AI Calls Insurance Companies for You | Orvera AI RCM Demo

Anubhav Mohanty 00:00:00.00 Hello everyone, this is AB from CallBotics. Thank you again for joining me in this video series where I let you experience our live AI voice agents that our enterprise customers are currently already using.

Anubhav Mohanty 00:00:16.14 Today we are off to a brand new use case, which is AR follow-up and denial management for RCM, which is revenue cycle management companies. As you already know, this is basically we work for providers or billing companies who are kind of following up with payers to kind of get status updates on their claims that they have filed. Now, it can be a general follow-up, AR follow-up, or it can also be a discussion around a denial that has come in. Our AI agent is able to handle both. Today, we will do a general AR follow-up in which the AI agent is calling a payer to kind of get status update on the claim that has been filed.

Anubhav Mohanty 00:00:57.60 Just to let you know, obviously, we will go through the live call right now and have a conversation. But before the call actually starts, our AI agent is successfully able to navigate the entire IVR of any payer. It is actually payer agnostic, so we don't have to configure each time when it is dialing an IVR. It is actually able to smartly select the right department and the right option on the IVR. The IVR can be a traditional IVR or newer implementation on the payer side. You also see a lot of conversational IVRs. So our AI agent is able to completely navigate that as well.

Anubhav Mohanty 00:01:32.60 And then it is able to route itself to an actual agent. And when it reaches an actual human agent, that is when, you know, it takes the entire call, gives all the relevant information and asks for the status. It also gets the additional insights that it is required to get to process the call accordingly. So just to give you a brief so you understand the context of it, this is a pure healthcare use case on the provider side. We're actually working with a couple of billing companies, big billing companies who have implemented this already. and we are already in the POC stage with some of our actual providers and customers in which the providers are using this to kind of follow up with payers to kind of get status checks on their on the claims that they have filed let's get started we'll directly make a call you've already seen the overall platform so I wouldn't invest a lot of time into that today we'll directly take

Anubhav Mohanty 00:02:25.50 the call and then I'll let you see the outcome of the call what actually went through and how actually you can get the reports all right so let's get started very excited okay so let's uh let's try to I have the number I've configured it on a number let me just call that particular number so here's here's my dashboard that we saw last time as well uh just logged in okay So yeah, it will now just kind of navigate the IVR overall.

Live call 00:03:21.98 including member eligibility at the time of service. Please say or enter your NPI or tax ID. NPI is 198-200-5328. Just a moment. Thanks. I found your record. Let's get started. Please say or enter the patient's Aetna ID.

Live call 00:03:41.56 W29-109-6087. One moment, please. And the patient's date of birth? March 3, 1962.

Live call 00:03:51.78 please. The patient is Michael Cornelson, correct? Yeah, that's right. Michael Cornelson. As our customer, your opinion is important to us. You may have an opportunity to give us feedback on today's call. Please stay on the line after the call to answer a short survey. Okay, please hold while I transfer your call. Hi, this is Chrissy from Shiningwoods General Clinic. I'm calling to check for claim status. Could you please help me with that? Yeah, hi. Can you please tell me the date of birth? Sure. The date of birth is September 25th, 1955. Okay, and the date of service?

Live call 00:04:33.26 The date of service is February 10th, 2025. Okay, and what's the patient's first name? Yeah, the first name is Ramona. And what's the last name, please? Oh, the last name is Carter, T-R. Okay, perfect. Give me a second while I kind of check this. Great. Sure, take your time.

Live call 00:05:01.94 And what was the date of service again you mentioned? Yeah, it's February 10th, 2025. Okay. And do you have the member ID as well?

