Right Party Verification

Inbound Calling Number

All calls selected for the pilot are selected based on the inbound calling phone number with a matching phone number on an account in RMeX that is not a hospital number. For the pilot, this will be considered one piece of verification data. That is, it's inherent that the calling phone matches a number in RMeX as a basis for being selected for the pilot.

Step 1: Gather Identifying Information

In the initial step, the AI assistant only gathers information without performing verification. The assistant will:

• Ask the caller if they are the patient on the account.
• Request the caller's first and last name.
• Request the caller's date of birth.
• Request the caller's full address, including:
  • Street number
  • Street name
  • City
  • State
  • ZIP code

Step 2: Verifying the Information

Not all collected information is used for verification purposes. Below is a breakdown of each data point and how it's handled:

Patient Status

• Purpose: Determines the caller's path through the system.
• Verification: Not used for verification.
• Logic:
  • If the caller is not the patient, they are transferred to a live representative after their intent is captured.
  • If the caller is the patient, the AI continues assisting them after their intent is captured.

First and Last Name

• Purpose: Used for verification.
• Verification: Via phonetic similarity algorithm.

Algorithm Details:

• An algorithm evaluates whether the name provided is phonetically similar to the name on file.
• Each comparison is scored on a 0 to 1 scale.
• A score ≥ 0.85 indicates that the patient name on the account IS phonetically similar to the name provided by the caller and should be accepted as part of the verification process even if the spelling is different, the name verified slot should be set to Y.
• A score < 0.85 indicates that the patient name on the account IS NOT phonetically similar to the name provided by the caller and should NOT be accepted as part of the verification process, the name verified slot should be set to N.

Examples:

• "Lin" vs. "Lynn" → High score (e.g., 0.91) → Result: Verified (Y)
• "Lin" vs. "Moore" → Low score (e.g., 0.52) → Result: Verified (N)

Date of Birth

• Purpose: Collected for record-keeping.
• Verification: Not used for verification.

Address

• Purpose: Used for verification.
• Verification: Via multi-step comparison.

Address Verification Logic: -Address verification uses a multi-path approach to match the address provided by the caller and the address on the patient account. Below are the possible comparison paths:

Path 1 - All components match exactly

Path 2 - Only street name differs

Path 3 - Street and house number differ

Path 4 - City/State/Zip differ

Path 5 - Using Smarty Streets for standardization

Path 6 - Using fuzzy matching for all components

-A score ≥ 0.80 indicates that the patient address on the account IS similar enough to the address provided by the caller and should be accepted as part of the verification process even if the spelling is different, the address verified slot should be set to Y. -A score < 0.80 indicates that the patient address on the account IS NOT similar enough to the address provided by the caller and should NOT be accepted as part of the verification process, the address verified slot should be set to N.

Examples:

• "15 Bee Street, Frank, MA 02038" vs. "15 Beech St, Franklin, MA 02038" → High score (e.g., 0.96) → Result: Verified (Y)
• "20 Beech St #1, Framingham, MA 01702" vs. "15 Beech St, Franklin, MA 02038" → Low score (e.g., 0.69) → Result: Verified (N)

Summary

Verification Results

Once all relevant identifying information has been gathered and processed, the next step in the call flow will be determined by the results of the verification process. The verification results are based on whether the name and address meet their respective criteria.

Possible Outcomes

-Verified
The caller's name and address meet or exceed the verification thresholds. The AI assistant proceeds with assisting the caller.

-Not Verified
One or more pieces of information do not meet verification criteria. The caller is either:

• Transferred to a live representative for further verification, or
• Asked to provide their information again.

Example Scenarios