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