An AI voice agent that answers routine provider eligibility and claim-status calls instantly — no hold, no repetitive lookups.
Live
Providers calling for eligibility checks and claim status waited on hold while staff looked up answers by hand. Pisteyo delivered a Provider Phone Agent that answers those routine calls instantly by voice. Routine provider calls are now contained by AI, staff are freed from repetitive lookups, and the capability went live on schedule.
The organization is a healthcare provider serving members and a provider network — handling eligibility, claims, and plan questions every day. Providers contact it constantly to confirm member eligibility and check claim status. Those answers already existed in the organization's self-service tools — but providers who called in still had to wait for a person to look them up, one call at a time.
Routine provider calls — eligibility and claim status — tied up skilled staff on lookups they repeated all day, while providers waited on hold. The organization asked Pisteyo to deliver those same answers over the phone automatically, with no disruption to how providers already call in.
A staged delivery designed for quality, compliance, and trust — moving from scope to a production-ready capability without disrupting the business.
Scoped two clear, routine call types — eligibility check and claim status — that mirror the organization's self-service tools.
Built the voice agent to return the same information staff would, from the organization's existing governed data.
Ran significant internal testing before handing anything to the business.
Conducted a focused user-acceptance test with the organization's team, logging and triaging issues through a single intake.
Confirmed no external communication was required — the agent is a natural part of the inbound call flow.
Went live on schedule, with no major risks outstanding.
The honest view: every deployment meets real-world constraints. Here is what was hard, and the deliberate choices that kept quality high and risk low.
Testing ran in a shared environment that could be unstable. A clear feedback loop and centralized issue logging separated environment quirks from real defects.
Keeping the agent to two routine call types kept quality high and risk low — deliberately resisting scope creep for launch.
The agent had to slot cleanly into existing call routing so providers reach it naturally, with a clean path to a person when needed.
The phone agent shipped alongside other AI capabilities; Pisteyo paced the rollout to protect adoption.
Pisteyo delivered a Provider Phone Agent that answers routine eligibility and claim-status calls instantly — no hold, no repetitive lookups. A meaningful share of routine provider calls is now contained by AI, returning significant time to staff.
With the provider channel proven, the same foundation extends to members, and the agent's scope can widen over time — turning the phone line into an always-on, self-service front door for the provider network. Every contained call is one a provider didn't wait on and staff didn't have to handle.
Two routine, high-volume request types — provider eligibility verification and claim status. Anything outside those routes cleanly to a person.
No. The agent sits inside the existing inbound call flow, so no provider retraining or external communication was required.
Callers are verified before any eligibility or claim information is shared, the agent is scoped to just two request types, and it draws on the organization's existing governed data — with HIPAA-aligned handling and full auditability.
Routine provider calls are contained by AI, handle time on those calls is shorter, and significant staff time is returned to higher-value work — delivered on schedule with a low-risk launch.
The same operator-led approach — strategy, build, and measured adoption — applied to your workflows.
