With Retell, we’ve increased scheduling NPS by 38%, and filled underutilized provider capacity, allowing our team to focus on meaningful patient care instead of phone tag.
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AI Claim Status Calls to Insurance Payers
5.0
ON G2
Claim status and eligibility calls to payers, placed by a voice agent instead of your billing staff. The agent dials the payer, works through the phone menu with keypad tones or speech, waits on hold, and asks the rep your questions, or hands the rep to your team when a person should take it. Results come back as structured fields for your system.
Trusted by over 4,000 businesses powering 100+ million calls per month.
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How It Works
Launch AI claim status calls in four stages, from payer scripts to results in your system.
Write payer scripts
Write the questions for each call type, the menu instructions for each payer, and the fields you want back, such as claim status, denial reason, deductible, and copay, and sign the BAA before patient data is sent.
Test against payer menus
Run test calls against the phone menus of the payers you call most, including speech menus, keypad menus, hold, and a rep who asks for a detail you didn't pass, and grade every run.
Start calls from your queue
Start calls from your work queue through the API, or upload a list as a batch call, with the claim and member details as variables for each call.
Go live and read results
Each call returns the status, reference number, and other fields you define by webhook and API, along with the recording and transcript, so your team updates claims without listening to calls.
Use Cases
Payer calls placed, navigated, and logged without tying up your billing team
Payer phone menus navigated by keypad and speech
Need someone to get through the payer's phone tree so your staff don't have to. The agent listens to each menu and presses the right key with IVR navigation, or speaks the answer when the menu takes speech. It enters the identifiers the payer asks for, such as a provider ID, tax ID, or member ID, from the details you pass in for that call, and ends the call if it reaches the wrong company.
Claim status after submission
Need to know whether a claim is paid, in process, or denied without a biller on hold. With the claim number, date of service, and member details passed in, the agent asks the rep for the status and the details you need, such as a denial reason, paid amount, or reference number. Each answer is stored as its own field, with status as a choice from your list, so it maps straight to your system.
Eligibility and benefits checks before the visit
Need coverage confirmed before a patient arrives. The agent calls the payer with the member and provider details, then asks about active coverage, deductibles, copays, and coverage for the specific services you list. Answers return as fields that fill your verification form. For the authorization side of payer calls, see prior authorization automation.
A person on the line when the rep answers
Need your team on complex claims without the dialing and waiting. Some teams start with the agent placing the call, working the menu, and waiting on hold, then transferring to a biller as soon as a live payer rep picks up. A warm transfer can play your biller a private note with the claim and patient before connecting, and if your team works from a queue, the agent waits for a real person to answer before it briefs them.
Calls started by aging reports and remittance codes
Need follow-ups to start from your data, not a to-do list. Your system can place a call through the API when a claim reaches an aging bucket you set, or when a remittance code shows a patient responsibility amount to check. Each call carries the claim, payer, and member details as variables, and payers that need different steps get their own instructions.
Results back to your team and your system
Need the outcome recorded without someone transcribing a call. When the call ends, post-call extraction returns the status, reference number, rep name, and next step as fields in the call_analyzed webhook, ready for your billing or practice management system through your own integration. The recording and transcript stay with the call for review, under the storage and retention settings you choose.
Built for Contact Centers, Not Demos
Retell is the AI Voice Platform Enterprise Contact Centers Run On
Retell lets you build, test and deploy AI phone agents that handle real call volume, so your team spends its time on the conversations that need a person.
Feature
Why revenue cycle teams choose Retell AI for payer calls
Payer-specific menu instructions
Every payer's phone tree is different. Pass the menu steps and the identifiers each payer needs as variables on each call, and set how long the agent waits after a menu pauses so it hears every option before it presses a key.
Answers stored as fields, not buried in transcripts
Define each answer you need, such as claim status, deductible met, copay, or reference number, as a post-call field with a type: a choice from a list, a number, yes or no, or text. They arrive in the call_analyzed webhook ready for your system.
Menu outcomes you can report on
Post-call fields can also record whether the agent hit a phone menu, reached a person, or got stuck in a menu loop, so you can see which payers' menus need better instructions.
Many payer calls at once
A biller can wait on one hold at a time. The agent places calls in parallel, with 20 concurrent calls included on pay-as-you-go and more on demand, and a batch call runs inside the time window you set for when payer lines are open.
Status, reach rate, and handoffs
You need to know how many calls got an answer. Post-call extraction records the status and whether a rep was reached, batch results show calls sent, picked up, and successful, and alerts tell you by email or webhook when success rate drops.
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Pricing
Cut Costs by 90% with AI phone Agents
Pay as you go
$0 to start.
$0.07–$0.31 per minute – Pay only for what you use.
60 mins of free access.
20 concurrent calls.
10 Free Knowledge Bases.
Enterprise Plan
For companies with large volumes, data or deployment requirements, or support needs.
White glove service for your use case.
Premium support with dedicated solution engineer teams.
Custom pricing and concurrent calls based on your needs
FAQ
Frequently asked questions.
Can the agent get through payer phone menus?
Yes. On outbound calls, the press digit tool sends keypad tones to work through menus, including digit sequences such as an ID followed by the pound key, and the agent answers speech menus by speaking. You tell it the department it is trying to reach, the words to listen for, and what to do when a menu is unclear.
What happens when the payer puts the agent on hold?
You instruct it to wait silently through hold messages and music and to pick the conversation back up when a person answers. Test the hold messages of the payers you call most, since some play prompts that sound like questions.
Does it connect to our clearinghouse or practice management system?
Retell does not ship prebuilt connectors for clearinghouses, practice management, or EHR systems. Your system passes claim and member details when it starts each call through the API, and results come back by webhook or the Get Call API. Custom functions can also call your system during the call, for example to fetch a detail the rep asks for.
Can one agent handle different payers?
Yes. Pass payer-specific instructions and identifiers as variables on each call, such as which ID the menu asks for first, or build a separate flow for payers whose menus differ a lot. Logic split nodes in a conversation flow branch on those variables.
Is Retell HIPAA compliant for payer calls?
Retell supports HIPAA workloads. Self-sign the BAA before any protected health information goes through the platform; there is no fee to sign it. Then choose per agent what is stored, scrub categories such as names, dates of birth, and medical IDs from transcripts and recordings, and set how long call data is kept, from one day to two years.
How much do AI claim status calls cost on Retell?
Retell voice agents are priced per minute of conversation, from $0.07 per minute, depending on the language model, voice, and telephony you choose. Pay-as-you-go needs no contract, and Enterprise plans have custom pricing for high volume or custom deployment needs. See pricing for your mix.
