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 Prior Authorization Calls to Insurance Payers
5.0
ON G2
Prior authorization calls to payers, placed by a voice agent instead of your authorization team. The agent dials the payer, works the phone menu, waits on hold, gives the rep the case details you pass in, and comes back with the status, authorization number, and approved dates as fields. Clinical questions and peer-to-peer requests go to your staff, and your team can listen in on any live call or take it over.
Trusted by over 4,000 businesses powering 100+ million calls per month.
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How It Works
Launch AI prior authorization calls in four stages, from payer scripts to approval details in your system.
Write payer and case scripts
Write what the agent says for each call type, such as a status check or a request the payer takes by phone, the menu steps for each payer, and the fields you want back. Retell offers a self-service BAA, which is required before any patient data is sent.
Test against payer calls
Run simulated calls with a rep who asks for a detail you didn't pass in, a long hold, a transfer to another department, and a pended case, and grade every run. Check that the agent answers the rep's questions from the case data instead of asking them back.
Start calls from your queue
Start calls from your authorization work queue through the API, or upload a list as a batch call that runs inside the hours payer lines are open, with the case details as variables on each call.
Go live and read results
Each call returns the status, authorization number, approved dates, and next step by webhook and API, with the recording and transcript, and your team can follow any call live while it runs.
Use Cases
Prior authorization calls placed, worked, and logged without tying up your authorization team
Status checks on pending authorizations
Need answers on pending cases without a staff member on hold. Physicians report an average of 40 prior authorizations a week, taking 13 hours of physician and staff time, in the AMA's 2025 prior authorization survey. The agent calls the payer for each pending case, works the phone menu with IVR navigation, gives the provider and member identifiers and the reference number, and asks whether the request is approved, pended, denied, or waiting on more documentation.
Requests the payer takes by phone
Need to submit where the payer still wants a call. When a plan takes an authorization request by phone, the agent gives the rep what your system passed in for that case, such as the procedure and diagnosis codes, the ordering provider, the facility, and the planned dates. It answers only from that data, and when the rep asks for something it doesn't have, it says your team will follow up or transfers the call. Referrals that need an authorization before the visit can start from patient referral calls.
Authorization numbers and dates returned as fields
Need the outcome in your system, not in a recording. Post-call extraction returns the status as a choice from your list, the authorization number, the approved start and end dates, the reference number, the rep's name, and where the payer will send the written decision. Fields arrive in the call_analyzed webhook, and a post-call function can send them to your own endpoint, so the case updates without anyone replaying the call.
Staff listening in, with the option to take over
Need a person close by while you build trust in the calls. With live monitoring, your authorization staff follow the transcript of any call in progress and listen silently, and neither the payer nor the agent is notified. If the rep raises something only your team should answer, a staff member takes over from the dashboard, which stops the agent for the rest of that call and connects them directly.
Clinical questions and peer-to-peer requests sent to your team
Need clinical conversations to stay with clinicians. When the payer asks for medical necessity details beyond the case file, offers a peer-to-peer review, or reads out a denial, the agent hands off by warm transfer. If your team works from a queue, it waits for a real person to answer, then briefs them privately on the patient, the payer, and what the rep asked before connecting.
Payer calls for many clients or sites on one platform
Need to run authorization calls for several provider clients or facilities. Revenue cycle companies and healthcare BPOs give each client its own agent, or pass client-specific instructions, provider identifiers, and payer menu steps as variables on each call. Calls run in parallel, with 20 concurrent calls included on pay-as-you-go and more on demand. Agencies that resell under their own brand can start with white-label AI voice agents.
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 prior authorization calls
Payer-specific menu steps and identifiers
Every payer's phone tree and identifier order is different. Pass the menu steps and the identifiers each payer asks for 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.
Case data in, answers out as fields
Your work queue passes the member, provider, procedure, and reference details into each call. Each answer you need, such as status, authorization number, and approved dates, is a typed field: a choice from a list, a number, yes or no, or text.
Warm transfer to your authorization team
When the rep needs a clinician or a decision your rules don't cover, a warm transfer briefs your staff privately on the case and what the payer asked, then connects them.
Many payer calls at once
A staff member 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 by payer
You need to know which payers answer and which cases moved. Post-call extraction records the status and whether a rep was reached, batch results show calls sent, picked up, and successful, and alerts notify you by email or webhook when the 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 an AI voice agent call payers about prior authorizations?
Yes. On outbound calls the agent presses keypad tones to work through payer menus, including sequences such as an ID followed by the pound key, and answers speech menus by speaking. You instruct it to wait silently through hold messages and pick up when a person answers, then it gives the identifiers for the case and records the answer. For calls coming in from members and provider offices about an authorization, start from the pre-authorization support template.
Does the CMS prior authorization rule end these calls?
No. Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), Medicare Advantage, Medicaid, and CHIP payers generally have had to decide expedited requests within 72 hours and standard requests within 7 calendar days since January 1, 2026, and to give a specific reason for a denial. The Prior Authorization API requirement starts January 1, 2027, drugs are excluded, and many commercial plans fall outside the rule, so status questions still reach payer phone lines. Our prior authorization automation guide covers which calls remain.
Does Retell connect to our EHR or authorization platform?
Retell has no prebuilt connector for EHRs, practice management systems, or authorization platforms. Your system starts each call through the API with the case details as variables, custom functions can call your API during the call when the rep asks for something, and results reach you by webhook, the Get Call API, or a post-call function that posts to your endpoint. Salesforce and HubSpot are native CRM integrations if your team works cases there. Read how to connect an AI voice agent to your EHR.
Can our staff step in during a call?
Yes, in two ways. With live monitoring, permitted users follow the transcript of any call in progress, listen silently, and take over, which stops the agent for the rest of that call. You can also set rules so the agent hands the payer rep to your team by warm transfer, with a private briefing, when a clinical question, a peer-to-peer request, or a denial comes up.
Is Retell HIPAA compliant for prior authorization calls?
Retell supports HIPAA workloads and offers a self-service BAA at no additional fee; the BAA is required before any protected health information goes through the platform. Then choose per agent what is stored, scrub categories such as names, dates of birth, and medical IDs from transcripts, recordings, and extracted fields, and set how long call data is kept, from one day to two years. Our HIPAA guide covers the details.
How are AI prior authorization calls priced on Retell?
Retell bills per minute of call time, and the rate depends on the language model, voice, and telephony you choose. Pay-as-you-go has no annual contract and includes 20 concurrent calls, and the Enterprise plan adds volume rates, custom terms, and a higher cap on concurrent calls. See pricing for your mix.
