Free Medicare Patient Verification*, HMO/PPO Detection, PBM Search, Unlimited Batch Eligibility Processing, and API Eligibility Verification Solutions

pVerify’s unique Medicare Patient Eligibility Verification includes:


HMO/PPO Alerts and Detection (helps you avoid Medicare Denials CO 22 and 109)


Subscriber Demographics Information (required for clean claims)


Hospice Episode information and dates


Home Health Care / Skilled Nursing Care information


Eligibility Dates: Effective and Expired


Medicare Part D: Prescription Benefits Manager, PBM details including Pharmacy Payer Name, Plan Number, and Network ID.


Actionable Preventative Care details for 54 HCPCS codes


Traditional details: Plan Active Status and Deductible Info


Specialty Specific Benefits and Deductible info


Search, review, and re-verify Medicare patient's stored by pVerify's HIPAA Compliant Cloud for up to 60-90 days.


Download PDF detailed reports of patient Medicare Eligibility Verification


UNLIMITED Batch Report Processing

pVerify's Comprehensive Real-time Medicare Verification will ensure that you don't end up dealing with costly denials (e.g. denial codes CO 24 and CO120)


Don’t take chances!  

What is pVerify Patient Eligibility Verification?



Examples of Verified Medicare Coverage with Details

Medicare with HMO Alert

Medicare with PPO

Straight Medicare A & B

Verify Medicare Coverage

Available in Individual Patient, Unlimited Batch Processing, and API Integration

Valley Behavioral Health has partnered with pVerify utilizing their Eligibility Verification Custom Excel Batch tool since Nov 2018.  Our first impression of this company was that they were very professional, attentive and listened to our needs.  They took our request and within a couple weeks of our introduction, they effortlessly built us customized discrete eligibility data that has proven hands down to be a great ROI.  We have been extremely happy with their diligent and efficient business relationship and their quickness in responding to our needs.  We have no problem making recommendations to other agencies within the state of Utah looking for proven valuable eligibility data

Kathy McCall

Director of Revenue Cycle, Valley Behavioral Health

Utilizing pVerify’s automated verification service, we are able to validate our patient’s benefits thoroughly and consistently in advance of their visit…This allows us to identify issues relating to patient’s coverage and take corrective action before the patient being seen..I highly recommend pVerify eligibility solutions for any busy practice

Albert Castillo

CEO , Texas Eye Center

Since using pVerify, we have significantly reduced claim rejections, lowered administrative cost (by reducing the time it takes to verify eligibilities) and has improved our cash flow. pVerify has contributed immensely to our practice and I am so happy that we began using them. pVerify truly is an efficient and cost-effective tool designed to facilitate the eligibility verification process.

Beth Carvajal

Administrator, Pediatric Associates of NYC

More pVerify Solutions

Same or Similar

pVerify is the ONLY company that provides a patient’s complete 5-year record across all 4 jurisdictions, with accuracy and near-realtime. Run a patient’s Same or Similar directly from their Eligibility Results without retyping patient info with pVerify’s complimentary radio button.

MBI Lookup

pVerify gives a scalable solution for obtaining the NEW Medicare MBI number, by submitting the patient’s SSN, DOB and Name. Available in single patient, batch processing, pVerify’s MBI Lookup is available without an NPI.

Preventive Care

pVerify returns 54 actionable Preventive/ Screening HCPCS Codes, including information on services like Annual Wellness Visit & Cancer Screening. With pVerify’s report, you can filter out of the list of patients the ones due for their next Annual Wellness Exam, for example.

Claim Status

pVerify’s Claim Status provides a quick glance at a patient’s Claim History, including Procedure Codes, Charge Amounts, and Status Codes up to a 12-month history. Staff can now check the current status of what the payer has on file as of that day and review the Status Codes to determine if action is required.

Patient Estimator

Use your own fee schedule (either global or per payer) or use the up-to-date medicare non-facility pricing in pVerify’s Patient Responsibility Estimator. Built into the Eligibility Solutions, quickly estimate and collect copay at check-in.

pVerify® was founded in 2006 by a team of accomplished Healthcare Professionals with a singular focus: streamline the front-end patient insurance eligibility and benefit verification processes so as to not only improve the patient collections but also to reduce back-office denials.It's HIPAA Complaint, SaaS offering includes robust set of REST APIs, fully-customizable Eligibility Portal and Mobile SDKs that have been powering mission-critical, front-end eligibility processes solutions for leading healthcare software companies as well as ambulatory practices in the healthcare sector.