The call that determines whether Thursday's visit generates revenue or a denial. Handled while the patient is still on the line.
Caller I'm coming in next week and I switched jobs, so my insurance changed.
ClinicFlow Thanks for letting us know before the visit. Can I confirm your name and date of birth?
Caller Priya Raman, 2/17/1990.
ClinicFlow Which insurer is the new plan with?
Caller It's United now, through my employer.
ClinicFlow Can you read me the member ID exactly as printed on the card, and tell me whether the policy is under your name?
Caller W881204523, and yes, it's mine.
ClinicFlow Got it. I've updated your chart and we'll run eligibility before your visit. If anything needs attention, someone will call you before Thursday.
Payer, member ID, plan name, and policyholder, collected and read back for accuracy.
Coverage details land in the EMR immediately, replacing the stale plan.
Real-time eligibility runs before the visit, not in the waiting room.
Coverage issues trigger a staff callback days before the appointment.
| Scenario | Destination |
|---|---|
| Routine coverage updates | Handled fully by the AI, EMR updated |
| Failed or ambiguous eligibility | Flagged to staff for pre-visit outreach |
| Authorization-dependent visits | Routed into your prior-auth workflow |
Every surprise denial at check-in is a schedule hole the practice already paid for. The fix is boring and structural: capture coverage changes the moment patients mention them, on whatever call they mention them, and verify before the visit. An AI that answers every call is in the right place to do that consistently.
Coverage details are PHI and are handled accordingly: captured on the call, written into your EMR through secure channels, and covered under the BAA ClinicFlow signs with every practice.
The visit is flagged and your staff gets a structured task with the details, in time to fix coverage or reschedule before the patient travels to the office.
Visits and procedures that need prior auth are flagged into that workflow. Automated prior auth submission is on our roadmap alongside the referral fax system.
A first-time caller with an injury is the most valuable call your practice gets. Here is how it becomes a booked visit in one conversation.
See this call type →Nobody calls about a bill because they're happy. The AI's job is capturing the issue precisely, resolving the simple ones, and routing the rest with context.
See this call type →A referred patient who cannot get through calls the next practice on the list. This is the call where leakage starts or stops.
See this call type →The demo line is the production agent. Call it, describe this exact scenario, and judge for yourself.
