VERIFY
Eligibility Intelligence
VERIFY provides real-time eligibility verification with intelligent coverage analysis that goes beyond simple active/inactive checks. By identifying coverage gaps, coordination of benefits issues, and authorization requirements before service, VERIFY prevents eligibility-related denials and improves point-of-service collections.
Key Capabilities
Advanced features designed to maximize your revenue recovery and operational efficiency.
Real-Time Batch Verification
Automatically verifies eligibility for all scheduled patients before they arrive, with real-time verification available at check-in.
Intelligent Coverage Analysis
Goes beyond active/inactive to analyze deductible status, copay amounts, coinsurance, and out-of-pocket maximums.
COB Detection
Identifies coordination of benefits situations and determines primary/secondary payer order to prevent claim rejections.
Authorization Requirements
Automatically identifies services requiring prior authorization and checks for existing authorizations on file.
Patient Cost Estimation
Calculates estimated patient responsibility based on coverage details, enabling accurate point-of-service collections.
Coverage Change Alerts
Monitors for coverage changes between visits and alerts staff to verify updated information with returning patients.
How VERIFY Works
A step-by-step look at how our AI agent processes and optimizes your revenue cycle.
Scheduled Patient Processing
VERIFY automatically processes eligibility for all patients on the next day's schedule during overnight batch runs. This ensures coverage information is ready before patients arrive.
Multi-Payer Query
For each patient, VERIFY queries all known payers to identify active coverage and detect potential COB situations. The system maintains connections to 2,000+ payers.
Coverage Intelligence Extraction
Raw eligibility responses are parsed to extract actionable information: deductible remaining, copay amounts, coinsurance percentages, and benefit limitations.
Authorization Check
Based on scheduled services or common urgent care procedures, VERIFY checks for authorization requirements and verifies any existing authorizations on file.
Patient Responsibility Calculation
Using coverage details and expected services, VERIFY calculates estimated patient responsibility to enable accurate collection at check-in.
Front Desk Presentation
Coverage summaries are presented to front desk staff in a clear, actionable format. Alerts highlight issues requiring patient attention or additional verification.
Technical Specifications
Enterprise-grade capabilities built for scale and compliance.
Payer Connectivity
- Direct connections to 2,000+ payers
- Real-time 270/271 transaction support
- Clearinghouse integration options
- Portal scraping for non-EDI payers
Coverage Analysis
- Benefit parsing for 50+ data elements
- Deductible and OOP tracking
- Plan type classification
- Network status determination
COB Intelligence
- Multi-payer coverage detection
- Primary/secondary determination
- Medicare coordination rules
- Workers' comp identification
Authorization Engine
- Service-to-auth requirement mapping
- Existing authorization verification
- Auth expiration tracking
- Automated auth request initiation
Cost Estimation
- Real-time patient responsibility calc
- Fee schedule integration
- Historical payment analysis
- Collection probability scoring
Integration
- PM/EHR system integration
- Patient portal connectivity
- Text/email notification capability
- Kiosk and tablet support
Case Study
Real results from urgent care centers using VERIFY.
Urgent Care Chain Increases Point-of-Service Collections 35%
The Challenge
A 10-location urgent care chain in Georgia was struggling with front-end collections. Staff were verifying eligibility manually, often getting incomplete information. Patients frequently left without paying their responsibility, leading to high patient A/R and collection costs. Additionally, 8% of claims were denied for eligibility issues discovered after service.
The Solution
VERIFY was deployed with overnight batch processing for scheduled patients and real-time verification at check-in. The system provided front desk staff with clear patient responsibility estimates and coverage summaries. Integration with their patient payment system enabled seamless collection workflows.
"VERIFY transformed our front desk operations. Staff now have complete coverage information before patients even arrive. Our point-of-service collections jumped 35%, and eligibility denials are almost non-existent."