EliseAI's voice agents verify insurance with Stedi
EliseAI is a multi-channel AI platform that automates patient engagement for medical practices. Its voice AI agents answer incoming patient calls around the clock, with no hold time.
EliseAI's agents automate about 60% of eligible inbound calls. Patients can use them to book appointments, reschedule visits, ask for prescription refills, or get answers to billing questions.
The agents write each outcome directly into the practice's Electronic Health Record (EHR) platform, the system practices use to manage patient records.
More than 3,500 healthcare providers use EliseAI. Its customers range from single clinics to groups with more than 600 providers. They cover specialties like women's health, dermatology, ophthalmology, and primary care.
Challenge
Providers wanted EliseAI's voice agents to check a patient's insurance coverage before the patient completed intake or scheduled an appointment.
"Our customers told us: before somebody books, we want to check coverage and make sure they have a clear picture of what to expect," says Ashim Vaish, Strategy and Operations Manager at EliseAI. "That way, patients and providers both know what's covered before the visit – so there are no surprises down the line."
"Before somebody books, we want to check coverage and make sure they have a clear picture of what to expect."
Without a voice agent, front-desk staff usually verify a patient's insurance. They log in to a payer portal and search for the patient. Or they call the payer and wait on hold.
But those options weren't viable. Payer portal logins are difficult to automate – portals vary across payers. And calling a payer takes too long while a patient is on the phone.
EliseAI needed a programmatic way for its agents to verify insurance in real time – with the patient live on the line.
Solution
EliseAI found its solution with Stedi's Real-Time Eligibility Check API.
Unlike portal logins or payer phone calls, which take minutes, Stedi's eligibility checks return responses in 1-3 seconds. In most cases, patients aren't even aware a check has occurred.
Those eligibility checks use standardized, HIPAA-compliant transactions to talk to payers. That means EliseAI's development team uses the same JSON request and response schemas for every payer its providers work with.
Stedi's API documentation made it easy for EliseAI's team to build and launch to production quickly.
"I don't trust an integration until it hits production. Stedi let me get there the same day," says Joshua Clark, founding software engineer at EliseAI.
"I don't trust an integration until it hits production. Stedi let me get there the same day."
Stedi also provided hands-on support to help EliseAI's team interpret eligibility responses and get EliseAI's providers the information they needed.
EliseAI works with Stedi in a dedicated Slack channel, where Stedi provides real-time support. Stedi's average support response is less than 10 minutes.
Joshua also notes that "we're pretty deep in payer responses day-to-day – but every once in a while we'll run into something truly in the weeds, some obscure response code or edge case. That's when we loop in Stedi. They know payer data better than anyone we've worked with."
"They know payer data better than anyone we've worked with."
Results
EliseAI now runs over 100,000 eligibility checks per month through Stedi, and volume continues to grow.
"Insurance verification stopped being something our customers worry about. The agent asks a few questions, and the booking is right," says Ashim. "99% of checks return a response before the call ends."
"Insurance verification stopped being something our customers worry about."
EliseAI's team is building on its success with Stedi. The team now uses Stedi's transaction enrollment APIs to register providers with the Centers for Medicare & Medicaid Services (CMS), making eligibility checks for Medicare possible.
"A patient calls once and leaves with an appointment they know is covered. Stedi is why we can promise that," says Ashim.
"A patient calls once and leaves with an appointment they know is covered. Stedi is why we can promise that."