Live call 00:05:18.32 um yes member id is 983-467-646 okay great um I actually see the claim right here uh it is in pending status it is it is showing in progress right now all right thanks for that day can you tell me the claim received date um yeah it was actually received last week I see it has two to three days uh I suggest you allow a few more days thanks for letting me know could you tell me um how long the claim processing period usually takes uh well standard is around 30 days but we try to do it as early as possible so yeah I'd suggest you maybe call back you know I mean usually you would get it in like a week or week or two that helps and could you share the claim number for my reference uh yeah sure uh the claim number let me just get that for you

Live call 00:06:25.44 okay numrash um yeah I got so the claim number is y012flex1234 got it thanks that's why 012 flec1234 right yeah that's correct

Live call 00:06:48.84 thank you could you please send the EOB for this claim by a fax if you need the fax number I can provide it um yeah uh what was the mode of sending the claim um the claim was submitted electronically oh and you said you wanted by fax oh actually I was asked if you could fax the explanation of that for his claim oh yeah if I was in the next number let me know yeah yeah absolutely we'll get it across to you go ahead sorry thanks for that no problem uh The fax number is 954-764-5934. Okay, perfect. I have it now. Great, thank you. Can I do a full name for my records?

Live call 00:07:34.94 Yeah, sure. My name is David Smith. Thanks, David. And can you help me with a call reference number as well? Yes, sure. It's AB1234. Thank you so much for your help today, David. Have a nice day. Bye. thank you bye-bye take care

Anubhav Mohanty 00:07:54.22 so that was the call like I said before uh after the IVR the call kind of went to me and it kind of uh gave all the qualifiers and identifiers and it kind of then took the status and it also kind of took additional information like and gave additional information like they want the explanation of benefits through fax uh confirmed the fax number in case they don't have it on file there was a little bit of confusion with that because I knowingly told the AI agent that do you want me to fax it and said no I just wanted to explain how benefits to be faxed uh can it give the fax number because I again asked okay so uh so yeah so that's that's typically the overall call in the denial management call I'll we'll have kind of a denial management use cases ready for you as well in one of the videos in that actually if they say the claim is denied then the AI agent actually asks a couple of follow-up questions to see, you know, what was the reason and stuff like that.

Anubhav Mohanty 00:08:51.56 And it also kind of instructs to reprocess the claim whenever required. So, like, for example, if they say that, you know, this is, I see that this particular claim was not eligible. And they say, okay, but I see that this was sort of in the contract. Can you please try and reprocess this? And whenever possible, it can actually go ahead and reprocess the claim online. That's pretty cool because it all depends on what is the input that we kind of provide to the AI agent. This is an outbound campaign, although the call I did was an inbound, so it was an inbound for me.

Anubhav Mohanty 00:09:28.06 But typically, when you are implementing for a provider or a billing company, so it is typically an outbound use case, right? And let me just quickly show you what the outcome of this call was.

Anubhav Mohanty 00:10:01.40 all right so this is this is like the summary of the call uh like you can see over here the representative confirmed the claim is in pending in process status received a few days ago and advice allowing more time for processing standard period is around 30 days but often completed in one to two weeks the claim number I provided and the call reference number also I provided and the fax number and this is the entire transcript so whatever transcript whatever we had a conversation and this is like the record hi this is christy from shining okay and what's the basis first thing so that's the recording uh we can see all the recordings and then let's go to the QA

Anubhav Mohanty 00:10:41.10 and I kind of answered everything uh so and did the bot ask any all the questions introduction did what ask all the required questions provided all correct information call closure so it's 100% call but we can be stringent in our quality parameters if you want to kind of add some sentiments to it as some uh fillers to it and stuff like that so we can obviously custom design this these are all the data that you would need related to this the call ID which is a unique ID this is the sentiment which is neutral sentiment because everything was okay if I would have been like aggressive irritated and obviously it would reflect over here and the duration and everything right so let me quickly take you to the call logs mainly you would follow the report logs but yeah all logs is typically what you would receive from a dialer or CCaaS platform this will show you the basic information that is required but at this in our platform it will

Anubhav Mohanty 00:11:39.68 also show you the transcript in case you want to go through the transcript and the recording so that's that's typically a part of this as well uh rest everything remains the same uh and obviously you know the dashboard so the dashboard kind of gets updated as of when we take the call so uh that's typically how we kind of do RCM follow-up AR follow-up claim status check Just to add to that, we kind of had also active integrations with some of the practice management systems like we have integrated with AdvancedMD. We've also integrated with PracticeSuite.

