Experts in Medicare Eligibility Verification

Ask us about the NEW pVerify powered Salesforce App for Medicare Eligibility and Same or Similar!

With Medicare Advantage Recursive Medicare Verification, pVerify will first verify a patient’s full Medicare Coverage (with Medicare MBI or SSN/HICN by including the Medicare MBI Lookup Feature). If a Medicare Advantage Payer is present pVerify will verify the Medicare Advantage Plan using human-enabled AI, machine learning, and our proprietary methods.

A leader in real-time insurance verification, pVerify’s Advanced Medicare Patient Eligibility Instant Verification provides more information than ever before for Medicare. Find what you need to see with the click of a button, from Episode Dates to HMO, PPO, and Plan Sponsor Details. Process Batches on your own with our Self-Batch Eligibility, view results on our Medicare Eligibility Summary Dashboard, and run Estimations, collect Co-pays, and view Same or Similar and Inpatient SNF.

Enjoy pVerify’s new Medicare Eligibility Check – Summary Dashboard to make easy and informed actions based on a quick-glance overhead view of if a patient has Medicare Part A, Part B, Home Health, Medicare Secondary Payer, HMO, Medicare Advantage Plan, Hospice Dates, and Deductible Remaining details. Labeled with a green check or a red exclamation, scan patients and make actionable decisions without toggling pages. Combine pVerify’s Medicare Eligibility Summary Dashboard with Self-Batch Eligibility to redesign and improve your workflow.

Once only available under our First-Class Batch Reports, now all users can improve efficiency with our Self-Batch Eligibility Patient Verification.  Just upload an Excel file of Medicare patients to be processed in near-real-time and view the results in the Medicare Eligibility Check – Summary Dashboard or on a color-coded Excel Spreadsheet with each patients verified information.

pVerify’s ACO Preventive Care Solution helps ACOs determine which beneficiaries are eligible for allowed preventive services.  pVerify ACO provides eligibility dates for 54 HCPCS Preventive Codes in every Medicare verification, including Annual Wellness Visit (G0438, G0439) and Cancer Screening Preventive Tests. ACOs can assign to primary care team members a list of all patients who are overdue or about to become due for an AWV and other additional Preventive Care Services and return an increase of 20% AWVs a year.

CMS replaced the SSN-based HICN with a new, randomly generated Medicare Beneficiary Identifier and requires the MBI ID for all Eligibility Verification, Claim Submission, reopening requests, and prior authorization requests.

pVerify offers a new, scalable solution for obtaining the new Medicare MBI ID, your patient’s MBI number, quickly and easily by submitting the patient data including SSN/HICN, DOB and Name.

Depending on the Provider, knowing a patient’s Home Health, Hospice, and Skilled Nursing usage and dates are a requirement to submit a claim correctly. Available in every Medicare Patient Eligibility Verification, pVerify provides start and end dates, the responsible Billing NPI, and how many dates are remaining for caps and lifetime limits.

pVerify goes one step further with our Inpatient SNF Solution, which, unlike the eligibility results, reports where a patient is during their Inpatient stay – available 72 hours after their admission, allowing for educated Medicare Part A billing.