Insurance Form Helper

Live Requires Standard plan or higher · Agent role

Industry: Pharmacy — this app appears only on tenants provisioned for that vertical.

Assist with insurance form completion.

Workspace fields

These labels match the live EZ4Youtech workspace (sidebar provider + main panel):

• Form type (required) — select field in the workspace
• Payer / plan name (required) — text field in the workspace
• Fields to complete (required) — multiselect field in the workspace
• Case notes (required) — textarea field in the workspace

Primary action button: Extract fields

Workspace overview

Before you start

• Log in as a user on your company tenant (admins set up BYOK separately).
• Confirm your tenant admin has saved at least one AI provider key (OpenAI, Together, or Anyscale).
• Verify your plan includes Standard apps — disabled apps show the plan required to unlock them.

Step-by-step

1. Open the app — In the workspace sidebar, select Insurance Form Helper under Industry apps.
2. Choose your AI provider — In the sidebar, pick the BYOK provider your admin configured (OpenAI, Together, or Anyscale).
3. Upload document (optional) — Under Upload document, attach a file and click Upload. Enable Run after upload to fill the workspace and run in one step.
4. Use file history — Under File history, select a saved file and click Load file to populate your text field.
5. Use run history — Under Run history, pick a prior run and click View run to restore inputs and output.
6. Guided step 1: Form & payer — In Guided workflow (step 1 of 2), complete Form type, Payer / plan name. Use Next → between steps.
7. Guided step 2: Case details — In Guided workflow (step 2 of 2), complete Fields to complete, Case notes. Use Next → between steps.
8. Run the app — Click Extract fields. Review the Result section and download if needed.
9. Review before client use — Confirm facts, dates, and compliance language. Do not paste full SSN or card numbers.

Example inputs

Paste similar data in the workspace — use only data you are allowed to process. Field names match the live product.

Form type

Prior authorization — specialty medication

Name the payer form or workflow you are completing.

Payer / plan name

BlueCross PPO — group 88421

Payer or plan name from the member card (redact member ID in demos).

Fields to complete

patient name, Rx number, prescriber, quantity, refills remaining

List the labels you want extracted from the pasted source text.

Case notes

Case notes: Member Jane D. — specialty Rx Humira. Diagnosis M05.79 on file. Prior auth required per plan formulary. Prescriber NPI on file.

Paste policy, contract, or report text — or use Upload document / Load file to fill this field.

Try these scenarios

Adapt these prompts to your client — do not paste payment card numbers, SSNs, or full IDs.

• Extract patient and Rx fields from faxed intake text.
• Pull vendor, date, and line totals from invoice paste.
• Map insurance form fields from scanned paragraph text.

Expected result

Shape of the AI output in the Result panel — review before client use.

Example output (extraction)

• Field table: name → value pairs you requested
• Missing fields called out when not found in source
• Confidence notes for ambiguous lines

Tips

• Keep prompts specific: include dates, names, and constraints for better drafts.
• Do not paste full payment card or government ID numbers — use business-appropriate excerpts only.
• If the app is locked, ask your admin to upgrade the tenant plan or confirm BYOK setup.

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