Payer-Facing AI Phone Calls
Payer-Facing AI Phone Calls includes products that enable AI-based interactions with payers over the phone. Generally, payer-facing companies will tend to be making outbound phone calls, but there may be some inbound-calling capabilities as well. Some of the common use cases for products in this category include:
Eligibility and verification of benefits
Prior authorization
Claims status checks
Denied claims appeals
Credentialing and provider management
Because the payer environment is generally much more controlled than a patient-facing environment, some of the differentiating factors in this space include:
Fallback support with human agents when the AI isn’t getting the job done
Technical considerations including data privacy, security, and EHR integration quality
Caller dashboard to enable requesting outbound calls and viewing call results.
Analytics capabilities to help track success rates and potential errors across calls.
Payer-specific modules to handle the IVR tree and agent script, or
Low-code script builder to enable customized calling procedures