Hospitals / Clinics
A hospital insurance team assistant for terms and pre-auth documents
The Phak AI insurance team assistant brings each insurer's and corporate partner's terms into one knowledge base. The team can ask which documents a case needs and which conditions to watch before submitting a pre-auth or claim. Answers cite the terms document, and approval still belongs to the insurer.
The old way
- Open each insurer's terms manual separately
- Rely on each person's memory for checklists
- Find missing documents only after rejection
With Phak AI
- Ask about any insurer's terms in one question
- Get a checklist that cites the terms document
- The team checks completeness before pre-auth
Where hospital insurance paperwork gets stuck
Every insurer has different terms
Each insurer and corporate partner has its own conditions, co-payment rules, and required documents.
Terms are revised in cycles
A new notice or manual comes out, but the team keeps using the checklist they remember.
Missing documents surface on rejection
The team has to request more documents from doctors or patients later. Cases slow down and payments arrive late.
Know-how sits with long-time staff
Experienced staff know what to watch for with each insurer. When they leave, that knowledge goes with them.
How the pre-auth document assistant works
Gather every insurer's terms
Import terms manuals, notices, and corporate contracts into the knowledge base, with a board for each insurer or partner.
Capture the checklists in use
Collect the checklists and watch-outs experienced staff already use, so they become the organization's knowledge.
Ask before submitting
Staff ask which documents this insurer needs for this procedure. The assistant answers and cites the terms document it used.
People check, then submit
Staff confirm completeness against the checklist before submitting a pre-auth or claim. Approval belongs to the insurer.
Questions the insurance team can ask
What we measure in the insurance team
Measured with the insurance team's own data, before and after launch.
- Rate of claims returned or asked for more documents
- Time to prepare pre-auth documents per case
- Number of questions escalated to the team lead or senior staff
- Time for new staff to prepare documents on their own
Scope of the insurance team assistant
What Phak AI does
- Phak AI helps look up insurer and corporate partner terms from documents the hospital holds.
- Phak AI helps draft pre-auth document checklists for the team to check.
- Phak AI helps mask personal data when PDF documents are imported.
What it does not do
- It does not decide on claim approvals or predict whether a claim will pass.
- It does not submit cases into insurers' systems on behalf of staff.
- It does not diagnose or give a medical opinion on whether a procedure is necessary.
- It does not replace the HIS and does not touch medical records.
Frequently asked questions
Can the assistant tell us whether a claim will be approved?
No. It answers terms and required documents based on the insurer's documents. Approval belongs to the insurer, and staff check every case before submitting.
Do we need to enter patient data into the system?
No. The assistant answers from terms documents and checklists and does not need medical records. If you import PDFs that contain personal data, the system helps mask it on import. See security.
What happens when an insurer changes its terms?
Add the new notice or manual to the knowledge base and have the team mark the current version. The assistant answers from that version and cites its sources.
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Read more →Talk to the Phak AI team
Tell us about your business. The Phak AI team will show you the systems that fit and plan the rollout with you, without replacing what you have.