Shift Agents · Insurance Verification
AI insurance verification that catches coverage problems before the visit.
The Insurance Verification Agent checks eligibility and benefits when a visit is scheduled, again before it, and again on the date of service. A changed plan, an expired card or a missing referral is caught days ahead, not at the front desk.
Maria T. · Lumbar injection
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Insurance Verification Agent
Re-checking coverage before the procedure…
Plan changed since scheduling. New payer on file.
Caught a plan change, six days out.
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Prior Auth Agent
The auth was tied to the old plan.
Memory: This payer wants the MRI attached for spine injections.
Resubmitted to the new payer with imaging attached.
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Insurance Verification Agent
Checking benefits on the new plan…
In-network. $40 copay. Patient told by text.
What it does
What it checks, before anyone has to call
Active coverage
On the date of service, not just the day it was scheduled.
Network status
Whether the provider is in-network on this plan.
Copay and benefits
What the patient will owe, so nobody is surprised at check-in.
Auth required?
Flags it, and hands it to the Prior Auth Agent.
Referral required?
Catches an HMO plan that needs a PCP referral first.
Where it works
One agent, three places it saves you money.
Before the visit
Verified when the procedure is scheduled, and again before it.
RCMOn the claim
Eligibility confirmed on the date of service before the claim is coded, and payer network errors caught on denials.
Contact CenterOn the phone
“Do you take my insurance?” answered from real coverage, not a guess, by call or text.
The line it won’t cross
Coverage informs care. It never gates it.
Never cancels, reschedules or denies care over a coverage finding.
When a plan comes back inactive, it keeps the appointment, asks the patient for their new card, and flags your front desk with time to fix it.
See every agent’s guardrails →How it connects
Works inside the systems you already run.
Your EHR / PM
Reads and writes in the systems your team already uses.
- athenahealth
- NextGen
- AdvancedMD
- eClinicalWorks
- Greenway
- ModMed
- SIS
Payers, by EDI
Eligibility and benefits in the standard format.
- EDI 270/271
Questions
Insurance Verification Agent, answered.
When does it check eligibility?
When a visit is scheduled, again before the visit, and on the date of service before the claim goes out. Most coverage problems appear between scheduling and the visit.
What happens when coverage comes back inactive?
The appointment stays on the schedule. The agent texts the patient for their new insurance card and flags your front desk with time to fix it. It never cancels care over a coverage finding.
Can patients ask it about their coverage?
Yes. By phone or text, it answers “Do you take my insurance?” and “What will it cost?” from the patient’s real coverage.
Does it work with our EHR?
It works with athenahealth, NextGen, AdvancedMD, eClinicalWorks, Greenway, ModMed and SIS, using APIs where they exist and Browser Agents where they don’t.
How is patient data protected?
Every customer gets a BAA, data is encrypted in transit and at rest, and each agent sees only what its task needs. Every action is logged with its reason.
Works alongside
See the Insurance Verification Agent work a week like yours.
20 minutes, with Lance Rodela, founder.