Medical Insurance Eligibility Verification
Medical Patient Insurance Eligibility Verification
Medical Eligibility Verification Solution
Complete Patient Eligibility Verification
Eligibility Verification Solution
Insurance Eligibility Verification
Medicare Eligibility Check For Providers
Medicare Eligibility Verification
Insurance Verification
Insurance Verification software
Office Insurance Verification
Verify Insurance coverage online
Verify Insurance Online
Patient Eligibility Verification Software
Medicare verify insurance
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Eligibility verification system
verify Medicaid eligibility
Verify Health Insurance
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Verify Medical Insurance
All Payer Eligibility
Build pVerify’s Advanced Eligibility Verification directly into your workflow
With the largest Medical Insurance Eligibility Verification 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.
A leader in real-time Complete Patient Eligibility Verification, pVerify’s Advanced Eligibility provides more information than ever before for Medicare. Find what you need to see, from Episode Dates to HMO, PPO, and Plan Sponsor Details. Process Batches on your own with our Self-Batches Eligibility, view results on our Medicare Eligibility Summary Dashboard, run Estimations, collect Co-pays, and view Same or Similar and Inpatient Skilled Nursing Facility records with the click of a button.
Medicaid patient verification is more complex on many levels. Be it the MCO, HMO, and Plan Sponsors, Medicaid simply supplies information differently than most other payers. Developed for this reason, pVerify First-Class Batch Reports can verify both levels, Medicaid and their MCO/HHO/Plan Sponsors, automatically and return benefits specific to what you are looking for. Additionally, Medicaid Insurance Discovery with Name/DOB and bi-monthly Active Status confirmation prevent future denials and allow for Retroactive Medicaid Claims.
The latest addition for the industry leader of Insurance Eligibility, pVerify has added Dental Payers to its Real-time Eligibility Verification Solutions. With requirements of a Dental NPI and Tax ID, pVerify users can now verify 150+ Dental payers in their secure Premium Portal. Dental is available via single patient verification, First-Class Batch Solution, and API Connection.
Founded in 2006, pVerify’s first specialty of focus was Ophthalmology. Spending over a decade researching Vision benefits in our Medical Eligibility Verification Solution, pVerify added Non-EDI Vision Payers to their payer mix by enhancing their Non-EDI capabilities. Beyond the detailed vision benefits available with Advanced Eligibility, Material Coverage Details, PCP information, and Copay/Co-insurance details are available with the First-Class Batch Reports for VSP, Eyemed, Davis Vision and MORE!
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. Beyond the detailed benefits available from EDI Payers, further details can be obtained through our Non-EDI Solutions, such as Material Coverage Details, PCP information, IPA Active Status, and benefits from payers not capable of EDI communication.
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.
Medical insurance eligibility verification
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Insurance Verification
pVerify’s Unique Patient Eligibility Verification Solutions Features:
- Detailed Benefit Information
- Additional Features
- Specialty Specific Examples
- Verify - Estimate - Collect
pVerify provides Patient Insurance details at a deeper level, with information separated and highlighted individually for easier review and understanding
Traditional Details available with Eligibility Verifications
- 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 Copay & 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 Eligibility Verification 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.
Additional Features
- Home Health, Hospice, and SNF Dates for Medicare
- Multiple level verification for IPA Payers
- Issues (Inactive) and Exception Reports (Clean Claims) Included
- Eligibility information for Preventative Services such as Cardiovascular Disease Screening (CARD )(HCPCS|80061)
- Multiple Patient Batch Upload, Single Patient Verification, First Class Batch Processing, API Integrations, and EHR/PM Integrations available
- Primary Care Physician Details
Additional Solutions
- Patient Estimator
- Patient Payments
- Claims Status Check
- Same or Similar (Equipment)
- On-going Skilled Nursing (Billing NPI)
- Medicare CMN (Rentals)
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 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.
Verify Eligibility
- Verify a patient ahead of time or during their procedure with Instant, Batch, or API Eligibility, in real-time with accuracy down to the service received.
Estimate Patient Responsibility
- Estimate patient financial responsibility powered by Eligibility results and your unique fee schedules for quick and easy cost estimates.
Collect Payment
- Collect payment during appointment with hands-free options with QR code, card-on-file and customized card-on-file payment plans.
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.
Connect to learn what pVerify’s Advanced Medical Insurance Verification Solution provides for your specialty!
Create your own combination of pVerify's Solutions below
pVerify Premium
The traditional Portal with add-on solutions
pVerify’s Premium Portal provides the widest offering of combination of services. It all begins with Advanced Patient Eligibility Verification and our intentional separation of details for easier review and understanding. With Self-Batch Eligibility and our First-Class Batch Reports, verifying large numbers of patients is no longer an issue. Get all the results you need in one place. Then, make one click to Estimate and Payments, or add additional Solutions such as Claim Status and Inpatient Skilled Nursing Facility.
