Prior authorizations happen when healthcare providers ask insurance companies for approval before doing some services or giving certain medicines. This step helps control costs and make sure patients get proper care. But the process can take a long time. Sometimes insurance data is missing or wrong, and many requests get denied at first. Research shows more than 7% of prior authorization requests are denied at first and need appeals and follow-ups. These delays can make patients wait for needed treatments and cause problems for hospitals.
A survey by the American Medical Association found that about 25% of doctors have seen bad outcomes in patients because of delays caused by prior authorization. This shows how important it is for healthcare groups to handle prior authorizations more quickly and correctly.
Usually, following up on prior authorizations means calling insurance companies many times, using complicated websites that don’t always show full information, and writing lots of papers to support appeals. These tasks take up a lot of staff time, keep clinical workers away from patients, and raise operating costs.
Also, hospital departments have high staff turnover. For example, revenue cycle management departments often lose 30% of their workers every year. This makes it harder to handle follow-ups well because new staff have to learn everything again.
Voice AI technology uses smart computer programs that can make phone calls like humans. These programs talk with insurance companies to get or give information about insurance eligibility, prior authorization requests, appeals, and medication exceptions. The AI listens, asks questions, understands answers, and reports back to hospital teams.
For example, Simbo AI is a company that works on phone automation for hospitals. They offer AI answering services that focus on prior authorization and appeal calls.
Using AI to make repeated follow-up calls lowers the amount of time staff spend on administrative work. AI takes over the “checking-in” calls that are time-consuming and stressful. This lets hospital workers focus on harder tasks and caring for patients.
Front-office workers have shorter phone wait times, fewer manual jobs, and smoother work routines. Financially, hospitals lose less money from denied or late claims. They get payments quicker because authorizations happen faster.
Some pilot programs show that AI can save up to 70% of the time staff usually spend on insurance calls. Also, AI helps cut operating costs by nearly 80% in revenue management tasks and speeds up claim processing by about 95%. These changes help hospitals run better and give patients faster care.
Adding voice AI agents into hospital workflows needs a clear plan. This plan should include new technology, changes in processes, and staff training.
Voice AI agents should connect with hospital revenue management systems and electronic health records using built-in or custom links. This connection helps clinical, billing, and admin teams share information quickly and stay updated.
By automating prior authorization follow-ups, appeal checks, and medication exception tracking:
Hospitals with high staff turnover can keep operations steady by letting AI do repetitive calls. AI works all day and night, so delays from limited office hours go away. Machine learning helps AI get better over time by learning from past data. This improves how AI predicts next steps in authorizations and appeals.
For AI integration to work well, hospital leaders must support it and keep training staff. Workers need to understand that AI helps them, not replaces them. Staff should learn how to use AI data to make better decisions. Clear communication and feedback help AI tools match what clinical and admin teams need.
Data from studies show several benefits when hospitals use AI voice agents for insurance and appeals tasks:
Clinically, faster and reliable prior authorizations help avoid treatment delays and reduce risks for patients. This supports hospital goals to improve care quality and follow regulations.
Hospital leaders and IT managers can use these steps to add voice AI technology:
Why are voice AI agents suitable for prior authorization follow-ups?
Because insurer websites often lack full information, like reasons for denial or how to appeal, voice AI fills those gaps by calling insurers directly. This lowers manual follow-up work and makes responses faster.
How do voice AI agents support formulary exceptions?
They check with insurers on the status of requests to cover medicines not normally included. They also gather reasons for denials and explain how to appeal so patients can get needed drugs sooner.
What role do voice AI agents play when prior authorizations are denied?
They find out exactly why a denial happened and get detailed appeal instructions. This helps patient support teams respond quickly and correctly.
How does AI reduce operational costs?
By automating many manual calls and sending hard cases to human staff only when needed, AI cuts labor time and errors. This makes revenue processes smoother and speeds up payments.
Voice AI technology helps hospitals and medical offices in the U.S. by lowering the burden of tasks related to prior authorizations, appeals, and insurance checks. Using AI agents lets health systems manage these tasks faster and more accurately, which also benefits patients. Adding AI requires planning, staff involvement, and ongoing management, but the benefits in better workflow, cost reduction, and timely care offer real value for healthcare administrators.
Follow-up calls are a fit for voice AI agents because payor portals often provide incomplete information, such as a denial without reasons or appeal instructions. Voice AI agents can acquire a full picture by calling payors, reducing administrative burden and improving timeliness of necessary follow-ups.
Infinitus AI agents handle checking prior authorization submission status, decision status, formulary exception status, and appeals status by calling payors, retrieving detailed information including denial reasons and appeal processes, and following up periodically until resolution.
Timely follow-up prevents treatment delays for patients and avoids revenue loss for providers. Inefficient follow-up can lead to adverse patient outcomes, as noted by AMA findings that nearly 1 in 4 physicians have seen serious events caused by prior authorization delays.
By automating routine, repetitive follow-up calls to payors regarding prior authorization status and appeals, Infinitus agents free healthcare workers from manual calls and administrative tasks, allowing them to focus on higher-value patient care activities.
When denied, the AI agents can acquire the exact reason for denial and obtain detailed instructions on the appeals process, enabling patient support teams to act quickly and efficiently on next steps.
They contact payors or PBMs to understand and follow up on formulary exception requests, check approval status, retrieve denial reasons if applicable, and provide guidance on appeal options to streamline coverage for non-formulary drugs.
Appeals processes vary by payor and often require repeated status checks. Automating these follow-ups reduces administrative work, ensures consistent monitoring, and quickly identifies if further appeals are possible or if the process is resolved.
Variable turnaround times cause uncertainty and force staff to waste time on repeated calls to payors. AI agents schedule and automate these calls, ensuring timely updates while eliminating the inefficiency of manual status checks.
These AI agents absorb the time and financial costs associated with frequent payor check-ins, reducing overhead for pharmaceutical patient support teams and minimizing risks of delays caused by administrative hold-ups.
Providers can reach out to Infinitus to learn about their voice AI agent platform, enabling automated follow-ups on prior authorizations, appeals, and formulary exceptions, thus integrating AI-driven efficiency into their administrative workflows.
Simbo is using AI agents to automate all phone related workflows. Connect now to know more.
Schedule AI Agents Demo Now© Since 2019, Simbo AI.
