For healthcare workers already plagued by the burden of administrative overwhelm, repeatedly checking in on the status of a prior authorization adds to an already taxing clerical burden. And yet, it’s necessary – if these calls aren’t completed in a timely fashion, patients can face delays in treatment and providers risk losing revenue.

That’s why we’re excited to share more about our AI agents that can follow up on critical tasks, including those related to prior authorization, at a pre-determined frequency. By doing so, Infinitus AI agents help reduce the mental and financial costs associated with following up with payors.

Why are follow-up calls a fit for AI agents?

While some payors do make information available digitally via portal, it’s generally not enough to make next steps clear. For example, a payor portal may reveal a prior auth request has been denied, but won’t include the reason why or share the appeals process. 

Infinitus AI agents, however, can acquire the complete picture. Considering over 7 percent of prior authorizations are denied and many of those appealed, patient support teams need all of this information.

Today, Infinitus AI agents are taking on follow-up work including:

Prior authorization submission status 

Only providers can submit prior authorizations on behalf of patients, which means pharmaceutical patient support teams don’t automatically know whether this critical first step in the process has occurred. Infinitus AI agents can call payors to acquire the status of a prior auth submission, returning that data to the support team within a matter of hours. 

Prior authorization decision status

As we know from our analysis in The truth about prior authorization, turnaround times for prior authorization decisions differ by payor. The reality of that uncertainty is that some support team members are having to take time out of their day for days in a row to wait on hold, only to be told that a determination has yet to be made. Infinitus AI agents can automate these calls, and follow up with payors at a predetermined frequency until the determination has been acquired. If the prior auth is denied, our AI agents can also acquire the reason for denial and the process for submitting an appeal.

Formulary exception AI agents

In most cases, a pharmacy benefit manager (PBM) covers only the drugs listed on a health plan’s formulary. An exception procedure can be used to request coverage for drugs that aren’t included, but as with other such appeals, this can take time. To help streamline the process, Infinitus AI agents can call payors to understand the process to submit a formulary exception as well as follow up on its status. Our agents can understand whether a formulary exception has been approved and provide any necessary details, or if it is denied, understand the denial reason and options for appeal.

Appeals status

As with the submission process, the prior authorization appeals and formulary exception appeals processes differ by payor, creating a lot of additional administrative work for patient support teams. Infinitus AI agents can automate status checks of appeals, following up at pre-set intervals until the appeal has been resolved. If the appeal has been denied, our AI agents can also find out how many chances to further appeal remain. 

Infinitus AI agents take on ‘the cost of checking in’

There is a very real cost involved in spending time following up with payors, and a very real risk if these follow-ups aren’t completed efficiently – according to the AMA, nearly 1 in 4 physicians report a prior auth has led to a serious adverse event for a patient in their care. 

Infinitus AI agents can take on this burden on behalf of pharmaceutical patient support teams, freeing up time to focus on other work. Reach out to us today to learn more about how to get started.