Realtime Insurance Eligibility Verification

 

Eligibility Exemplified.

The Leader in All-Payer Realtime Patient Insurance Eligibility Verification with Instant, API and Batch Solutions that blend technology with human-enabled AI to simplify the complex landscape of the patient care cycle for Medical, Dental, and Vision Healthcare Providers.

What's New in 2021

Knowledge Base Business Rules Engine

Available NOW →

Realtime Vision Eligibility

Available NOW →

SalesForce App

Coming Winter 2021 →

SOC 2 Certification

Coming Fall 2021 →

 Realtime Insurance Eligibility Verification

Industry Leaders choose pVerify’s Eligibility Verification Software

100+ Million Transactions

%

Reduction of Claim Rejection and Denials

%

Less Staff Time Spent on Eligibility

%

Complete Payer Coverage EDI and Non-EDI

Realtime Insurance Eligibility Verification

Why Choose pVerify

pVerify tailors Eligibility Verification specifically to your practice and make it easy for you to see the details you need.  The addition of The Patient Estimator and Patient Payments complete the patient cycle, allowing for correct estimates of a patients financial responsibility and contactless payment collection.

Powered by its own APIs pVerify aimed it’s focus on studying over 1350 payer responses to compile unique eligibility settings for each. Championing the highest level of benefits parsing with consumable API endpoints, pVerify’s team of expert developers stride forward to refine and maximize benefit reporting.

“I’ve been impressed with Pverify since we began working with them. We started out utilizing the same and similar service and immediately implemented the SNF check when it became available. Their development team worked well with our IT team to create an API for our front-end application. As a high-volume provider, it is important that we can quickly get results that allow us to determine whether a patient has had a same/similar product provided. We utilize both the individual patient lookup and the batch search and are delighted with the simplicity. The responsiveness of the entire team from the relationship manager to the developers has been phenomenal. I recommend Pverify to any provider that is looking for same/similar or SNF checks.”

Sam Jacobson

Senior Director, DJO Global

Don’t just verify, pVerify!

Leading the Industry with the Best Healthcare APIs and Realtime Insurance Eligibility Verification Software, pVerify provides details at a deeper level, with 270/271, robust Eligibility APIs, First-Class Batch, and Realtime Patient Eligibility Insurance Verification.

pVerify® Featured Integrations

Verify Eligibility Insurance Verification Software

Advanced Eligibility

With the Largest Payer List in the industry, pVerify is the only company to go beyond the traditional EDI payers to provide the eligibility benefits from the smaller and time-consuming non-EDI Payers. We provide details at a deeper level, with information separated and highlighted individually for easier review and understanding.

Beyond EDI and non-EDI, we are capable of providing information no one else can, like MA Payer changes, automatically verify MA Plans from Medicare Benefit results, and MORE!

Medicare Eligibility check Medicare MBI Lookup

Business Rule Engine

Business Rules is pVerify’s unique way of taking a client’s rulebook of proprietary knowledge, the binder and post-it notes of information gathered over the years by experienced verification specialists and inserting that knowledge to be cycled through and reported on qualifying patient benefits. Based off of a Payer, Group Name/Number, Member ID, Plan Name/Number or Policy ID.

Add your verification specialist’s expert knowledge into pVerify’s Business Rule Engine, to be returned automatically on verified patient benefits.

Medicare Experts:

  • Medicare Eligibility
  • Recursive Medicare Advantage Payer Auto-verification
  • Medicare Summary Dashboard
  • Self-Batch Eligibility 
  • Medicare ACO – Preventive Services Eligiblity Dates
  • Medicare MBI Lookup
  • Episode Dates, Caps, and MORE!

Medicare Experts

pVerify’s Medicare Eligibility provides more information than ever before for Medicare. Find what you need to see with the click of a button, from Episode Dates to HMO, PPO, and Plan Sponsor Details. Process Batches on your own with our Self-Batch Eligibility, view results on our Medicare Eligibility Summary Dashboard, and run Estimations, collect Co-pays, and view Same or Similar and Inpatient SNF.

Insurance Discovery:

  • Search top 10 payers based on patient’s location
  • Find Medicare coverage with SSN, Name, and DOB
  • Obtain Medicare MA Plan details, including subscriber ID, from Medicare verification
  • Discover thousands of plans with unlimited Batch Uploads

Insurance Discovery

pVerify’s Insurance Discovery allows Hospitals and Providers to find a patient’s insurance coverage to collect potentially millions from insurance companies, allow prompt claim submission, increase patient payment collection, and drastically decrease Account Receivables.

Before providing service or afterward while prepping the claim, pVerify’s Insurance Discovery can detect up to 50% coverage for self-pays and incomplete patient files.

Medicare Eligibility

Verifying Medicare coverage to detect Medicare Advantage Plans is the first step for all possible Medicare patients. Providers and Suppliers need to know each patient’s Medicare Part A, Part B, and MA Payer details in order to bill the correct payer. 

Medicare Claim History

pVerify’s Same or Similar goes beyond any other solution to take the guesswork out of a very complex system by creating a “flag” to determine if the patient qualifies for a new item or if they have already received one similar. This interpretation flag saves suppliers a significant amount of time, reduces denials and prevents revenue loss by interpreting the Claim History for the user.

Inpatient SNF Details

Durable Medical Equipment Suppliers need to know if a patient is admitted into a Rehab Facility prior to issuing their equipment or risk not getting paid.

pVerify vs Clearinghouse and Payer Sites

pVerify Eligibility

Cloud-based Portal, Batch, API or Integrated

  • Realtime Dental, Vision, and Medical Eligibility
  • Business Rules Engine (AI Supported)
  • Multiple Service Types per Verification
  • Robust APIs (270/271, HL7, FHIR, REST API)
  • Highly Parsed Benefits – at a deeper level
  • Turn-key First-Class Batch Reports
  • Unlimited Self-Batch Eligibility
  • Easy-to-read User-friendly Premium Portal
  • Hands-on API Development Support
  • API Consulting Services
  • Human-enabled AI and Machine Learning
  • Unlimited Users, Providers, and Locations
  • HIPAA Compliant and secure cloud-based Portal

Clearinghouse

Long-term Contract

  • Restricted Payer List | No non-EDI Payers
  • Limited to one Service Type per Verification
  • Complex Display | No Parsing of Key Data
  • Minimal Customer Support
  • Large Setup Fee
  • Long-term Contract

Free Payer Site

Manual Verification Only

  • Payer-Specific
  • Multiple Web Portals
  • Completely Manual
  • No Parsing of Key Data
  • Complex Displays
  • Minimal Customer Support

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