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Pre-authorisation agent for Aetna

The pre-authorisation agent for Aetna gathers what a pre-authorisation needs before a planned procedure.

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Riverside Family ClinicPre-authorisation agentWhatsApp
  1. Customer: I need a knee scope next month. What do I do?
  2. Read the plan’s authorisation rulesAetna
  3. 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?
  4. Customer: I’ll send a photo.
  5. Quote received: codes and hospital foundHealth Loops
  6. Complete request sent to the authorisation team
Sample conversation. People, brands and figures are made up.

What it can do with Aetna

  • Reads the Aetna authorisation rules for the member’s plan and gathers what they need
  • Match the member to their Aetna option from the 3 on file (Open Access, HMO and PPO), with their membership number, from a message or a photo of their card
  • Answer general questions about Aetna cover, and send plan-specific ones to the Aetna service line rather than guess
  • Read a claims or benefit statement the member sends and explain each line still owed, in plain words

Tools.

AetnaLiveWhatsAppLiveEmailLiveDiscovery HealthLiveVoice and phone callsLive

Questions

What does the pre-authorisation agent do with Aetna?

Reads the Aetna authorisation rules for the member’s plan and gathers what they need.

Is the Aetna connector live?

Yes.

Does the pre-authorisation agent approve procedures?

No.

Does the agent decide Aetna claims or authorisations?

No.

Does the agent triage or diagnose patients?

No.

Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.

The pre-authorisation agent by vertical

Other agents for Aetna

The pre-authorisation agent with other connectors