The Most Comprehensive Eligibility Solutions on the Market
Eligibility APIs Made Easy
Reducing manual tasks, cutting costs, and minimizing denials start with the right solutions. With nearly two decades of expertise, pVerify has designed fast, automated eligibility verification solutions that accelerate claims approvals, reduce rejections, and optimize billing workflows—maximizing financial performance for healthcare organizations.
Eligibility Exemplified: Step-By-Step
1 |
Patient Information InputThe provider enters the patient’s basic demographic information (name, date of birth, insurance details) into the pVerify platform. |
2 |
Patient Demographic ValidatorIf the office has limited patient information, they can utilize the Patient Demographic Validator (PDV) to verify key eligibility details with minimal information—such as a name and location—all while maintaining data integrity and privacy. |
3 |
Real-Time Eligibility CheckpVerify queries the patient insurance carrier to retrieve their current carrier status and benefit details. |
4 |
Detailed Benefit AnalysisThe system parses the data to extract key coverage insights, including deductibles, copays, out-of-pocket maximums, and applicable treatment limitations. |
The Right Solutions for Seamless Billing
Core Eligibility Verification
Dramatically reduce administrative time with real-time eligibility checks that cover benefits, copays, deductibles, and authorizations.
Claims History & Compliance Tracking
Improve billing accuracy, streamline reimbursement tracking, and enhance compliance with payer policies—connecting to over 1,500 payers.
Enhanced Patient Coverage Insights
With in-depth views of coverage limits, co-insurance, and patient responsibility, providers can reduce claim denials and set accurate cost expectations.
The Five Essentials
What to Look for in a Real-Time Eligibility Solution
Not all real-time eligibility verification (RTE) solutions are created equal. The right system should maximize accuracy, minimize rejections, and integrate seamlessly with payer networks. Below are five critical factors to consider when selecting an RTE solution for your organization.
Coverage
A robust RTE solution should connect to extensive insurance databases, ensuring accurate and comprehensive verification results. More connections mean fewer errors and faster approvals.
Reliability
System outages happen. Your solution provider should have backup connections to prevent disruptions and ensure continuous access to critical eligibility data.
Experience
There’s no substitute for expertise. Vendors with a long history of working with payers provide more accurate and complete verification results, reducing claim denials and payment delays.
Multi-Level Verification
A strong RTE solution should retrieve, organize, and simplify complex payer data—from network status and coordination of benefits to if-then scenarios that impact claim success.
Service Lines
Understand how many service types you need and how vendors charge. Bundled pricing often provides more value, while single-service charges can add up, leading to higher costs.
See more essential factors to consider when choosing a vendor.
Since using pVerify, we have significantly reduced claim rejections, lowered administrative costs (by reducing the time it takes to verify eligibilities), and improved our cash flow.
Practice Manager,
Large NYC-based Pediatric Group
Utilizing pVerify’s automated verification service, we were able to focus and streamline our eligibility verification workflow and dramatically reduce the FTEs required to manage that process. I highly recommend pVerify eligibility solutions for any busy practice.
CEO,
Large Texas-based Eye Institute
We have used pVerify consistently on a daily basis, and the verification process has been seamless. We verify upwards of 1,000 patients a month, and pVerify provides all the details we need accurately. This system has improved our productivity, and we recommend the pVerify platform to others.
Reimbursement Manager,
Large Carolina-based surgical ortho biologist
Reliable. Compliant. Proven.