02 / RCM and prior authorization
Days of waitingon hold with payers.Now measuredin dollars per call.
Six voice agents that navigate payer IVRs in parallel for prior auth status, eligibility, claim follow-up, and denial capture. Built to run hundreds of concurrent calls. Built to fail loudly to humans when the line stops being deterministic. Engineered to be cheaper per call, faster per resolution, and fully audited end-to-end.
The benchmark
Send us 100 of your real calls. We'll run them through our agents at no charge and publish the unit economics back to you in a week.
Agents we deploy
Six agents.
Each scoped to a single payer-facing job.
01
prior_auth_status
Prior auth status check
Does
Calls payer IVRs, navigates menus, captures status, reference numbers, and required next actions. Hands you a structured event.
Does not
Doesn't initiate new auths. Doesn't argue with the rep. Hands off to a human when the line gets non-deterministic.
Outcome
PA turnaround: days → hours
02
eligibility_check
Eligibility and benefits verification
Does
Confirms active coverage, captures plan details, copay, deductible status, in-network provider check.
Does not
Doesn't make medical-necessity calls. Doesn't fabricate plan details that the IVR didn't surface.
Outcome
~92% first-call resolution
03
claim_status
Claim status follow-up
Does
Calls payers for claim disposition, captures paid amount, denial codes, pending reasons, expected next action dates.
Does not
Doesn't dispute, appeal, or rebill. Captures the truth and routes it.
Outcome
10x throughput vs human agent
04
denial_capture
Denial reason capture
Does
Pulls denial reasons in structured form. Categorizes against your taxonomy. Routes to the right work-queue or appeals path.
Does not
Doesn't write appeals. Doesn't make legal or coding judgments.
Outcome
100% denial-reason coverage
05
patient_balance
Patient balance outbound
Does
Calls patients about outstanding balances. Offers payment plans within your policy. Captures intent and routes to collections only when needed.
Does not
Doesn't pressure or threaten. Compliant with TCPA and state-level rules. Always offers human handoff.
Outcome
~30% of balances resolved on first call
06
appeals_status
Appeals status tracking
Does
Periodic outreach to payers for appeals progression. Captures decision dates, escalation paths, supplemental info requested.
Does not
Doesn't prepare or submit appeals. Doesn't argue clinical necessity.
Outcome
Appeals follow-up at zero marginal labor cost
The hard part
IVRs are
where most agents die.
Anyone can build a chatbot. Building an agent that reliably navigates a UnitedHealthcare or Aetna IVR — with mid-call menu changes, dynamic prompts, hold-music with periodic interruptions, and human reps who pick up at unpredictable points — is hard engineering.
Our agents are built to detect when the line stops being deterministic and hand off to a human with full context instead of guessing. We measure ourselves on three numbers: first-call resolution rate, average handle time, and handoff-quality (does the human get the context they need to finish without asking).
Concurrency
200+
FCR
~92%
Handoff context
100%
Payers navigated
RCM platforms
Run the unit economics
Type your
payer-call volume.
Conservative defaults. We benchmark against a 100-call sample of your real traffic before committing to a contracted unit cost.
Type your numbers · the model recalculates live
Annualized savings
$1,476,000
Cost / call
$7.00 → $0.85
AHT
14 → 4.5 min
Turnaround
−68%
Monthly run-rate savings
$123,000
Hours reclaimed / month
3,167
Agent unit cost of $0.85/call assumes a typical payer-IVR navigation mix at our 4.5-minute average handle time. Pricing varies with concurrency, retries, and the complexity of your payer set. We benchmark against a 100-call sample of your actual calls before committing to a number.
Built for audit
Full recordings
Every call captured at the platform layer with full bidirectional audio, retained per your retention policy and payer requirements.
Structured outputs
Every call resolves into a typed event your platform can ingest. Auth status, reference numbers, denial reasons, next actions, and confidence scores.
Queryable logs
Every prompt, tool call, and decision logged. Customer-queryable via API for compliance, payer audits, or internal QA.
Pilot in progress
Pilot 02 · American Infusion Care · Florida
Mid-size RCM running prior auth across orthopedics and cardiology. Three agents live: PA status, eligibility, and claim follow-up.
Calls / month
22,000
FCR
91%
Cost / call
$0.85
PA turnaround
−84%
The benchmark, on us
100 of your calls.
One week. The numbers, published back.