Automate prior authorization status inquiries with an AI agent that verifies member identity, retrieves PA cases, and explains next steps.
The Pre-Authorization Support template creates an AI agent for inbound PA status calls. It verifies caller identity, retrieves PA cases via webhook, and explains current status and next steps.
Designed for health plans and payer call centers fielding high volumes of PA inquiries, this template deflects routine calls so clinical staff can focus on complex cases.
The template comes pre-configured with member verification, PA case retrieval, and compliance-aware conversation flows.
Verifies caller identity using name, date of birth, and member ID via webhook.
Fetches prior authorization cases and presents status, dates, and next steps clearly.
Explains approval, denial, pending, and in-review statuses in plain language.
Only shares information with verified members or authorized callers.
5 minutes
A Telnyx account with a phone number.
Sign in to your Telnyx account. Navigate to AI Assistants, click Create New Assistant, and select Pre-Authorization Support from the Healthcare category.
Replace placeholder webhook URLs with your prior authorization system API endpoints.
Update the organization name in dynamic variables.
Update instructions with your specific PA statuses and next-step guidance.
Run test calls with sample member data to verify verification and case retrieval.
Thank you for calling. I can help you check the status of a prior authorization. Can you tell me your full name and date of birth?
Ensure your webhook returns clear status labels with plain-language explanations.
Ensure your webhook returns clear status labels with plain-language explanations.
Configure different verification flows for different caller types.
Configure different verification flows for different caller types.
Add transfer destinations for clinical review and appeals.
Add transfer destinations for clinical review and appeals.
