Insurance Form Helper

Live Standard plan or higher · Team member

Industry: Pharmacy: this app appears only in company workspaces set up for that vertical.

Assist with insurance form completion.

Workspace fields

These labels match the live EZ4YouTech.com 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

• Sign in as a team member on your company workspace (admins connect AI accounts separately).
• Confirm your company admin has connected at least one supported AI provider: leading AI services such as OpenAI, Together, Groq, and xAI (Grok); see the full list and pricing comparison in admin BYOS setup.
• Verify your plan includes Standard apps: locked apps show which plan unlocks 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 AI provider your company admin connected (your admin sets try-order in BYOS setup).
3. Review Guide & support: Expand Guide & support at the top for what the app does, how-to steps, tips, and feedback.
4. Acknowledge AI use notice: On first workspace entry each browser session, read the AI use notice and click I understand: continue to workspace.
5. Use sample inputs (optional): Click Use sample inputs above the form to load demo values from the tutorial, then edit before you run.
6. Paste or type your document: On the Intake tab, add content to Case notes: paste text or use Use sample inputs to load a demo, then edit before you run.
7. Guided step 1: Form & payer: In Guided workflow (step 1 of 2), complete Form type, Payer / plan name. Use Next → between steps.
8. Guided step 2: Case details: In Guided workflow (step 2 of 2), complete Fields to complete, Case notes. Use Next → between steps.
9. Run the app: On the Intake tab, click Extract fields. Review output on the Result tab and download if needed.
10. 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 click Use sample inputs to load a demo, then edit before you run.

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 inputs 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 your plan or confirm AI account setup.

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