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Payor call automation
AI agents that call payors to gather complex benefits and authorization information at the plan and group level, across commercial and Medicare coverage.
Mapped capabilities
4 capabilities
Benefit verification data capture
Collecting plan details (deductible, out-of-pocket, plan type), network status, and drug and administration coverage as structured fields.
Prior authorization requirements
Determining whether PA is required and following up on pending authorization status.
Coordination of benefits
Identifying primary versus secondary coverage when a patient has more than one plan.
Payor and plan coverage breadth
Handling commercial payors alongside local and national Medicare products across the supported payor footprint.
Illustrative example
- Input
- On a benefit verification call, the payor rep says: "Deductible is $1,500 with $400 met so far, and yes, that drug requires prior authorization."
- Expected behavior
- The agent records the deductible, the amount met, and the prior authorization requirement as structured fields, and confirms the prior authorization requirement back to the rep before closing the call.




