pVerify Eligibility verification

A leading Insurance Verification Software that provides Insurance Eligibility Verification, Medicare Verification, and the largest payer list for Health Insurance Verification 

pVerify’s Patient Insurance Eligibility Verification

Speciality Specific | All Payer Coverage | Realtime Accurate Results 

Established in 2006, pVerify has been a reputable leader in specialized Insurance Verification and continues to lead the industry in innovation and solution development. pVerify provides a new concept in eligibility verification and specialty benefits customization, called Eligibility Summary, that allows in-depth specialty-focused customized parsing of verified eligibility data for 100% of payers in the market. With the largest payer list in the medical industry, pVerify can verify benefits from all EDI payers plus Non-EDI payers (including vision payers) via our Batch Verification Processing Solution.

pVerify's Insurance Verification Solutions are available in 4 ways:

Individual Patient, Unlimited Batch Processing, EMR/PM Integration and API Development


Cloud-based Portal for realtime single patient verification

 Unlimited Self Batch upload and first class Batch solution with customized Excel reports

Build pVerify directly into your website with real-time API system of secure exchange supporting 1-to-1 transactions

Integration with an established EMR or Practice Management system

 pVerify’s Unique Patient Eligibility Verification Solutions Include:

Traditional Details

  • Plan Active Status
  • Demographics Discrepancies (clean claims)
  • HMO/PPO Details
  • Deductible & OOP Remaining
  • Eligibility Dates: Effective & Expired
  • Additional Payer Info (Plan Sponsor or CA IPAs)

Detailed Benefit Information

  • Co-pay/Co-insurance details per Service Type
  • Benefits by location: In Office, Out-patient, Ambulatory Facility Center and MORE!
  • Prior Authorization Requirements
  • Visits allowed vs remaining
  • Telehealth Details

Additional Features

  • Search, review, and re-verify patient’s stored by pVerify’s HIPAA Compliant Cloud for up to 60 days. 
  • Download PDF detailed reports of patient Eligibility Verification 
  • Estimate Patient Responsibility to collect correct copays on DOS with Patient Estimator

Complete Medicare Information

  • Highlighting Medicare Advantage (Part C) including HMO/PPO Alerts with Medicare Advantage Payer names
  • Identify Primary Payer if Medicare is secondary (helps you avoid Medicare Denials CO 22 and 109)
  • ACO/ Preventative Service HCPC codes to determine which patients are due for their Annual Wellness Exam, among others for Medicare
  • Home Health Care and Skilled Nursing Care spell information, Hospice Episode information and dates 
  • Medicare Part D: Pharmacy Payer Name, Plan Number, and Network ID. 

Schedule a Demo

Available in Real-time, Batch Report Processing, EMR/PM Integration, and API Development

More pVerify Solutions

Preventive Care

pVerify returns 54 actionable Preventive/ Screening HCPCS Codes for Medicare, including information on services like Annual Wellness Visit & Cancer Screening. With pVerify’s report, you can filter out of the list of patients the ones due for their next Annual Wellness Exam, for example.

Claim Status

pVerify’s Claim Status provides a quick glance at a patient’s Claim History, including Procedure Codes, Charge Amounts, and Status Codes up to a 12-month history. Staff can now check the current status of what the payer has on file as of that day and review the Status Codes to determine if action is required.

Estimate Patient Responsibility

Use your own fee schedule (either global or per payer) or use the up-to-date medicare non-facility pricing in pVerify’s Patient Responsibility Estimator. Built into the Eligibility Solutions, quickly estimate and collect copay at check-in.

Same or Similar

pVerify provides a patient’s complete 5-year record across all 4 jurisdictions in one verification, with accuracy and near-realtime. Run a patient’s Same or Similar directly from their Eligibility Results without retyping patient info with pVerify’s complimentary radio button. Solution requires existing NPI and PTAN numbers

pVerify vs Clearinghouse and Payer Sites

pVerify® 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 so as to not only improve the patient collections but also to reduce back-office denials.It's HIPAA Complaint, SaaS offering includes robust set of REST APIs, fully-customizable Eligibility Portal and Mobile SDKs that have been powering mission-critical, front-end eligibility processes solutions for leading healthcare software companies as well as ambulatory practices in the healthcare sector.