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AI insurance eligibility verification that charts benefits at intake.

Call payers before each visit, ask your coverage questions, and save benefits to the chart.

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Have benefits on the chart before the patient arrives

Benefits are saved before each visit, and the agent records only what the payer says.

The agent loads tomorrow's visits, dials the provider line, says it is an AI assistant for your practice, and gives the member ID from the chart.

Insurance eligibility verification by phone, for the answers a portal leaves out

What is insurance eligibility verification?

Insurance eligibility verification means confirming with the payer, before a visit, that a patient's plan is active and what the visit will cost them. This agent does it by phone, calling the provider line as an AI assistant for your practice and asking your questions out loud.

  • Get tomorrow's visits
  • Get plan and member ID
  • Save the benefits
  • Transfer to billing staff

Why call if you have insurance eligibility verification software?

Medical insurance eligibility verification usually starts with a simple electronic check. The specifics can still need a person on the provider line, such as a specialist copay, the deductible left or prior authorization for a knee MRI, and that hold time lands on billing staff.

Does a knee MRI for member 5207 need prior authorization?

Yes, it does. The reference for this call is C-5521.

Prior authorization required, call reference C-5521. Is that right?

How does automated insurance eligibility verification work by phone?

The agent loads tomorrow's visit list, pulls each plan and member ID, and dials the payer. It asks whether the plan is active, the visit copay, the deductible left and whether prior authorization is needed, reads the figures back, and saves them once the rep agrees.

Benefits saved

Did the agent save the plan status, copay, and deductible the payer confirmed before the call ended?

Is this a real-time insurance eligibility verification API?

No. It's a phone agent and won't return an instant response. It also decides nothing about coverage. When a rep wants a person or an authorization number, or the hold runs long, it transfers to billing staff with the member ID. Outbound calls go to US numbers only.

  • Get tomorrow's visits
  • Get plan and member ID
  • Save the benefits
  • Transfer to billing staff

Your billing team's morning, before the first patient arrives

Healthcare insurance eligibility verification services usually mean an outside team working your list. Here the agent takes on the dialing and the waiting, and your billers keep the visits that need a human decision.

Benefits sit on the chart the day before

Plan status, copay and deductible left are saved to the patient record ahead of the 8:30, so the front desk can quote what the payer confirmed.

Each figure was read back

The rep hears the $40 copay and the $300 remaining before anything saves. A misheard number gets caught while the payer is still on the line.

Prior auth needs surface early

When a payer says an MRI requires authorization, the chart gets that flag and the call reference before the visit, which leaves staff time to act.

Payers know who is calling

Its opening line says it is an AI assistant calling for your practice, and it repeats that when asked.

Long holds have a limit you set

You choose how long the agent waits. Hold time is billed at the same per-minute rate, and a hold that runs long goes to billing staff.

It never rules on coverage

The agent won't interpret a benefit, promise a payer anything or supply an authorization number. It records what the rep said, and your billers judge what it means.

Keeping up with a payer rep on the provider line

Provider service reps take these calls all day and move fast. Member IDs and dollar figures arrive in one breath, and the call only works if they land correctly.

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Knows when the rep is done

Reps go quiet while a screen loads, then answer two questions at once. The agent waits through the silence and doesn't restart the question.

Your questions, your LLM

Choose the LLM and hand it four tools, for the visit list, the plan and member ID, saving benefits and the billing transfer.

Clear on member IDs

Pick a voice from the library that reads IDs and birth dates plainly, so the rep doesn't need them twice.

Phone agent, staff on the phone or an electronic check

Most practices already run some electronic check. The open question is who makes the calls when it comes back thin, and software takes the first row.

Cartesia agentBilling staff on the phonePortal or electronic check
Speed on a simple active checkMinutes per call, plus any holdMinutes per call, plus any holdUsually seconds
Your own benefit questionsAsked in your order on every callYes, and staff can improvise follow-upsLimited to what the payer returns
Time on holdThe agent waits, up to your limitA biller waits instead of working claimsNone
Record of what was saidRecording, transcript and call referenceUsually a note in the chartUsually a saved response
A rep asks for a personTransfers to billing with the member IDAlready a personDoes not apply
How you pay$0.03 per minute, hold included, plus LLM usage and telephonyStaff hoursUsually a subscription or per-check fee

See which calls put benefits on the chart

Every call is recorded and transcribed. See which calls saved benefits to the chart, which flagged a prior authorization, and which need another call.

Launch an AI eligibility verification agent in three steps

Start building

  1. Clone eligibility verification

    Bring the agent into your account, swap in your practice's standard questions and set your hold limit.

  2. Connect your visit list and chart

    Link the visit list, patient insurance and benefit saving to your system through tools you configure, then set the billing transfer number.

  3. Play the payer on a test call

    Have a biller answer as a rep and give a $40 copay and a prior auth requirement. Check the read-back and the saved record before going live.

Enterprise-grade security

  • HIPAA compliant badge

    HIPAA compliant

  • SOC 2 Type 2 badge

    SOC 2 Type 2

  • GDPR badge

    GDPR

Eligibility checks FAQs

What is insurance eligibility verification?

Insurance eligibility verification is checking a patient's coverage with the payer before a visit. This AI agent does it by phone. It calls the insurer's provider line, says it is an AI assistant, asks your standard coverage questions, and saves the answers to the patient record.

Is this automated insurance verification?

Yes, by phone. The agent loads tomorrow's visits, calls each payer, and asks whether the plan is active, the visit copay, the deductible left and whether prior authorization is needed. It reads each answer back to the payer before saving it.

Does the agent flag visits that need prior authorization?

Yes. When the payer says a service needs prior authorization, the agent saves that to the chart with the payer's call reference before the visit.

Does hold time on an AI eligibility verification call cost anything?

Yes. Hold time is billed at the same per-minute rate, and you set how long the agent waits on hold.

What does an AI eligibility verification agent say when the insurer asks who it is?

Its opening line says it is an AI assistant calling for your practice, and it says the same when asked.

Who is responsible for the data an AI eligibility verification agent writes?

Your practice owns the record, and the agent saves only what the payer says. Cartesia is HIPAA compliant, SOC 2 Type II certified, and signs business associate agreements with healthcare customers. See conversational AI in healthcare.

Can the agent transfer the payer to our billing staff?

Yes. When the payer asks for a person or for an authorization number the agent doesn't have, or the hold runs long, the agent transfers to billing staff and gives the member ID.

Does this work as dental insurance eligibility verification software?

It can, by phone. The agent calls the provider lines you give it and asks the questions you write, so a dental office can swap in its own list. It reads each answer back and saves only what the payer says. It decides nothing about coverage, and it isn't a portal or an instant electronic check.

How much does AI insurance eligibility verification cost?

Hold time counts as call time, so a payer with a long queue costs more per member than a quick one. The agent is $0.03 per minute of call time. LLM usage is billed separately. A Cartesia phone number adds $0.014 per minute, or nothing if you bring your own Twilio account or SIP trunk. The free plan includes $1 of agent calls a month, so you can test the agent before you pay. See pricing.

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