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Pre-authorisation agent for Eden Care

The pre-authorisation agent for Eden Care 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 rulesEden Care
  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 Eden Care

  • Reads the Eden Care authorisation rules for the member’s plan and gathers what they need
  • Save the member’s Eden Care cover and membership number from a message or a photo of their card
  • Answer general questions about Eden Care cover, and send plan-specific ones to the Eden Care service line rather than guess
  • Read a claims or benefit statement the member sends and explain each line still owed, in plain words

Tools.

Eden CareLiveWhatsAppLiveEmailLiveDiscovery HealthLiveVoice and phone callsLive

Questions

What does the pre-authorisation agent do with Eden Care?

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

Is the Eden Care connector live?

Yes.

Does the pre-authorisation agent approve procedures?

No.

Does the agent decide Eden Care 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 Eden Care

The pre-authorisation agent with other connectors