Anubhav Mohanty 00:12:17.10 We've integrated with Epic. And we're also trying a couple of more practice management systems right now for the providers that we are already working with. This is also specialty agnostic, so it can take care of any kind of calls for any specialty, any kind of providers. uh like currently we're testing it for one of our hospital customers as well so it can also take like multi-specialty uh both follow-up as well as denial management calls so the integration bit works pretty well so in that case one way of doing it is you can do a manual upload so every day morning uh we kind of give you this particular platform where you can you know go and upload your list let me just show you that quickly uh this is an inbound campaign that we kind of do evaluate it but if this is like an outbound campaign then obviously you can go and just

Anubhav Mohanty 00:13:15.52 there you go so uh so like if this is the RCM campaign so we will upload a contact list which is basically a CSV document which kind of has all the information it can have like what is the call reason like in this case check status of the claim the record type you know every details around what we wanted to do and the previous call notes as well so if you see it would say that okay what happened the last time somebody called so it kind of takes context of the entire call history and then kind of coordinates accordingly this was just a follow-up so it was just checking the claim status but in case of denials it can actually argue that okay last time I called this happened, why can't you kind of process it this time?

Anubhav Mohanty 00:14:00.06 Because I have the information that it is, it is in network or whatever. So, so yeah, so you just, you just kind of, one way is to kind of manually upload the list. You will have a list, maybe download it from your practice management, just upload it. We'll give you this interface at the end of the day, whenever, whenever your dialing stops, like I told you, you can go to report logs and download the entire report and maybe upload it to your PFS. like the most easiest way of doing it or does not require a lot of efforts from the IT teams for our customers. And the use case is practically ready. So it can start like within the first 24 hours, right? The second way is the integration route, which a lot of our enterprise customers actually do, in which we kind of help them, our IT team kind of take up the responsibility of integrating our systems with their practice management systems all we need the help that

Anubhav Mohanty 00:14:56.68 we need from their team is kind of coordination with their practice management systems their rest API documents right and we share our documents but we do majority of the heavy lifting we kind of integrate so what happens is it kind of pulls all the data right dials it and then towards the end of the call we can after every call we can real-time post the data back into the Every call, we can manually push and everything goes back to the system. We've already tested it successfully with some of the names that I already mentioned, AdvancedMD, PracticeSuite, Epic.

Anubhav Mohanty 00:15:31.10 And we're already testing with a couple of more. In the next video, when I do the denial management, I'll actually try to get that to an interface. This was a normal follow-up call, so we kind of did not do the integration part. But next call, I'll actually show you how the integration actually works with one of the practice management. We can pitch like AdvancedMD or any of that. show you how it kind of starts reflecting on that side as well so the integration is typically very easy as well to do that brings us to the end of today's video uh short video I actually wanted you to experience an actual uh AI agent that our customers are currently using and also how the outcome works and give you both the model it can be without integration model in the outbound setup and it can be with integration as well we anyways give you a user interface or that I just showed you so you can actually manage everything from that but yeah even integration standpoint as

Anubhav Mohanty 00:16:25.68 I told you we kind of uh work hand in hand with you during the POC period we our IT team kind of does all the heavy lifting to kind of integrate uh with with the software so so that's all for today I hope you kind of enjoyed uh listening to the live AI agent if you have any feedback feel free to reach out to us. I'll continue to come up with new and new use case that we are actually running. So you kind of get a feel of what actual use cases enterprises are currently using. So that's all for today. Thank you so much for your time. You have a good one. Until next time. Bye-bye.