Challenge

One of California’s largest Medicaid and Medicare health plans, serving more than a million members and thousands of providers, was facing mounting pressure in its provider service operations. Providers routinely contacted the health plan’s call center to:

• Verify member benefits and authorizations before delivering care
• Check the status of claims and respond to documentation requests
• Manage credentialing requirements and directory updates

These repetitive, high-volume inquiries consumed provider relations staff time, delayed care, and drove up administrative costs. With provider satisfaction and network stability at stake, the health plan needed a new approach to delivering timely, accurate support.

Solution

To alleviate this burden, the health plan deployed Ushur’s AI Agent for Provider Servicing. Integrated into the provider portal, the AI Agent delivers conversational, 24x7 self-service for the inquiries that dominate provider call centers:

• Benefits Verification – Providers can instantly check authorizations, coverage details, and contract-specific requirements before delivering care.
• Claims Status & Documentation – The AI Agent guides providers through claims status checks and documentation needs, ensuring faster adjudication and payment.
• Credentialing & Network Management – Providers receive immediate answers on onboarding requirements, directory updates, and site reviews, helping maintain compliance and reduce delays.
• Administrative Requests – Routine questions such as payer IDs, fax numbers, and process steps are handled automatically, sparing providers from long hold times.

By focusing on these high-value interactions, the AI Agent directly addresses the areas that make up the majority of provider service call volume in real-world operations.

Results

With the AI Agent in place, the health plan is now able to:

• Deflect high-volume calls by automating benefits, claims, and credentialing inquiries through digital self-service.
• Reduce administrative costs by cutting the cost-to-serve on repetitive provider questions.
• Accelerate provider workflows by delivering instant, accurate responses that help providers move faster on behalf of patients.
• Improve provider satisfaction through frictionless, always-available service that replaces long hold times with quick answers.

Conclusion

This health plan’s deployment shows how AI-powered provider automation can handle the same inquiries that make up the bulk of provider service center traffic. By bringing automation to benefits, claims, credentialing, and everyday administrative questions, Ushur’s AI Agent strengthens provider relationships, lowers operational costs, and enables smoother care delivery at scale.

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