At Develop Health, we understand the importance of accuracy and reliability in the benefit verification process. While our advanced AI technologies handle the bulk of the work with efficiency, there are instances where human intervention is crucial. This is where our Human Fallback system comes into play, ensuring that every verification process is handled with the utmost precision and care.

The Role of Human Fallback:

When AI Meets Its Limits:

In cases where our AI system encounters complexities or ambiguities that it cannot resolve, such as unclear responses from a PBM or unusual case scenarios, our Human Fallback mechanism is triggered.

Skilled Human Intervention:

Our team of trained professionals steps in to take over the process. They handle the necessary calls and interactions with PBMs to clarify and verify the required information.

Seamless Transition:

The transition from AI to human intervention is smooth and seamless. Our system is designed to provide our team with all the relevant context and information gathered by the AI up to that point, ensuring no loss of data or time.

The Benefits of Human Fallback:

  • Reliability: While AI provides efficiency, the addition of human oversight ensures that the verification process is reliable and thorough.

  • Flexibility: Human intervention allows for the handling of unique or complex cases that might be beyond the scope of pre-programmed AI responses.

  • Quality Assurance: With humans in the loop, we can guarantee a higher level of accuracy and attention to detail, crucial in the healthcare industry.


The Human Fallback feature in our Benefit Verification service at Develop Health is a critical component that underscores our commitment to quality and accuracy. By combining the speed and efficiency of AI with the discernment and adaptability of human expertise, we ensure that healthcare providers receive the most reliable and comprehensive benefit verification information. This balanced approach is integral to our mission of facilitating efficient and effective healthcare services.