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Provider Services Call Center Virtual Agent Fact Sheet

 

Last Updated: July 2024

GABBY™ is a verbal interactive virtual agent which is a part of the provider services call center. It is designed to listen to the caller and respond accurately, learning new vocabulary, phrases, accents and ways to communicate with each call. The virtual agent can fulfill multiple call flows (member eligibility, warrant, claim status) based on the users' inquiry without having to return to the main menu.
 

Enrolled Providers

The virtual agent works best with the Health First Colorado provider ID. If an NPI is preferred and the provider has multiple locations or provider types, the virtual agent will ask for the 9-digit ZIP code. The virtual agent asks the caller what is needed, analyzes what is said, and responds accordingly. It can answer the following inquiries:

  • Member Eligibility – The virtual agent can search for a date of service up to five years in the past. The caller can choose specifics about member eligibility such as Lock-in, Third Party Insurance (TPL), Managed Care, etc. rather than hearing the information all at once.
  • Warrant – The virtual agent can give weekly payment amounts.
  • Claim Status - The virtual agent can give the Explanation of Benefits (EOB) associated with the claim.

If the request cannot be supported, the virtual agent will transfer the call to a live agent. 

 

Phrases to Reach a Live Agent

Callers can say “details, detailed information, or more details” to reach a live call center agent any time after verification.

 

Below are some key phrases that will route the caller to a live agent:

  • Claims information other than claim status: Use statements such as pricing, revenue code, electronic visit verification, remittance advice
  • Portal: Use statements such as portal, web portal, add a delegate
  • Prior Authorization: Use statements such as prior authorization, PA, or PAR
  • Password Inquiries: Use a statement containing the word “password”.

The Call Tracking Number (CTN) will be read out at the end of the call, even when transferred to a live agent.

Additional Tips

  • Callers can use terms or phrases such as “EDI, Prior Authorization, I’m not enrolled, application, or password” to be transferred to the appropriate queue.
  • When checking a claim status by member ID and date span, speak the date by saying the name of the month, the date and the year. For example, 1/20/2022 would be spoken, “January 20 2022.”
  • Provider IDs and ICNs may be keyed in. This is often faster and more accurate than speaking the numbers. 

Need More Help?

Visit the Quick Guides web page to find all the Provider Web Portal Quick Guides.