REAL-TIME MEDICARE PATIENT ELIGIBILITY

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:

New Medicare View

Medicare with HMO Alert

Medicare with PPO

Straight Medicare A & B

Traditional Details

  • Plan Active Status
  • Plan Coverage Details: HMO and PPO
  • Demographics and Spelling Alerts (for clean claims)
  • Deductible & Out of Pocket Remaining
  • Eligibility Dates: Effective & Expired
  • Additional Payer Info (Plan Sponsor or CA IPAs)

Medicare Specific Services

  • Highlighting Medicare Advantage (Part C) including HMO/PPO Alerts with Medicare Advantage Payer names (helps you avoid Medicare Denials CO 22 and 109)
  • Identify Primary Payer if Medicare is secondary (helps you avoid Medicare Denials CO 22 and 109)
  • Actionable Preventative Service HCPC codes to determine which patients are due for their Annual Wellness Exam, among others preventative services.
  • Home Health Care and Skilled Nursing Care spell information, Hospice Episode information and dates 
  • Medicare Part D: Prescription Benefits Manager, PBM details including Pharmacy Payer Name, Plan Number, and Network ID.

 

Additional Features

  • Search, review, and re-verify patient’s stored by pVerify’s HIPAA Compliant Cloud for up to 60 days. 
  • Download PDF detailed reports of patient Eligibility Verification 
  • Estimate Patient Responsibility to collect correct copays on DOS with Patient Estimator
  • Unlimited Batching

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?

 

 

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 provides a patient’s complete 5-year record across all 4 jurisdictions in one verification, 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. Solution requires existing NPI and PTAN numbers. 

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.