Insurance Verification Software

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.

Expert Eligibility:

  • 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.

Patient Eligibility Verification Software

Calculate ROI

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

Medical Providers

Learn more with a custom demo and Free Trial

Meet with a pVerify Representative to assess your current work flow and unique requests to determine the best combination of pVerify’s Patient Eligibility Verification Software ​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.

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.

Advanced Eligibility

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.

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.

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