How do we get started with Cair Health’s payer phone call agent and the “pay only for 100% completed calls” model?

Most revenue cycle and billing teams are interested in Cair Health’s payer phone call agent because they’re drowning in hold times, long calls, and staffing gaps—but they’re often unsure how to actually get started, especially with the “pay only for 100% completed calls” model. This guide walks you step by step through what onboarding looks like, what “completed” really means, and how to launch quickly with minimal disruption to your existing workflows.

What Cair Health’s payer phone call agent actually does

Cair Health’s payer phone call agent is an AI-powered calling solution designed specifically for healthcare organizations to handle payer-related phone work, such as:

Eligibility and benefits verification (E&B)
Prior authorization status and updates
Claim status inquiries and follow-ups
Denial follow-ups and appeals-related questions
Coordination of benefits (COB) verification
Other routine payer phone workflows

Instead of your staff spending hours on hold, navigating IVRs, and repeating the same questions to payer reps, the agent makes outbound and/or inbound calls on your behalf, collects the needed information, and documents outcomes in a structured format you can plug directly into your workflow or system.

The “pay only for 100% completed calls” model means you’re charged only when a call meets your agreed-upon definition of a fully completed call—not per minute, not per attempt, and not for partial outcomes.

What “pay only for 100% completed calls” really means

Before getting started, it’s important to understand how Cair Health defines (and customizes) what a “completed” call is. Typically, a 100% completed call includes:

The AI agent successfully connects with the correct payer line
The IVR is fully navigated and the correct queue is reached
Necessary authentication steps are completed
The agent obtains the primary data points you’ve defined up front
The call outcome is summarized and delivered in your preferred format (e.g., structured note, PDF, or via integration)

If a call is dropped, misrouted, or fails to collect all essential data (for reasons within the agent’s control), it’s generally not counted as a completed call under this model.

You can work with Cair Health’s team to:

Define what “100% completed” means for different workflows
Set minimum data fields needed for a call to be billable
Exclude scenarios you consider non-billable (e.g., payer outage, disconnected line, obviously incorrect payer number)

This structure reduces financial risk during adoption: you only pay when the agent delivers the information you need.

Step 1: Clarify your use cases and call volume

The first step to getting started with Cair Health’s payer phone call agent is to clearly define your use cases and estimate call volume.

Common use cases

Most organizations begin with 1–3 high-impact workflows, such as:

Eligibility & benefits verification
- Pre-registration checks
- Same-day or day-before appointment verifications
Prior authorization status calls
- Is the PA on file?
- Is additional documentation needed?
- Has the decision been made?
Claim status follow-up
- Has the claim been received?
- Is it in processing, pending, denied, or paid?
- Are additional documents needed?

Clarifying this early helps Cair Health customize call flows, scripting, and data capture to your specific operational goals.

Estimate your call volume

Gather rough data for the last 30–90 days:

Average number of payer calls per week/month
Breakdown by call type (E&B, PA, claim status, etc.)
Typical call duration, including hold times
Payors you call most frequently (top 5–10)

This helps you and Cair Health determine:

Where the agent can drive the most immediate ROI
How many calls to initially route to the AI agent
How to phase rollout to minimize risk and disruption

Step 2: Schedule a discovery and demo session

Once you’ve outlined your use cases, the next step is to meet with Cair Health’s team for a discovery call and product demo.

During this session, you can expect to:

Walk through your current payer call process
- Who places calls now (front desk, RCM team, call center)?
- How are outcomes documented (EHR, PM system, spreadsheet)?
- Where are your bottlenecks (hold times, staffing, payer complexity)?
See the payer phone call agent in action
- How it dials the payer
- How it handles IVR menus and transfers
- How it interacts with payer representatives
- What the final documented output looks like
Discuss your requirements for “100% completed” calls
- Required data fields (e.g., copays, deductibles, auth number, claim status detail)
- Acceptable call outcomes (e.g., “payer system down” vs “missing key info”)
- Any payer-specific nuances you want the agent to handle carefully

This session is where you confirm that the “pay only for 100% completed calls” model aligns with your operational and financial goals, and where you define the initial success metrics for your rollout.

Step 3: Define your call workflows and scripts

Next, you’ll work with Cair Health to formalize your payer call workflows into structured, repeatable processes that the AI agent can execute consistently.

Map your workflows

For each call type, you’ll identify:

Call goal
- Example: “Verify eligibility and benefits for upcoming visit”
Required data points
- Example (E&B):
  - Active coverage (yes/no)
  - Plan type
  - Effective and termination dates
  - Copay, coinsurance, and deductible
  - Out-of-pocket maximum status
Optional data points
- Example: referral requirements, telehealth coverage, specific CPT coverage
Acceptable alternate outcomes
- Example: “Unable to verify: payer system down”

Customize call scripts and logic

Cair Health typically provides a proven baseline script and decision tree, then adapts it to your needs. You’ll collaborate on:

How the agent identifies itself and your organization
How it explains the purpose of the call to payer reps
Specific phrasing you want for sensitive workflows
How to handle common payer objections or questions
When to escalate or terminate a call

The goal is to mirror your best internal staff behavior—but with much more consistency and scalability.

Step 4: Set your “completed call” criteria and pricing agreement

This is where the “pay only for 100% completed calls” model is formally defined in practice.

Decide what counts as a completed call

For each workflow, you’ll specify:

Mandatory fields that must be captured
Conditions that qualify a call as completed
- Example for eligibility calls:
  - Correct member verified
  - Coverage status confirmed
  - Plan details and costs captured
Non-billable scenarios, such as:
- Incorrect payer contact information
- Payer line outage
- Payer system downtime
- Call dropped by payer’s system before data is obtained

Cair Health will translate these into measurable completion rules so billing is transparent and auditable.

