Solutions for Large, Multi-location Medical Groups
Patient Eligibility Verification Software
Next-level Customization with Business Rule Knowledge Base and Expert Consulting Services
Complex needs simplified with pVerify’s Solutions.
- Specialty-specific verifications supporting multiple services in one transaction
- Benefits are categorized and reported in a clear, straightforward manner
- Systematic inclusion and return of proprietary knowledge base within respective Eligibility benefits
- Multi-point solutions built into existing workflows for optimum Return on Investment
- Largest Payer List in the Industry including Medical, Dental, and Vision Payers
Experts in Eligibility
Verification of patient benefits is an ever-changing landscape. Determining coverage prior to DOS is the best way to accept patients, collect copayments, and submit claims correctly. Beyond the traditional needs like copay and deductible remaining: understanding prior authorization requirements, if surgical co-insurance varies by the location of the procedure, and other details that would result in denials.
Verifications include multiple services per transaction, separated and displayed to include all relevant information in a straightforward manner.
Business Rule Knowledge Base
Business Rules is pVerify’s unique way of taking a client’s bible 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.
Insurance Coverage 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.
Insurance Coverage 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
EMR Integrations and Benefit Write-back
pVerify’s Integrations automate real-time and DOS patient verification to return the benefits directly into the integrated system. A unique blend of machine-learning, human-enabled AI, and Business Rule Engine increases our means of returning essential information for both traditional and more difficult payers.
With 1350+ payers, pVerify provides multi-specialty-specific details for Medical, Dental, and Vision Payers. Filter with ease and identify desired benefit details. In addition to the returned data, pVerify offers the First-Class Batch Excel Report for easy filtering and patient review.
pVerify’s suite of products reduces labor costs and increases front-office cash flow and significantly decreases claims denials due to incorrect insurance data.
Imagine decreasing your Verification Team of 100 to 25 and re-allocating 75 staff members to other projects or new departments. With the automation and collection of information required for your Verification Team to make actionable decisions, one person can handle the work of four in many cases.
Connect to learn how to add pVerify’s Business Rules and Advanced Eligibility directly into your workflow
EMR/ Practice Management Integration
As an Authorized Integrator with established PMs like AdvancedMD and Allscripts, we go lengths beyond the basic eligibility typically provided with today’s software. pVerify provides Advanced Eligibility coupled with our First-Class Batch Reports to automate patient verification and provide helpful tools to enhance patient review prior to their appointment.
pVerify’s Integrations automate realtime and DOS patient extraction to verify in advance, and return the benefits directly into the integrated system. 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!
First-Class Batch Report
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. Minimum plan of $400 per month required.
The traditional Portal with add-on solutions
pVerify’s Patient Eligibility Verification Software Portal provides the widest offering of combination of services. It all begins with Advanced Eligibility 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, simple make one-click to estimate and to collect 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 priced separately. No long-term contracts.
APIs and Easy Endpoints
Build Eligibility directly into your website
Streamlining enhanced Eligibility Endpoints with over 50 years combined knowledge of parsing and coding Medical Benefit Data to provide front-end patient insurance eligibility and benefit verification processes which will improve the patient collections and reduce back-office denials. pVerify offers extensive capabilities with our robust APIs, Widgets, Drop-In UI and MORE. Add Eligibility as a consumer-facing solution or automate on the billing end of your processes.
With hands-on and responsive API Support, pVerify assists with designing your API workflow, acts as a hand-on guide throughout development, and remains a go-to expert post-development.
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 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.
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 Professional (Physician) Visit – Office to receive active status, standard benefit details such as HMO/PPO Payers, deductible and OOP remaining ,and more. Viewable in a similar color-coded file, Self-Batch Eligibility 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.
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.
Verify – Estimate – Collect
Our automated, date-of-service patient insurance verification brings unprecedented efficiency to your front-office workflow. Coupled with our Patient Estimator and hands-free Patient Payment, our Solutions can significantly reduce patient debt and improve front-office collections.
Verify a patient ahead of time or during their procedure with pVerify’s All Payer Advanced Eligibility Solution in Instant, Batch, or API Eligibility, in real-time with accuracy down to the service received.
Estimate patient financial responsibility powered by Eligibility results and your unique fee schedules for quick and easy cost estimates.
The Industry service leader in Realtime Healthcare APIs for Eligibility, Claim Status, & DME Solutions.