Providers and payers want to improve member care and reduce administrative costs by reducing the number of inefficient and manual administrative tasks. But verifying coverage and benefits information continues to be notoriously tedious for payers and providers. While payers have tried to develop workflows that streamline these interactions, questions about coverage, benefits, and copays continue to be among those that provider offices call contact centers about most frequently.
The overuse of contact centers results in higher human capital costs for payers and disengaged and dissatisfied providers. With the use of AI and natural language processing, HIPAA-compliant, virtual assistants can simplify insurance verification with a single interaction.
Costs are reduced, clinical outcomes are improved, and providers are more engaged. Here’s how:
1. Determine Active Coverage
Instead of calling the contact center during specific hours and waiting to speak with a provider services rep, or using an online directory or manual question form, a provider’s office can instead communicate with the virtual assistant from a phone or web chat 24/7.
“Does this member have active coverage?” Using the same information the rep would have collected, the virtual assistant quickly returns coverage verification, reserving provider services reps’ time for more complicated requests, and returning quick, convenient, and accurate results.
2. Determine Benefits
Once a provider’s office has confirmed active coverage, the next step is to determine what benefits are covered by a members’ plan. Even if a provider’s office used a digital resource to determine active coverage, they are still more likely to call a contact center to collect benefit information because the interaction is considered more complicated.
“Can I get information on what benefits are covered in this member’s plan?” With basic member information, the virtual assistant can share relevant benefit information to ensure that services are covered and to what degree.
3. Determine Copay Amount
Finally, a provider’s office needs to know the copay expected from a member at the time of their visit so they can improve copay collection.
“What is this member’s copay?” Just as with more complicated queries, the virtual assistant can quickly access this information and share the estimate with a provider’s office.
Have you considered a virtual assistant?
Hx Virtual Assistants orchestrate the efficient intersection of payer goals and provider needs–improving engagement and clinical outcomes, and effectively reducing contact center costs–in a HIPAA-compliant, cloud-based environment.