Products/ AI Physician Front Door
AI Physician Front Door
Solution
The phone line between physicians and health plans is broken in both directions. Office staff wait on hold to ask questions a machine could answer: is this covered, where is the claim, what does this prior auth need. Most prior auth denials are administrative failures, not coverage decisions. A case missing one document gets denied, appealed, and approved three weeks later, while the patient waits to start therapy.
AI Physician Front Door handles all things prior auth: every interaction between physician and payer, in both directions. Inbound, it is a line built for providers, not consumers. It speaks clinical vocabulary and answers eligibility, benefits, claim status, prior auth, referral, and exception questions immediately, around the clock. Outbound, it does the practice’s side of the same transaction. It assembles the clinical documentation a PA requires, submits it, tracks it, and waits on payer hold lines so staff don’t have to.
When a request needs clinical justification, the agent collects it in structured form during the call. The review starts complete, and a case that would have been denied for missing paperwork gets approved the first time. Every call is tagged and analyzed, revealing which UM policies cost more in friction than they save.
Use Cases
• Prior Authorization & Coverage
• Claims & Billing
• Patient Eligibility & Benefits
• Referrals & Care Coordination
• Clinical Reviews
• Step Therapy Exceptions
• Formulary Exceptions for Non-covered Drugs
+ more
Features
• A provider-facing line with clinical vocabulary and workflow fluency, not a consumer IVR
• 24/7 answers on eligibility, benefits, claim status, PA status and criteria, referrals, and exceptions
• Real-time integration to UM, claims, and formulary systems
• Step-therapy and formulary-exception agents collect required clinical justification in structured form during the call, so review starts complete instead of pending on missing documentation
• The reverse direction too: agents that assemble and submit the PA package, track and escalate it, sit on payer hold lines indefinitely at zero marginal cost, navigate payer IVRs, and write results and reference numbers back to the practice-management and EHR systems
• Structured tagging turns the call corpus into policy analytics: which UM criteria generate the most calls, exceptions, and overturned appeals
ROI
Provider cost per contact and hold time drop. PA turnaround compresses ahead of tightening CMS timeliness requirements. Administrative denials and the appeals they generate are avoided through complete first-pass intake. Patients start therapy in days instead of after a three-week appeal.
On the practice side, staff hours spent on hold with payers, the most literally wasted labor in healthcare administration, go to zero, accelerating cash and cutting cost to collect. The strategic return is provider abrasion itself: friction between physicians and payers shows up in contracting leverage, network stability, and provider attrition, and it is underinvested because provider lines do not score on CAHPS.