Last Updated: July 2024
GABBY™ is a verbal interactive virtual agent which is a part of the Provider Services Call Center. The virtual agent is designed to listen to the caller and respond accurately, learns 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
Note: Providers must enter the Health First Colorado ID not the National Provider Identifier (NPI) when asked for ID verification.
The virtual agent asks the caller what is needed, analyzes what is said, responds accordingly and can answer the following inquiries:
- Member Eligibility – Search for a date of service (DOS) 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 – Provide weekly payment amounts.
- Claim Status - Provide 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 key terms or phrases such as “EDI," "Prior Authorization," "I’m not enrolled," "application" or "password” to be transferred to the appropriate Provider Services Call Center queue.
Callers can say “details,” “detailed information,” or “more details” to reach a live call center agent after Health First Colorado ID verification.
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.”
- Provider Web 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.”
Note: The Call Tracking Number (CTN) will be stated at the end of the call even when the caller is transferred to a live agent. The CTN can be referenced if additional calls are made to the Provider Services Call Center.
Additional Tips
- 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, 06/01/2024 would be spoken, “June one, 2024.”
- Provider IDs and Internal Control Numbers (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.