are found, Sam flags this for proper coordination of benefits