Healthcare Eligibility Solutions

A Complete list of our Solutions

Eligibility Solutions

Patient Eligibility Solutions

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.

Medicare Eligibility

An expert in all things Medicare, pVerify provides Medicare patient Verification in our Medicare Eligibility - Summary Dashboard, Unlimited Self Batch Verification, First Class Batch Solution, and API Connections.

Batch Verification

Automate verification to pVerify with our First-Class Batch Solution to verify patients and review on a color-coded and highlighted Excel report. Self-Batch Eligibility is available at no extra cost.

Patient Eligibility Solutions

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.

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

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!

Patient Eligibility Solutions

Insurance Discovery

Prevent A/R by detecting existing insurance for self-pay and unconfirmed coverage with a patient’s name and date of birth. 

Business Rules Engine

Take the knowledge from your senior verification specialists and build it into each patient result – allowing all staff to share historic knowledge without constantly memorizing existing materials.

Recursive Medicare

pVerify will first verify a patient’s full Medicare Coverage, if  a Medicare Advantage Payer is present pVerify will verify the Medicare Advantage Plan using human-enabled AI, machine learning, and our proprietary methods.

Beyond Eligibility Solutions

Prior Authorization

Obtain Prior Authorization with pVerify’s automated offering.

Coming Soon

Patient Estimator

Estimate patient financial responsibility powered by Eligibility results and your unique fee schedules for quick and easy cost estimates.

Patient Payments

Collect payment during appointment with contactless QR code, card-on-file and customized card-on-file payment plans with no contract commitment.

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.

Learn more about our Suite of Solutions with a DEMO, live Webinar, or Personal Conversation.