Batch Eligibility Verification

First Class Batch Eligibility

Outsource your complete verification needs to pVerify

pVerify is the leader in custom batch eligibility reporting, with our unique blend of machine and human-enabled AI and ability to use business logic and manual means of obtaining information from traditional and more difficult payers. With the largest payer list in the industry, pVerify provides specialty-specific details for all Medical, Dental, and Vision Payers. Outsourcing patient verification is a huge time and cost saver for Medical Practices and Hospitals that can easily glance at one place for all of their daily appointments, filter with ease, and identify specific benefit details.

Let us do all the work!

pVerify provides a completed report in Excel format with all of your requested patient benefit information. Color-coded font and highlighted rows help identify and flag specific patients: High Deductible, Medicare Risk, HMO Detection, and others, per request. Each patient is linked to their full patient record within the pVerify Premium Portal for additional patient benefit review.

pVerify’s Batch Reports are verified daily. The window of time allows for automated verification combined with manual efforts for difficult payers, unexpected payer downtime, and quality control review of each patient’s benefits to ensure various customization requests are added. The patients pulled for the DOS verification can be broken down by provider, appointment type, or service, ensuring only the patients that need to be verified will be pulled.

As pVerify’s Signature Batch Eligibility Verification Solution, First-Class Batch meets the needs of large Medicare Practices that provide a variety of services, as well as Specialists that require detailed benefit information.  pVerify is able to capture copays and co-insurance for multiple services in one verification. Additionally, they can go further by providing additional information unique to each industry, such as Routine Visit details for Ophthalmology, visits remaining out of allotted for Physical Therapy, and Surgical details based on the location of the procedure.

Depending on the EHR, Practice Management, or CRM, the extraction of the DOS patient file can be automatically pulled and received via STF File, removing the remaining manual aspect from the Provider’s side. Additionally, integrations with EMRs/PMs like AdvancedMD and Nextgen support pVerify’s FILE extraction.

First-Class Batch Eligibility Verification Solution Features:

Completely automated and outsource your entire appointment schedule, including the most difficult payers, to be verified in advance to your specifications.

 

Features Highlight:

  • Specific and customized, discrete benefits such as copay for your practice. For example: Specialist office copay or In-office Sx copay
  • Over 1350+ payers for eligibility verifications, highest payer list in the industry
  • Non-EDI payers, meaning we can get payers others won’t touch
  • Human-enabled AI and machine learning means every verified batch will have a person involved to apply payer-specific logic and conditions (for example one payer requires pre-authorization, another has surgical copay the same as specialist)

pVerify provides details at a deeper level, with information separated and highlighted individually for easier review and understanding

 

Traditional Details

  • View Plan Active Status with HMO/PPO Alert
  • Detect HMO, PPO, MCO, IPA, and Plan Sponsor Names when verifying Secondary
  • Capture Deductible & OOP allotted vs remaining
  • Additional Payer Info (Plan Sponsor or CA IPAs)
  • Standard Co-pay & Co-insurance details per Specialty.
  • Exception Reporting – Identify spelling errors and typos in Name, DOB, and Member ID to send correct information on each claim.

 

Detailed Benefit Information

  • Plan Name & Number, Policy Type, Group Name & Number
  • Important Dates: Effective, Expired, Plan Began, Service Began.
  • Learn if NPI is in Network (limited to participating payers)
  • Payer Billing Address, ID, and/or Phone Number
  • Co-pay, Co-insurance, Deductible applies to OOP details
  • Individual and Family Deductible and OOP information
  • Plan Group or Plan Network Tier information

pVerify aims to capture as much detail as possible through EDI, human-enabled AI, machine learning and manual effort. The availability of the above information varies and depends wholly on the payer.

Physical Therapy Examples

  • If Prior Authorization is required
  • Co-pays & Co-insurance details
  • Physical Therapy visits included in benefits vs remaining
  • Combined therapy details for visits allotted vs remaining
  • Used amount of Therapy Cap for Medicare
  • …and MORE!

 

Mental Health Examples

  • If Prior Authorization is required
  • Telemedicine and Virtual Visit Details
  • Co-pay & Co-insurance details for multiple Behavioral Health Services including: Mental Health Facility & Provider and Psychiatric,  Psychotherapy & Substance Abuse – Inpatient/Outpatient
  • Medicare Lifetime Days Reserve and Remaining

 

Ophthalmology Examples

  • If Prior Authorization is required
  • Co-pay & Co-insurance details
  • If routine exam is included in plan and available
  • Surgical and ASCF Co-pay & Co-insurance
  • Materials Information: Frames, Lenses, & Contacts
  • Non-EDI Payer verification: VSP, Eyemed, Davis Vision, etc.
  • Primary Care Provider Name

pVerify aims to capture as much detail as possible through EDI, human-enabled AI, machine learning and manual effort. The availability of the above information varies and depends wholly on the payer.

Additional Benefits and Solutions

  • Home Health, Hospice, and SNF Dates for Medicare
  • Issues (Inactive) and Exception Reports (Clean Claims) Included
  • Multiple level verification for IPA Payers
  • Primary Care Physician Details
  • Eligibility information for Preventative Services, including Annual Wellness Visit

 

Additional Solutions

  • Patient Estimator
  • Patient Payments
  • Claims Status Check
  • Same or Similar (Equipment)
  • Inpatient Skilled Nursing (Billing NPI)
  • Medicare CMN (Rentals)

First-Class Batch Reports

Outsource patient verification to pVerify to take on high volume, multiple services with discrete or difficult to obtain benefits, and Non-EDI Payers.

  • Includes access to Premium Portal and instant verification
  • Batches with no size limit and/or multiple services
  • Processed completely by pVerify
  • Integration with compatible EHR/PM
  • Minimum plan of $400 per month required

 

Self-Batch Eligibility

pVerify’s Self-Batch Eligibility is for users that want to run their own real-time batches and receive the highlighted Excel Report of benefit information but do not have the volume or need the customized service of the First Class Batch Solution.

*Does not include non-EDI payers and detailed benefits reporting

  • Included with pVerify Premium
  • Medicare and Medicaids included
  • Verify unlimited Batches in real-time
  • Commercial (EDI) Payers included for Active Status confirmation and Specialist benefits

Outsource your complete verification needs to pVerify

Let us do the work!

Learn more about pVerify’s highly customized First-Class Batch Eligibility Verification Solution

Meet with a pVerify Representative to assess your current work flow and unique requests to determine the best combination of pVerify’s Eligibility Solutions for your needs.

Featured Clients

pVerify works with clients in some of the largest Medical Practices, IPAs/MSOs, and Medical Billing companies. We have a very strong presence in Primary Care, Therapy (speech, occupational & physical), Orthopedics, Sleep Centers, and Imaging Centers.