Standard 270/271 captures pVerify’s Advanced Eligibility REST API, bringing key data to EHR Integrations, plus Prior Authorization on the horizon.
pVerify’s enhanced EDI 270/271 brings discrete benefits data to standard X12 Eligibility
pVerify, Inc, the leader in all-payer real-time patient insurance eligibility in API and cloud-based portal services for Medical, Dental, and Vision Providers introduces enhanced ANSI X12 technology along with the release of Prior Authorization (PR), and Business Rules Engine (BRE) at the MPE: Leaders Conference in San Diego this week. The conference, formerly known as the MGMA Annual Conference, will draw the most influential healthcare leaders from across the United States.
pVerify’s enhanced ANSI X12 allows standard 270/271s to easily consume pVerify’s Advanced Eligibility, offering detailed and discrete key data, by utilizing standard MSG segments to return parsed data. The latest version of HIPAA EDI standards, ASC X1 version 5010, required January 1st, 2013 according to CMS.gov, is the transaction used to communicate a patient’s eligibility status for coverage in the health insurance plan(s) for the requested date or date range and represents the third-most used transactions in healthcare, according to 1EDISource.
EHR/EMRs utilize EDI 270/271 but do not parse the data, often leading to front-office staff confusion. By adding the pVerify AI based parsed data engine on top of the standard EDI 271 result, pVerify is allowing traditional EMR vendors to utilize parsed data with minimal coding efforts, to return co-pay and other crucial benefit information that can be buried in the eligibility report.
In addition to standard EDI 271 results from the Payer, pVerify returns practice-specific, discrete benefits data by adding an EB – MSG segment. This can dramatically lower front-office errors since they can see the key, actionable data in a dashboard-type view (just a few rows of data) versus 10 pages of data that clearinghouses normally return. Plus, data can power a custom Patient Estimator by mapping this discrete data we return in the MSG.
Reaching beyond Eligibility, pVerify announces pAuth, a tool that removes the burden of manually obtaining prior authorization, available in winter 2021. According to the 2020 AMA Prior Authorization Physician Survey, 94% of physicians report care delays with 79% of patients abandoning care treatment due to Prior Authorization issues. With the average physician spending 2 full business days on Prior Authorization, pAuth aims to reduce time spent to a handful of hours.
Developed using 15 years of medical verification research, pVerify’s Advanced Eligibility is powered by historical knowledge to produce a unique benefits check, with additions like the Business Rule Engine fuelling optimized results. Capturing all possible Eligibility details for Healthcare Providers, the Business Rules Engine surpasses available information by systematically inserting verification specialists’ archival knowledge directly into qualified eligibility returns, adding more details than ever before available.
pVerify®’s HIPAA-complaint, SaaS offering includes a fully customizable Eligibility Portal, robust set of REST APIs, and Mobile SDKs that power mission-critical, front-end Eligibility process solutions for leading software companies in the healthcare sector.
pVerify, Inc was founded in 2006 by a team of accomplished Healthcare Professionals with a singular focus: streamline the front-end patient insurance eligibility and benefit verification processes to maximize practice revenue and minimize insurance denials.