Advantages of AI-Powered Automated Phone Systems Over Traditional IVR in Managing Healthcare Benefits Verification and Prior Authorization Processes

IVR is a technology that talks to callers using pre-recorded or computer-made audio menus. It works fine for simple questions but struggles with complicated healthcare tasks. Benefits verification and prior authorization involve many details like patient eligibility, plan coverage, drug lists, authorization needs, and appeal options.

IVRs use fixed menus that make users pick options step-by-step. This often confuses callers or sends them to the wrong place. Calls take longer and this frustrates both staff and patients. Also, IVRs cannot carry on real conversations or change based on different payer rules and policies.

Data shows more than 90% of healthcare calls between providers and payers in the U.S., about 3.2 billion every year, are still done by people on the phone. Staff spend a lot of time on these calls: doctors nearly 28 hours per week on paperwork tasks and office workers up to 36 hours weekly on phone calls. This is inefficient and costly, with prior authorizations delaying treatments nearly 94% of the time.

AI-Powered Automated Phone Systems: How They Differ From IVR

AI-powered phone systems use smart technology like natural language processing (NLP) and machine learning to talk with payers like humans do. Unlike traditional IVR menus, AI agents understand spoken questions and reply with useful answers.

These AI systems handle complex jobs such as checking eligibility, benefit coverage, prior authorization, appeals, and prescription help by themselves. For example, Infinitus uses AI agents to manage calls about pharmacy benefits and authorization status for over 100 million healthcare minutes. VoiceCare AI’s agent “Joy” can stay on calls up to two and a half hours, dealing with different people and IVR menus in one call.

AI agents connect with healthcare IT systems like Salesforce Health Cloud and Life Sciences Cloud. This connection lets providers see updated information quickly without typing it all in by hand. It helps reduce mistakes and speeds up work.

Specific Advantages of AI Phone Agents Over Traditional IVRs

1. Improved Call Efficiency and Reduced Hold Times

AI systems like Infinitus’ FastTrack™ let users skip long IVR menus and long on-hold wait times by connecting directly with payer systems using AI. This cuts waiting and helps staff get information faster, so they can help more patients.

Traditional IVRs cause delays because callers have to pick many menu options and wait for human help. AI agents handle all the steps in one call without making users wait or repeat their information.

2. Handling Complex and Extended Calls

AI agents can manage long conversations that involve talking to many people on the payer side. IVRs cannot do this. VoiceCare AI tested this at Mayo Clinic, where their AI agent helped with authorization and benefit checks in specialized areas like neurology and pediatrics.

The AI agent can stay in calls for hours, follow transfers, and remember the whole conversation. This cuts down the need for human staff to take over tough jobs.

3. Real-Time Updates and Integration with Existing Systems

AI systems automatically update benefit and authorization data in electronic health records (EHR) and practice management software using APIs. Infinitus AI agents, for example, add info to Salesforce platforms almost right away. This gives staff quick access to patient benefit and authorization status.

This reduces entering the same data twice, errors, and extra follow-up work that slows treatment and adds delays.

4. Accuracy and Compliance

AI voice agents use multiple AI techniques and human oversight to keep data accurate and follow healthcare rules like HIPAA.

Unlike IVRs with fixed scripts, AI agents learn from new information and update how they respond. This helps avoid errors, missing details, or using outdated data that could delay or block treatment approval.

5. Reducing Staff Burnout and Administrative Costs

AI takes over the many routine phone tasks, letting healthcare workers focus more on patient care. This can improve job satisfaction and work quality.

Healthcare administration costs about $1 trillion in the U.S. each year. Staff spend many hours a week on phone tasks. Automating these calls can save money and improve productivity.

For example, NexAuth cuts prior authorization decision times by up to 40% and lowers costs by about 30%.

AI and Workflow Automations: Enhancing Operational Efficiency in Medical Practices

AI automation helps with benefits verification and prior authorization workflows. These usually need many manual steps like calling payers, recording authorization info, updating records, and following up.

AI automates this by:

• Starting and finishing calls automatically, checking coverage or authorization without staff helping.
• Handling calls dynamically, navigating payer IVRs, talking to many people, and adjusting as conversations change.
• Sending call data like approval status, denial reasons, appeal advice, and drug coverage straight into provider systems to avoid manual mistakes and delays.
• Learning continuously from billions of healthcare calls to stay updated on payer rules and healthcare laws.

Medical practices can use AI automation to reduce delays, improve scheduling, and make workflows smoother. IT managers look for easy integration with existing tech, security compliance like HIPAA and SOC 2 Type II, and minimal disruptions.

By automating time-consuming calls, healthcare groups can lower patient appointment cancellations and raise patient satisfaction.

Industry Examples Demonstrating AI Advantages

• Infinitus Systems handles over 100 million healthcare call minutes. Their AI works with Salesforce Health Cloud and Life Sciences Cloud to automate calls about medical and pharmacy benefits, prior authorizations, and appeals. Their FastTrack™ tech cuts patient wait times and avoids IVR menus.

• VoiceCare AI created the agent “Joy,” which manages long, complex provider-payer calls on its own. Mayo Clinic pilots showed it helps in special departments. Their AI uses generative AI and reinforcement learning to finish calls accurately and efficiently.

• Simbo AI offers automated calls for hard prior authorization tasks. Their system reduces manual work and cuts treatment delays. Their software connects through APIs to give nearly real-time authorization info and better communication between providers and payers.

Addressing the Unique Needs of U.S. Healthcare Medical Practices

The U.S. healthcare system has a big problem with too much administrative work. Practices that handle many benefit verification and prior authorization calls every day find AI phone agents helpful. These agents ease frustrations with long waits, repeated calls, and broken workflows.

Mobile and cloud-based AI agents work with popular EHRs and patient management systems many U.S. practices use. This makes it easier to switch to AI. Cutting manual work and mistakes helps lower appointment cancellations and treatment delays, which is important for good patient care.

Also, AI systems are scalable. Small practices with fewer staff can use automation tools that were once only for big healthcare groups.

Summary of Key Takeaways for Medical Practice Administrators and IT Managers

• AI automated phone systems work better than traditional IVRs. They are more efficient, accurate, and flexible.
• They reduce administrative work by automating complex calls for benefits verification and prior authorization.
• AI connects with EHRs and practice management systems for smooth data updates in near real time.
• Automation cuts staff burnout, lowers costs, and helps speed up patient treatments.
• AI systems follow healthcare privacy and security rules to protect patient information.
• Practices of all sizes in the U.S. can use these systems to improve workflow and productivity.

Medical practice administrators, owners, and IT managers in the U.S. looking to improve healthcare billing and administrative efficiency should consider AI-powered automated phone systems. These systems fix many problems of traditional IVRs and manual calls. They help reduce worker strain, cut costs, and shorten patient treatment delays in the complex healthcare system. Advances in AI and good integration make these systems a useful choice for today’s healthcare providers.