Prior authorization is a process where healthcare providers must get approval from insurance companies before giving certain medical treatments or medicines. This process makes sure the treatment fits with insurance rules and controls costs. But prior authorization causes some problems:
The American Medical Association found that nearly one in four doctors in the U.S. reported serious patient problems caused by delays in prior authorization. This shows how important it is to process authorizations on time.
Voice AI agents are software programs that can make calls on their own to insurance companies. They talk like humans to get information about the status of prior authorizations and related issues. One example is the Infinitus voice AI system. It can check if requests were submitted, approved, or denied, and even get reasons for denials. When there are denials, these AI agents find instructions for appeals, helping the patient support team handle cases faster.
Key features of voice AI agents in prior authorization follow-ups include:
Aparna Sridhar Murthy, product lead at Infinitus, says these AI agents lower both the time and mental stress in prior authorization follow-ups. Automated calls stop healthcare teams from staying on hold or calling many times, which helps workers be more productive and makes fewer errors.
Medical office managers and IT staff in the U.S. are under pressure to work more efficiently while dealing with tight budgets and fewer workers. Voice AI tools like those from Infinitus offer clear benefits in this situation.
Prior authorization is just one part of healthcare admin work that AI can help with. Voice AI works well with other automation strategies to support healthcare providers in many ways.
Agentic AI is an advanced type that can make decisions on its own beyond simple tasks. These AI agents remember past actions, connect with various data systems, and handle complicated workflows without human help. This helps with multi-step processes like prior authorization follow-ups, appeals, and drug exceptions. Raheel Retiwalla, Chief Strategy Officer at Productive Edge, says Agentic AI can cut manual review time by 40% while managing care and admin work at the same time.
Many clinics use EHR systems like Epic or athenahealth. AI built into these systems makes picking insurance, sending claims, managing denials, and handling authorizations easier. For example, athenahealth’s AI tools have cut prior authorization time by 45% and improved claim accuracy with a 98.4% clean claims rate.
Voice AI often works with chatbots, text messaging, and other electronic tools to help reach patients and check with insurers. Collectly’s AI voice agent Billie solves 85% of billing questions on its own, anytime, which helps patient communication and money flow.
The U.S. healthcare system faces rising costs, not enough qualified staff, and tougher insurance rules. These cause delays in payments, staff burnout, and lower quality care.
Voice AI agents help in several ways:
Healthcare administrators and IT teams planning to use voice AI agents for prior authorization should consider some key steps:
Voice AI agents that handle prior authorization follow-up calls help medical office managers and IT staff in the U.S. reduce administrative work and improve how healthcare providers operate. These AI tools speed up the authorization process, support managing revenue cycles, and help keep patient care steady. As healthcare faces growing pressures from costs and complex rules, voice AI agents offer a practical way to improve administrative tasks and let healthcare teams spend more time on patient care.
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.
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