Pverify
Eligibility Exemplified. Facilitating Faster Patient Care.
The Leader in All-Payer Realtime Patient Insurance Eligibility Verification with Instant, API and Batch Solutions that blend technology with human-enabled AI to simplify the complex landscape of the patient care cycle for Medical, Dental, and Vision Healthcare Providers.
Tailored Solutions
Advanced Eligibility Verify patients coverage prior to service.
pVerify’s Business Rules solution returns the information your team needs to identify authorization and referral requirements – saving time and money.
Insurance Discovery Quickly identify patient insurance coverage.
With just a patient’s name and DOB, pVerify’s Insurance Discovery solution identifies their coverage. Facilitating timely claim submissions, enhancing patient payment collection, and significantly reducing Accounts Receivables.
MBI Lookup Find a Medicare patient’s new MBI ID.
pVerify’s NEW Enhanced MBI Lookup solution allows users to identify a patients Medicare Beneficiary ID (MBI) plus their coverage benefits, including important details like Medicare Advantage Plans.
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A Complete list of our Solutions
Eligibility Solutions
Advanced Eligibility
All Payer Advanced Eligibility Solution for Vision, Dental, and Medical Payers provides the Deepest Level of Benefits Reporting for Commercial, Medicaids, and Medicare Payers.
Go beyond standard Eligibility with our Business Rules Engine for no extra cost.
Insurance Discovery
Championing the highest percentage of coverage identify through nearly two decades of payer research, understanding payer criteria, DOS range details, and our proprietary set unique to 51 states.
Now supporting California Medicaid and BC of CA. Tricare East, West, and LIFE to be added in summer 2023.
Business Rules Engine
Empowered productivity from clinical and administrative staff by delivering critical information at moment of need with our reliable system to recycle staff knowledge across numerous locations.
The BRE automatically includes detailed communication on specific types of patients or coverage.
CPT Benefits Investigation
pVerify offers a game-changing solution to long and frustrating phone calls and hold times with a team of Expert Verification Staff and Robotic Process Automation (RPA) to gather critical CPT Code Benefit information.
Batch Verification
Let pVerify handle complex patent verification with our First-Class Batch Solution and review results in a color-coded and highlighted Excel report or directly within your EMR. Self-Batch Eligibility is available at no extra cost.
Integration and APIs
pVerify’s enhanced Healthcare Eligibility and Medical APIs endpoint’s advanced configuration features allows Developers to get the data they want without wading through complex objects for 10 unique Healthcare API Solutions.
FHIR, HL7, 270/271, RESTful API, SalesForce and MORE!
Medicare Eligibility
An expert in all things Medicare, pVerify has a Medicare Eligibility – Summary Dashboard, HMO/PPO Flags with auto-verification, identifies changes 4 months into the future, provides PBM details and Cap information, and even offers a second solution that obtains a patient’s MBI Lookup with just their Name/DOB.
Vision Eligibility
Vision Eligibility
As of September 2021 pVerify now offers real-time Vision Payer Verification in the Premium Portal and API Integration for VSP, Eyemed, March Vision, Premier, Davis, Spectera, and MORE! Beyond the detailed vision benefits available with Advanced Eligibility, Material Coverage Details, PCP information, and Copay/Co-insurance details are available.
Vision Prior Authorization Coming Soon
Dental Eligibility
Dental Payers Verification is now available as a real-time Eligibility Verification Solution. With the requirements of a Dental NPI and Tax ID, pVerify users can now verify 180 Dental payers in their secure Premium Portal. Dental is available via single patient verification, First-Class Batch Solution, and API Connection.
Beyond Eligibility Solutions
Prior Authorization
pVerify’s Fast-PASS Prior Authorization houses a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions in over 50% of submissions, case validation, status updates, and streamlined supporting documents transfer.
Patient Estimator
Estimate patient financial responsibility powered by Eligibility results and your unique fee schedules for quick and easy cost estimates.
Claim Status
pVerify’s Claim Status allows users to check the current status from the payer to discover the claim was accepted, or denied, and review the Status Codes to determine if action is required.
Durable Medical Suppliers
Prevent denials, decrease write-offs, and improve cash flow with Pverify.
Ask us about our NEW Pverify powered Salesforce App for Medicare Eligibility and Same or Similar Lookup!