*As pVerify’s main portal, Premium clients always have unlimited users, locations, and NPIs. Each Solution is price separately. No long term contracts.
pVerify Lite
Simplified Portal at a lower cost
Just for patient verification, the pLite Portal is powered by the same Advanced Medical Insurance Eligibility Verifications with a simplified top dashboard display. With the same separation and display of details under individual tabs, individual providers receive the eligibility solution they need at a lower price point.
*Eligibility only, does not support additional solutions. $50 per provider with unlimited users. No long-term contracts.
Medicare – Summary Dashboard
The summary everyone needs
Enjoy pVerify’s new Medicare Eligibility Summary Dashboard to make easy and informed actions based on a quick-glance overhead view of a patient’s Part A, Part B, Home Health, Medicare Secondary Payer, HMO, Medicare Advantage Plan, Hospice Dates, and Deductible Remaining details. Labeled with a green check or a red exclamation, scan patients and make actionable decisions without toggling pages. Combine pVerify’s Medicare Patient Verification Solution – Eligibility Summary Dashboard with Self-Batch Eligibility to redesign and improve your workflow.
*Included with Premium at no extra cost. Open a patient’s record for more detailed review. One-click redirect buttons with form-autofill for Same or Similar, Inpatient SNF, and Medicare CMN.
First-Class Batch Reports
Outsource your patient verification to pVerify
Received and processed days before the appointment, 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.
*Add Instant Single Patient Verification at no extra cost. Supports EHR/Practice Management integration, pVerify extraction of appointment file, and other automations – participation of other software required. Minimum plan of $400 per month required.
Self-Batch Eligibility Verification
Run your own batches in real-time
pVerify now offers a Self-Batch Eligibility Feature for all Premium clients. Created for most basic verification needs, confirm active status for all EDI payers and/or for Specialist benefits to receive active status, standard benefit details such as HMO/PPO Payers, deductible and OOP remaining and more. View in a similar color-coded file, Self Service Batching is for clients that want to verify patient in mass but do not require a custom report with enhanced details reporting.
*Included with Premium Portal at no extra cost. Reports full details on Medicare and Medicaid batches – Medicare batches contain extra features. Insurance Discovery for Medicaids supported. Commercial (EID) payer patients are verified for the Specialist service type only. Batches are processed by user in real-time.
EMR/ Practice Management Integration
Automate First-Class Batches with Write-back Notes
pVerify’s Eligibility integrations automate patient extraction for a specific DOS to verify in advances, and returns the benefits directly into the integrated system (most often as a patient note.) In addition to the inserted data pVerify offers the First-Class Batch Excel Report for easy filtering and patient review. Examples of existing integrations: AdvancedMD, Allscripts, NextGen, Centricity, Raintree, and MORE!
*Integrations vary, highly customized eligibility details provided. Minimum plan of $250 per month required.
APIs and Easy Endpoints
Build Eligibility directly into your website
pVerify Best Healthcare APIs offer extensive capabilities with our robust Eligibility APIs, Widgets, Drop-In UI, and MORE. Add eligibility as a consumer facing solutions or automate on the billing end of your processes.
*Find the Developers Tab for more information
Schedule custom DEMO or Free Trial of pVerify’s Insurance Verification Solutions
Meet with a pVerify Representative to assess your current verification work flow to determine the best combination of pVerify’s Medical Insurance Eligibility Verification Solutions for your needs.
Create your own Hybrid Solutions Combination
pVerify is the only company to offer hybrid combinations of Online Portal Features, First-Class Batch Processing, White-labeled API Integrations, and more. Our suite of products can increase front-office cash-flow and significantly decrease claims denials due to incorrect insurance data, all while reducing labor costs related to phone calls, manual verification and recording, and workflows.
Effortless, automatic outbound/inbound connection from your EMR/Practice Management System to pVerify
Automated verification of your entire appointment calendar with First-Class Batch Processing
Complete and concise Batch Report supporting multiple specialties verified on your requested schedule
White-label pVerify’s secure cloud-based portal with location management, unlimited users, and NPIs
Build pVerify’s APIs directly into your own software with our robust APIs providing Easy Eligibility Endpoints
Verify instantly, estimate the patient responsibility powered by our Medical Insurance Eligibility Verification, and collect payment all in one portal
More pVerify Solutions
Claim Status
pVerify’s Claim Status allows users to check the current status from the payer to discover the claim was accepted, or denied, and review the Status Codes to determine if action is required.
Patient Estimator
Estimate patient financial responsibility powered by Eligibility results and your unique fee schedules for quick and easy cost estimates.
Healthcare APIs
The Industry service leader in Realtime Healthcare APIs for Eligibility, Claim Status, & DME Solutions.
