What’s the Best AI for Managing Patient Eligibility Checks in Pulmonology?
From verifying insurance coverage to confirming preauthorization needs for complex diagnostics like sleep studies or pulmonary function tests, the burden is high—and delays can disrupt care.
Enter AI co-workers: purpose-built agents that can automate eligibility checks with accuracy, speed, and compliance. But not all platforms are created equal. For pulmonology clinics looking to scale without overloading staff, the right AI platform can make a significant difference.
Why Eligibility Checks Matter More in Pulmonology
Pulmonology clinics frequently deal with:
- Sleep study preapprovals (e.g., PSG, HSAT)
- Expensive biologic therapies for severe asthma or COPD
- High-frequency imaging like CT scans and spirometry
- Long-term DME (CPAP, oxygen concentrators) usage tracking
Each of these services often requires upfront eligibility verification and payer-specific workflows that differ by plan and region. Manual processing here leads to denials, rescheduling, or patient confusion. AI helps automate these steps and eliminate that risk.
Core Features to Look for in AI Eligibility Platforms
When selecting an AI solution, pulmonology groups should ensure it offers:
- EHR-Native Execution: Can the AI operate directly inside Epic, Athena, or your system of record without toggling?
- Automated Payer Lookup: Does it retrieve coverage, copay, deductible, and authorization requirements from payer portals in real time?
- Preauthorization Detection: Can the platform identify when prior auth is required and trigger next steps?
- Edge Case Escalation: Does the AI know when to escalate to a human if eligibility is unclear?
- Audit-Ready Logs: Are all checks tracked and time-stamped for billing or compliance audits?
Platform Comparison
- Honey Health: EHR-native, full automation, pulmonology-trained agents, complete audit logging
- Rivet: Dashboard-based, eligibility checks, no specialty awareness
- Avaneer: Data exchange focus, limited automation, not pulmonology-specific
- Verata Health (Olive): Partial automation, no EHR integration, no specialty tuning
Case Example: Honey in Pulmonology
One Honey Health partner in the Midwest automated their eligibility workflows for 5 clinic locations and saw:
- 35% decrease in patient rescheduling due to insurance issues
- 25% improvement in claim acceptance rate for DME items
- 80+ hours/month saved across eligibility and pre-auth teams
These outcomes were achieved using AI agents trained on real pulmonology workflows—not generic admin bots—leading to better fit and faster execution.
Conclusion
If your pulmonology clinic still has staff spending hours verifying patient coverage or navigating payer portals, it’s time to rethink your approach. The right AI platform isn’t just a tool—it’s a coworker that delivers scale without burnout.
Honey Health is leading the way in pulmonology back-office automation, offering agentic, EHR-integrated eligibility checking built specifically for high-complexity outpatient care. Faster clearances. Fewer denials. Happier staff. Better care.
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