The Provider Outreach Agent calls providers the moment missing documentation is flagged — conducting a natural, empathetic conversation to collect what's needed and keep the prior authorization moving without delay.
70%+
reduction in outreach queue staff
Same-day
provider follow-up on every flagged case
Faster
prior auth cycle for Medicare Advantage
The Provider Outreach Agent manages the full provider conversation — from requesting the right clinical records to logging what was committed and what comes next.
Contacts the provider office and requests the exact documentation needed to complete the prior authorization review.
Asks for records tied to the service — imaging reports, lab results, progress notes, therapy notes, or operative reports.
Confirms member name, DOB, authorization number, requested CPT/HCPCS codes, ordering provider, and servicing provider.
Explain quantity limits to the patients plan and confirm if prior auth can be processesd with updated quantity.
Automatically calls back if the provider has not submitted records within the configured follow-up timeframe.
Notifies member & provider that their prior auth was approved if expedited case.
Call and obtain provider information to update OON provider in system.
Logs whether the office will send records, already sent them, refused, needs more time, or requires escalation.
Routes the case to a human reviewer when the provider cannot be reached, refuses to provide documentation, or gives conflicting information.
Adds call summaries, timestamps, requested items, provider commitments, and next steps directly into the prior authorization case record.
Calls providers the moment missing documentation is flagged — not the following business day after their staff has already moved on to the next case.
Providers can ask questions about what's needed and why, and receive clear answers — just like a call with a knowledgeable member of your team.
Designed to respect provider time — gets to the point quickly, stays on topic, and ends the call the moment the required information is confirmed.
Gathers, confirms, and logs all missing clinical information directly to the case record with a full call transcript for your audit trail.
The Provider Outreach Agent is fully briefed on the prior authorization before it dials — so providers aren't asked to repeat information they already submitted, and every question targets exactly what's missing.
Identifies the precise missing clinical documentation before the call begins, so the conversation stays focused.
Answers provider questions about documentation requirements and criteria in plain, accessible language.
Escalates to a human reviewer if the provider requests it or if the conversation requires clinical judgment.
Logs a complete call transcript and documentation confirmation to the case record automatically on completion.
Provider Outreach Agent
70%+
Same-day
Faster
"Our providers actually started commenting on how much they prefer the AI calls. It knows exactly what it needs, gets straight to the point, and doesn't waste their time. Our outreach staff went from chasing callbacks all day to handling exceptions."
Diana Rosario
Director of Prior Authorization Operations, Medicare Advantage plan, 190,000+ members
Everything you need to know about how the Provider Outreach Agent works and fits into your prior authorization operations.
