pVerify

pVerify is a healthcare company that offers patient eligibility verification solutions. According to the vendor, their product aims to provide detailed insurance information, including benefit details, to healthcare providers. pVerify caters to healthcare organizations of various sizes, including medical practices, hospitals and healthcare systems, dental practices, vision clinics, and laboratories.

Key Features

Business Rules Engine: According to the vendor, pVerify's Business Rules Engine allows clients to incorporate their verification specialist's expert knowledge into the system. The engine cycles through and reports on qualifying patient benefits based on payer, group name/number, member ID, plan name/number, or policy ID. Clients can customize payers with business rules to identify authorization and referral requirements, as well as laboratory information for pathology.

Detailed Benefit Information: pVerify provides detailed patient insurance information at a deeper level, separating and highlighting individual details for easier review and understanding. According to the vendor, traditional details such as plan active status with HMO/PPO alert, deductible and out-of-pocket details, and co-pay and co-insurance details per specialty are available. Additional information includes plan name and number, policy type, group name and number, important dates, NPI network status, payer billing address, and more. The availability of this information depends on the payer.

Self-Batch Eligibility Verification: According to the vendor, pVerify offers a self-batch eligibility feature for all premium clients, allowing them to run their own batches in real-time. This feature is designed for basic verification needs, confirming active status for all EDI payers and specialist benefits. It provides standard benefit details such as HMO/PPO payers, deductible and out-of-pocket remaining, and more. Self-batch eligibility verification is ideal for clients who want to verify patients in mass but do not require a custom report with enhanced details reporting.

EMR/Practice Management Integration: pVerify's eligibility integrations automate patient extraction for a specific Date of Service (DOS) to verify in advance. The benefits are returned directly into the integrated system, often as a patient note. According to the vendor, this integration streamlines the verification process and eliminates the need for manual data entry. Examples of existing integrations include AdvancedMD, Allscripts, NextGen, Centricity, and Raintree.

APIs and Easy Endpoints: According to the vendor, pVerify offers extensive capabilities with their robust eligibility APIs, widgets, drop-in UI, and more. These APIs allow users to build eligibility directly into their website or software. They can be used as consumer-facing solutions or automated on the billing end of processes. pVerify provides developer resources and support for seamless integration.