Yes. An AI agent can check the status of a submitted authorization or claim, tell a caller what's outstanding, and route a new authorization request to the right queue — all pulled directly from the practice's or payer's system. Approving or denying an authorization, and anything involving a dispute, still requires a person.

What authorization and claims calls actually consist of

• Status checks on a submitted prior authorization
• Status checks on a submitted claim
• Questions about what documentation is still needed for either
• New authorization or claim submissions requiring structured intake
• Disputes or appeals on a denied authorization or claim

Which of these calls should you automate first?

Start with status checks — both authorization and claim status are lookups against a system of record with a defined set of possible answers. Then missing-documentation questions, once status is known. Then structured intake for new authorization requests, capturing the same fields a staff member would collect. Denials, appeals, and disputes should never be automated — they require judgment and often a clinical or coding review outside the AI agent's scope.

What should not be automated in authorization and claims?

Route to a human: any dispute or appeal, any authorization or claims decision itself, and any case where the payer's system returns unclear or conflicting information. An AI agent should report status and collect information — it should not be making or influencing the underlying coverage decision.

How does an AI agent handle status and intake without creating risk?

• Status comes directly from the payer or claims system, never inferred from patterns.
• New-submission intake follows fixed, payer-specific field requirements, not general-purpose data collection.
• Anything resembling a decision, dispute, or appeal is routed to staff immediately, with the case history attached.
• Every interaction is logged for audit, including exactly what status was communicated.

What integrations does this require?

• The payer or clearinghouse system, for authorization and claims status
• The practice management or EHR system, for visit and procedure context
• Telephony and contact center infrastructure, for routing disputes and denials to staff
• The CRM or case management system, for logging

What results should you expect?

CorVel, a workers' compensation and managed care company, has used Replicant to automate claims-related conversations at scale, according to Replicant. That builds on the same non-clinical intake workflow that already cut CorVel's average handle time in half — from five minutes to two-and-a-half — at 100% non-clinical intake accuracy, per Replicant's published case study. The pattern — capture the structured details a claim needs, verify them, and get the case in front of the right person — applies just as directly to authorization and claims status calls in a clinical setting.

For your own program, track:

• Percentage of status calls resolved without escalation
• Time from authorization submitted to status available to the patient
• Rate of new submissions with complete documentation on first pass
• Escalation rate on disputes and denials

What to ask a vendor before automating authorization and claims calls

• Can the agent check real-time status from our payer or clearinghouse connections?
• How does the agent distinguish a status question from a request to dispute a decision?
• Can required fields for new authorization submissions be configured per payer?
• What does the audit trail look like for a claims-related call?
• How are denials and appeals routed, and with what context attached?

Frequently asked questions

Can an AI agent approve or deny a prior authorization? No. It can check and report status, and collect information for a new submission, but the authorization decision itself stays with the payer's review process.

What if a caller wants to appeal a denial? That should route to a person immediately — appeals require judgment and documentation review the AI agent isn't positioned to handle.

Can this reduce the number of "where's my authorization" calls? Yes — status checks are one of the most repetitive call types in this category, and giving callers an immediate, accurate answer removes them from the queue instead of just triaging them faster.

Is this different from how AI handles claims in insurance generally? The underlying pattern — status lookup, structured intake, escalate decisions and disputes — is similar, but health services authorization calls involve clinical documentation and payer-specific rules that differ from a P&C insurance claim.