A game-changing combination for DMEs
pVerify leads the Durable Medical Equipment Supplier Industry with the most user-friendly portal, built-in interpretation flags for quick equipment issuing decisions, and continued enhancement.
From Eligibility to Medicare Claims History and Inpatient episode details, pVerify is an expert of all things Medicare.
At-a-glance Features
- Verify Eligibility with Medicare – Summary Display
- One click auto fill for Same or Similar and Inpatient SNF
- Interpretation flags for decisive and quick action
- Unlimited Batch, API endpoints, and single patient functions.
- Unlimited Locations, User Logins, and NPIs
- User Management to control what each user can see and do
Build Pverify directly into your workflow
Designed specifically for Durable Medical Suppliers
pVerify’s DME Solutions allow users to combine verification methods in order to verify in real-time and API, along with automated and batch solutions.
The DME Experts
Verification of patient benefits is an ever changing landscape and that includes the Equipment Suppliers world. Determining coverage and Medicare Claim History is the only way to ensure you will get paid. pVerify takes on the complex steps to streamline and relieve the stress and time commitment it takes to correctly qualify a patient before issuing their equipment. Our goal is to speed up each part of the patient cycle, with automation and accuracy, and highlight important details that can prevent denials and chasing of payment. Beyond confirming they are eligibility (confirming Medicare coverage and reviewing 5-year Claims History), pVerify as will alert you to if a patient is currently in the Hospital or Skilled Nursing Facility.
Create your own Combination
pVerify streamlines all of our DME Solutions into one, by combining Batch Reporting with APIs, unlimited user access within the real-time portal, and assists each client develop the workflow that improves their ROI.
Additional Medicare Solutions That We Provide
Same or Similar
Pverify’s Same or Similar allows users to review a patient’s 5-year Claim History in near real-time with interpretation flags for easy and actionable decisions.
Inpatient SNF
Pverify Inpatient SNF Solution provides details on current SNF and Hospice stays, as close as 72 hours after admission, including the provider’s NPI.
Medicare CMN
Pverify’s Medicare CMN allows users to review a patient’s CMN history for approved certificates along with the initial and last claim date, to see what rentals have been approved.
MBI Lookup
Find a patient’s new MBI ID with their Name and SSN/old HICN.
Billing and Revenue Cycle Management Companies
Outsource your client’s verification for fast, automated, and accurate benefits reporting.
Why insurance verification is so important
Determining coverage is imperative for Medical Providers to prevent denials and major loss in revenue. While simple eligibility verifications can be used to obtain active status, copays/co-insurance, and the remaining deductible and out-of-pocket amounts, many billing and Revenue Cycle Management companies struggle to verify large quantities of patients or obtain detailed results they need.
pVerify’s streamlined eligibility handles all sizes of verification needs and reports the data that is required to submit claims correctly and get paid on time.
Features Highlight
- Supports Multi-Specialty Medical Practices and Hospitals
- Upload batches of 100-100,000+ patients daily
- Build verification directly into your own website
- Detailed Patient Benefits available in Excel Format
- Includes Medical, Dental, and Vision Payers (EDI and Non-EDI)
- Use the Premium portal for real-time verification and patient review
Complex needs simplified with Pverify’s Solutions.
A Leading Insurance Eligibility Verification Software that supports Multi-Specialty Medical Practices and Providers with specific verification needs while showcasing the largest list of Health Insurance Payers.
Experts in Eligibility
Verification of patient benefits is an ever changing landscape. Determining coverage prior to DOS is the best way to accept patients, collect copayment and co-insurance, and submit claims correctly. Beyond the traditional needs like co-pay and deductible remaining: understanding if prior authorization is need, if surgical co-insurance varies by the location of the procedure, and if a patient is currently in the Hospital can prevent in denials and chasing of payment.
Largest Payer List
With the largest Payer list for Medical Insurance Verification, pVerify is the only company to go beyond the traditional EDI payers to provide the eligibility benefits from the smaller and time-consuming non-EDI Payers. pVerify works with over 1350+ payers to compile the largest eligibility list of Medical, Dental, and Vision Payers in the industry.
Why Choose us
pVerify is a unique service-oriented healthcare company that focuses on value-added solutions for your business needs.
pVerify shines alone in the industry for unparalleled support, excellent development tools, and easy to use Solutions on an affordable and scalable platform.