Realtime Eligibility Engine

Some of the most consistent drivers of denials in healthcare come from front end failures. The patient is seen, but their coverage was not verified, and 30 days later you learn that their coverage lapsed, or they were seen for a service that was not covered under their plan. Maybe the have a high deductible that was not met, and none of it was collected. Now you are chasing money you will never collect. Worse yet, the payer can't even identify the patient because the data was entered incorrectly and not validated.

This Engine is designed to prevent those issues before the patient is even seen. It automates the extraction and verification of patient insurance data using ANSI X12 271 response files and translates the details into plain English, so your team knows exactly what they're looking at. The dashboard gives you coverage details based on practice specialty, that includes information such as patient cost share information, covered services, and effective dates.

For technical details: View technical documentation