Insurance Verification Bot

Overview

An orthopedic surgery center was losing revenue from claim denials due to incomplete insurance verification. Front desk staff spent hours daily calling payers, sitting on hold, and manually entering benefit information. We built an automated verification system that reads insurance cards (front and back) via OCR, identifies the payer and plan, queries eligibility databases in real-time, and pre-authorizes scheduled procedures — all before the patient arrives.

The Challenge

Insurance verification involves hundreds of different payers with different portals, different data formats, and different authorization requirements. Some require phone calls, others have web portals, and many have different processes for different plan types. The system needed to handle all of these while keeping data current (benefits change annually).

Our Approach

We built a multi-channel verification engine. The OCR layer extracts payer ID, member ID, group number, and plan details from card images. The verification engine routes requests to the appropriate channel — EDI 270/271 transactions for major payers, web scraping for those with portals, and AI voice calls for payers that only support phone verification. Results are normalized into a standard format and pushed to the practice management system.

Key Features

• Insurance card OCR (front and back)
• Real-time eligibility verification
• Multi-channel payer communication
• Automated prior authorization
• Benefit detail extraction
• Practice management system sync
• Denial prediction and prevention

Results

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