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Pre-authorisation agent for Profmed

The pre-authorisation agent for Profmed 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 rulesProfmed
  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 Profmed

  • Reads the Profmed authorisation rules for the member’s plan and gathers what they need
  • Match the member to their Profmed option from the 5 on file (ProActive Plus, ProSelect, ProSecure and 2 more), with their membership number, from a message or a photo of their card
  • Answer general questions about Profmed cover, and send plan-specific ones to the Profmed service line (0860 679 200) rather than guess
  • Read a claims or benefit statement the member sends and explain each line still owed, in plain words

Tools.

ProfmedLiveWhatsAppLiveEmailLiveDiscovery HealthLiveVoice and phone callsLive

Questions

What does the pre-authorisation agent do with Profmed?

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

Is the Profmed connector live?

Yes.

Does the pre-authorisation agent approve procedures?

No.

Does the agent decide Profmed 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 Profmed

The pre-authorisation agent with other connectors