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Pre-authorisation agent for SHA Kenya

The pre-authorisation agent for SHA Kenya 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 rulesSHA Kenya
  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 SHA Kenya

  • Reads the SHA Kenya authorisation rules for the member’s plan and gathers what they need
  • Match the member to their SHA Kenya option from the 1 on file (Social Health Insurance), with their membership number, from a message or a photo of their card
  • Answer general questions about SHA Kenya cover, and send plan-specific ones to the SHA Kenya service line rather than guess
  • Read a claims or benefit statement the member sends and explain each line still owed, in plain words

Tools.

SHA KenyaLiveWhatsAppLiveEmailLiveDiscovery HealthLiveVoice and phone callsLive

Questions

What does the pre-authorisation agent do with SHA Kenya?

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

Is the SHA Kenya connector live?

Yes.

Does the pre-authorisation agent approve procedures?

No.

Does the agent decide SHA Kenya 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.

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Other agents for SHA Kenya

The pre-authorisation agent with other connectors