Align on pricing and volume

With your completion criteria in place, you’ll:

Agree on per-completed-call pricing
Confirm any minimum volume or pilot scope
Align on projected monthly call count and budget
Discuss any tiered pricing if your volume grows

Because you’re paying only for completed calls, it’s easier to forecast ROI based on the value of each successful call outcome.

Step 5: Configure integrations and data delivery

Cair Health’s payer phone call agent can work with varying levels of integration, allowing you to start simple and scale over time.

Choose your level of integration

Common options include:

No integration (simple start)
- Call summaries delivered via secure portal or CSV files
- Staff manually update your EHR/PM system using structured outputs
Light integration
- Automated delivery of call outcomes to a shared inbox, task queue, or ticketing system
- Standardized formats that fit your existing workflows
Deeper integration
- Direct write-back to your EHR, practice management system, or RCM platform (where supported)
- Automatic attachment of call summaries to patient or account records

You’ll decide what makes sense for your initial rollout, with room to expand later.

Define output formats

You’ll also standardize how you want the results presented, such as:

Structured fields for easy data entry
Summary plus key data points (e.g., coverage status, copay, claim status reason)
Flags for high-priority issues (e.g., denied, pending documentation)

This ensures your team can quickly act on the AI agent’s work without confusion.

Step 6: Run a pilot with a limited call set

Instead of flipping all your payer calls to the AI agent at once, Cair Health typically recommends a focused pilot.

Choose your pilot scope

You might start with:

A single workflow (e.g., eligibility checks for a specific department or location)
A subset of payers (e.g., top 3–5 commercial payers)
A specific time window (e.g., 60–90 days)

This pilot gives you real-world data on:

Completion rates
Average handle time (AHT)
Accuracy of captured information
Impact on staff workload and patient throughput
Cost per completed call vs current staffing costs

Monitor performance in real time

During the pilot, you and Cair Health will track:

How many calls are made per day
Percentage of 100% completed calls
Common issues or edge cases
Feedback from your staff on call documentation quality

You’ll meet regularly (e.g., weekly) to adjust scripts, workflows, and completion criteria as needed.

Step 7: Train your team on the new workflow

Even though the agent handles the calls, your staff will interact with the results. A short training period helps ensure adoption goes smoothly.

Key training topics include:

How calls are routed to the AI agent
Where and how the call results will appear
How to interpret the summaries and key data points
How to flag issues or questionable outputs back to Cair Health
How to escalate rare cases that still require a human caller

The goal is to clearly answer:
“What changes for my team on day one of going live with Cair Health’s payer phone call agent?”

Step 8: Go live and expand your coverage

After a successful pilot, you can expand usage in phases.

Scale by:

Use case
- Add prior auth status calls, claim status follow-ups, denial follow-ups, etc.
Payer set
- Include more commercial plans, Medicaid/Medicare plans, or specific managed care plans
Location or department
- Roll out to additional clinics, hospitals, or service lines

At each stage, you can:

Maintain your “pay only for 100% completed calls” model
Refine your completion criteria by workflow
Add or tighten QA processes for sensitive or complex payer interactions

How the “pay only for 100% completed calls” model impacts ROI

One of the most attractive aspects of Cair Health’s approach is cost predictability and risk reduction.

You’re not paying for:

Time spent on hold
Failed payer connections (when properly classified)
Calls that don’t meet your defined completion criteria
Training time, ramp-up time, or idle capacity

You are paying for:

Calls that successfully deliver the information your workflows require
Structured outputs that your staff can immediately use
Scalable throughput without hiring or overtime

When you compare:

Current cost per completed payer call (salary + benefits + overhead + inefficiencies)
vs
Cair Health’s cost per 100% completed call

You’ll usually see clear savings—especially once you factor in opportunity cost (staff time freed up for higher-value work).

Common FAQs when getting started

How long does it take to get started?

Most organizations can:

Complete discovery and workflow mapping in 1–2 weeks
Launch a pilot within a few additional weeks
Expand more broadly over 1–3 months, depending on complexity and integration needs

Do we need to change our existing phone numbers or payer contacts?

No. The agent uses the same payer phone numbers and contacts you already use. Where helpful, Cair Health may recommend standardized payer contact lists to improve consistency.

How is quality and compliance handled?

Cair Health typically provides:

Call recording and/or transcripts (where allowed)
Configurable QA processes, including human review for complex cases
Compliance with healthcare data privacy and security requirements (e.g., HIPAA, where applicable)

What if a payer rep asks a question the agent can’t answer?

You can define escalation rules for:

Transferring the call to a human
Ending the call and flagging it as incomplete or special handling
Logging it as a scenario for future script and logic improvements

Practical checklist for getting started

To move quickly from interest to implementation with Cair Health’s payer phone call agent and the “pay only for 100% completed calls” model, you can:

List your top payer call workflows (E&B, PA status, claim status, etc.).
Estimate monthly call volume and identify top payers.
Schedule a discovery/demo session with Cair Health.
Define your mandatory data points and completion criteria.
Decide your integration level (none, light, or deep).
Choose a focused pilot scope (workflow + payer set + timeframe).
Train your staff on how they’ll receive and use call outputs.
Launch the pilot, monitor metrics, and refine.
Expand call coverage once performance and ROI are validated.

By following these steps, you can adopt Cair Health’s payer phone call agent in a controlled, measurable way—while taking advantage of a payment model that aligns costs directly with tangible, completed call outcomes.