Quickly Verify Eligibility and Benefits

Get patient financial clearance, and preserve reimbursement leveraging artificial intelligence and automation.

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Avoid Manual Eligibility Workflows

Eligibility and benefits verification is a time-consuming and error-prone process critical to reimbursement. Staff spend hours on the phone and on payer portals trying to verify incomplete, inaccurate, or expired benefits, risking denials or write-offs that can ultimately impact a provider’s reimbursement.

Reduce Eligibility Denials with Technology-Driven Solutions

Our eligibility and benefits solution streamlines the pre-service financial clearance process, reducing denials and revenue loss for healthcare providers. With the power of AI, automation, and payer integration, we help you accelerate financial clearance while improving accuracy resulting in fewer denials.

AI/ML
Execution

Benefits
Automation

Payer
Integration

ELIGIBILITY + BENEFITS

Eliminate Eligibility Errors That Cost You And Your Patient

Our eligibility and benefits solution combines payer automation and patient access expertise to provide you with the patient’s complete coverage details.

  • Determine benefits accurately
  • Gain real-time access and approval
  • Reduce denials 
  • Stop Medicare plan guessing 

Gain instant, accurate access to procedure coverage, co-pays, and co-insurance information.

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INSURANCE DISCOVERY

Uncover Hidden Coverage and Avoid Patient Surprise Bills

Our insurance discovery tool uses machine learning, deep data mining, and probabilistic analytics to identify undisclosed coverage for your patients.

  • Discover unrealized benefits
  • Mitigate risk of non-payment
  • Improve patient satisfaction

Your practice gains higher reimbursement and reduces write-offs. Your patients get the treatment they need and avoid unnecessary bills.

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PATIENT PAY ESTIMATES

Give Patients A Complete Financial Picture

Our Patient Pay Estimates solution helps educate patients on their financial responsibility for care and treatment plans.

  • Educate patients before delivering service
  • Establish payment plans as needed
  • Increase cash flow and decrease collections

You’ll see more payments, more cash flow, and fewer collections with a complete financial picture.

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Millions Of Transactions Processed Annually

Our cutting-edge machine learning technology and certified specialists learn from millions of transactions processed for leading healthcare providers and 1000+ payers across the United States.

2M+

Benefits Verified

$2B+

Revenue Collected

5M+

Patients Served

Extensive Experience With Most Systems

We are able to integrate with most electronic health/medical records (EHR/EMR) systems with APIs, HL7, FHIR, X12, or EMR Developer Programs.

Lean on Easy Eligibility Workflows

Our streamlined, four-step process ensures you get the eligibility and benefits you need to clear patients quickly, reducing scheduling time.

Stay Current on Eligibility and Benefits Best Practices

We spend time creating helpful content to help streamline revenue cycle workflows at your organization. If you are looking for content on a particular subject matter, feel free to reach out to us.

Patient Access and the Importance of Insurance Verification

Read More

Out-of-Network v. In-Network: How to Set Up a Patient Centered Process

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Can Automated Insurance Verification directly Impact Claims Denials?

Read More
Explore Content

You Asked, We Answered

Curious if our eligibility solution will meet your needs? Here are the most common questions your peers ask when evaluating our eligibility and benefits solution.

What eligibility and benefit information will I receive?

Our eligibility and benefits solution verifies if the patient has active insurance coverage. After verifying eligibility, we check to confirm the specific service is covered and give you the benefits at the plan level, including deductibles, stop loss, copays, and co-insurance.

We integrate with most EMR, EHR, and PMS’s through APIs or HL7. Schedule a demo here to learn if we integrate with the specific system your organization uses.

We currently support the following specialties – radiology, orthopedics, laboratory and pathology, cardiology, PT/OT, pain management, and oncology. We are also running pilots on niche specialties so please reach out to us here if you would like to learn more.

We connect to over 800 national and regional payers.

Our solution allows you to select a place of service. You can choose from a facility, physician’s office, specialist, or home visit, and we’ll obtain benefits for that setting.

The list of services for which you’ll receive benefits information is listed below:

  • Medical Care
  • Surgical
  • Consultation
  • Diagnostic X-ray
  • Diagnostic Lab
  • MRI/CAT Scan
  • Pathology
  • Emergency Services
  • Urgent Care

Our solution helps you discover any other insurance a patient has and avoid unnecessary bills.

When you are logged in, click on a case and open the summary view. You will see a tab next to “Active Procedure” called “Insurance Discovery”. This tab will show you the new-found coverage along with all the available eligibility and benefits details. If you are integrating our solution with your EMR, the information is added to the patient’s chart.

We need the patient’s name, date of birth, date of service, payer name, patient subscriber ID, and the provider’s NPI to find coverage.

You can also add service type to obtain service level benefits.

Our solution gives you the ability to input your fee schedule to ensure accurate cost estimates via .xls or .csv files. We can also accommodate multiple facilities with different fee structures.

We calculate a patient’s payment based on their benefits and the allowed amount. Our solution will take that data, determine the patient’s estimated payment, and how we calculated the cost.

Accelerate Eligibility and Achieve

We help not only help improve eligibility but also impact your organization’s revenue.

Lower Costs

35% lower cost versus manually managing eligibility and benefits checks.

More Covered Patients

Find coverage for more than 30% of patients who had identified themselves as self-pay.

Reduced Denials

Avoid the 2% denials that usually occur due to eligibility and benefits.

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Health-Report-Infinx

Tackle Eligibility for Good

Schedule a call to see our eligibility and benefits solution in action today.

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