Healthcare Eligibility Solutions
A Complete list of our Solutions
Eligibility Solutions
Advanced Eligibility
All Payer Advanced Eligibility Solution for Vision, Dental, and Medical Payers provides the Deepest Level of Benefits Reporting for Commercial, Medicaids, and Medicare Payers.
Go beyond standard Eligibility with our Business Rules Engine for no extra cost.
Insurance Discovery
Championing the highest percentage of coverage identify through nearly two decades of payer research, understanding payer criteria, DOS range details, and our proprietary set unique to 51 states.
Now supporting California Medicaid and BC of CA. Tricare East, West, and LIFE to be added in summer 2023.
Business Rules Engine
Empowered productivity from clinical and administrative staff by delivering critical information at moment of need with our reliable system to recycle staff knowledge across numerous locations.
The BRE automatically includes detailed communication on specific types of patients or coverage.
CPT Benefits Investigation
pVerify offers a game-changing solution to long and frustrating phone calls and hold times with a team of Expert Verification Staff and Robotic Process Automation (RPA) to gather critical CPT Code Benefit information.
Batch Verification
Let pVerify handle complex patent verification with our First-Class Batch Solution and review results in a color-coded and highlighted Excel report or directly within your EMR. Self-Batch Eligibility is available at no extra cost.
Integration and APIs
pVerify’s enhanced Healthcare Eligibility and Medical APIs endpoint’s advanced configuration features allows Developers to get the data they want without wading through complex objects for 10 unique Healthcare API Solutions.
FHIR, HL7, 270/271, RESTful API, SalesForce and MORE!
Medicare Eligibility
An expert in all things Medicare, pVerify has a Medicare Eligibility - Summary Dashboard, HMO/PPO Flags with auto-verification, identifies changes 4 months into the future, provides PBM details and Cap information, and even offers a second solution that obtains a patient's MBI Lookup with just their Name/DOB.
Vision Eligibility
As of September 2021 pVerify now offers real-time Vision Payer Verification in the Premium Portal and API Integration for VSP, Eyemed, March Vision, Premier, Davis, Spectera, and MORE! Beyond the detailed vision benefits available with Advanced Eligibility, Material Coverage Details, PCP information, and Copay/Co-insurance details are available.
Vision Prior Authorization Coming Soon
Dental Eligibility
Dental Payers Verification is now available as a real-time Eligibility Verification Solution. With the requirements of a Dental NPI and Tax ID, pVerify users can now verify 180 Dental payers in their secure Premium Portal. Dental is available via single patient verification, First-Class Batch Solution, and API Connection.
Beyond Eligibility Solutions
Prior Authorization
pVerify’s Fast-PASS Prior Authorization houses a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions in over 50% of submissions, case validation, status updates, and streamlined supporting documents transfer.
Patient Estimator
Estimate patient financial responsibility powered by Eligibility results and your unique fee schedules for quick and easy cost estimates.
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.
Additional Medicare Solutions
Same or Similar
pVerify’s Same or Similar allows users to review a patient’s 5-year Claim History in near real-time with interpretation flags for easy and actionable decisions.
Inpatient SNF
pVerify Inpatient SNF Solution provides details on current SNF and Hospice stays, as close as 72 hours after admission, including the provider's NPI.
Medicare CMN
pVerify’s Medicare CMN allows users to review a patient’s CMN history for approved certificates along with the initial and last claim date, to see what rentals have been approved.
MBI Lookup
Find a patient’s new MBI ID with their Name and SSN/old HICN.