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

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Patient-Facing AI Phone Calls

Amperos Health

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Payer-Facing AI Phone Calls

Amperos Health is an AI agent for RCM-related outbound calling, focused on follow-ups for outstanding and denied claims. It calls insurance for claims status, investigates denied claims based on the reason for denial, and provides actionable steps to the RCM team to get paid faster.

Bland AI

Payer-Facing AI Phone Calls

Patient-Facing AI Phone Calls

Bland is an infrastructure solution to build AI phone agents for a variety of healthcare use cases, including cold calling for surveys, prior authorization, appointment scheduling, verification of benefits, and automated follow up to inbound inquiries.

Infinitus Systems, Inc.

Infinitus

Payer-Facing AI Phone Calls

Infinitus offers an outbound AI phone platform to handle calls like benefit verification, prior authorization, and prescription follow-up. It automates data collection processes with accuracy, integrates with existing healthcare systems, and supports a variety of standardized call flows.

Opkit

Payer-Facing AI Phone Calls

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Patient-Facing AI Phone Calls

Opkit is a customizable AI phone call platform with both AI agents and human agents. Common use-cases include eligibility checks, prior authorizations, denied claim appeals, formulary checks, and appointment scheduling.

SuperDial

Payer-Facing AI Phone Calls

Eligibility Checking

SuperDial is a platform for AI-enabled payer phone calls for insurance verification, prior authorization, credentialing and enrollment, and claim follow-ups.

Tucuvi

Tucuvi Health Manager

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Payer-Facing AI Phone Calls

Patient-Facing AI Phone Calls

Patient Engagement

Tucuvi is an phone-based AI agent trained in evidence-based clinical protocols to automate clinical calls for care plans and chronic conditions, such as follow-ups for COPD, heart failure, and maternity. It guides conversations based on clinical guidelines to ensure meaningful and medically informed interactions, and is integrated with EHR systems for appropriate data access and writeback.

Health Harbor

Payer-Facing AI Phone Calls

Eligibility Checking

Health Harbor is an AI agent that calls insurance companies for eligibility and claim status checks.

Majorboost

Payer-Facing AI Phone Calls

Majorboost offers an AI-based outbound calling copilot for AR, Prior Authorization, Credentialing, Eligibility, and Patient Calls, with handling for phone trees, waiting on hold, and note-taking to augment in-office satff.

Outbound AI

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Payer-Facing AI Phone Calls

Outbound AI is an AI virtual agent for medical billing teams.

Standard Practice

Payer-Facing AI Phone Calls

Standard Practice provides voice AI for outbound calls to payers and pharmacies for workflows like benefits verification, credentialing, prior authorization, and medication checks.