Pre-authorisation agent for medical aids
A ready-made Health Loops agent for medical aids that gathers what a pre-authorisation needs before a planned procedure.
Coastline Medical SchemePre-authorisation agentWhatsApp
- Customer: I need a knee scope next month. What do I do?
- Read the plan’s authorisation rulesDiscovery Health
- Pre-authorisation agent: You’ll need authorisation before you’re admitted. Your plan guide asks for the doctor’s quote with the procedure codes and the hospital’s name. Do you have the quote?
- Customer: I’ll send a photo.
- Quote received: codes and hospital foundHealth Loops
- Complete request sent to the authorisation team
What it does with your systems
- Reads the Discovery Health authorisation rules for the member’s plan and gathers what they need
- Collects documents on WhatsApp, including photos
- Collects documents on Email, including photos
- Collects documents on Voice and phone calls, including photos
Questions
What is a pre-authorisation agent for medical aids?
A ready-made Health Loops agent for medical aids that gathers what a pre-authorisation needs before a planned procedure.
Does the pre-authorisation agent approve procedures?
No.
What does it ask the member for?
Only what the plan’s rules need, usually the quote, procedure codes, the hospital and the referral.
Where do the agent’s answers about benefits come from?
From the scheme’s own published plan guide for the member’s option, and from statements the member sends.
Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.