One of California’s largest Medicaid and Medicare health plans, serving over 1m members and thousands of providers, was struggling with mounting pressure in its provider service operations. Providers frequently contacted the plan’s call centre to verify member benefits and authorisations, check the status of claims, respond to documentation requests, and manage credentialing requirements and directory updates.
These high-volume, repetitive inquiries consumed significant provider relations staff time, delayed patient care, and increased administrative costs.
With provider satisfaction and network stability at stake, the health plan sought a more efficient approach to delivering accurate, timely support.
To tackle this challenge, the health plan implemented Ushur’s AI Agent for Provider Servicing. Integrated directly into the provider portal, the AI Agent offers conversational, 24×7 self-service for the inquiries that dominate provider call centres.
Key functionalities include:
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Benefits verification – Providers can instantly confirm authorisations, coverage details, and contract-specific requirements before delivering care.
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Claims status and documentation – The AI Agent guides providers through checking claims status and necessary documentation, facilitating faster adjudication and payment.
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Credentialing and network management – Providers receive immediate answers on onboarding, directory updates, and site reviews, ensuring compliance and reducing delays.
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Administrative requests – Routine questions, such as payer IDs, fax numbers, and process steps, are handled automatically, eliminating long hold times.
By focusing on these high-volume interactions, the AI Agent directly addresses the majority of provider service call traffic, freeing staff to focus on more complex issues.
The results have been transformative. The health plan now:
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Deflects high-volume calls by automating benefits, claims, and credentialing inquiries through digital self-service.
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Reduces administrative costs by lowering the cost-to-serve for repetitive provider questions.
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Accelerates provider workflows with instant, accurate responses that help providers act faster on behalf of patients.
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Improves provider satisfaction through frictionless, always-available service, replacing long hold times with quick answers.
This deployment illustrates the potential of AI-powered provider automation to manage the bulk of service centre traffic efficiently. By automating benefits, claims, credentialing, and routine administrative queries, Ushur’s AI Agent strengthens provider relationships, reduces operational costs, and enables smoother care delivery at scale.
Read the full blog from Ushur here.
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