Every January, healthcare organizations brace for a predictable yet punishing event: the reverification surge. Insurance plans reset, benefits change, deductibles start over, and coverage quietly shifts beneath the surface. For front office teams, it feels less like a surge and more like an overwhelming wave of eligibility and benefits verification checks, prior authorization resets, system delays, and anxious patients.
In a recent Office Hours session, Lora Pada, AVP of Client Success, and Jonathan Aguiar, Senior Solutions Engineer, unpacked the operational realities of reverification and where intelligent automation is already creating leverage, particularly for PT, OT, orthopedics, and other high-volume specialties navigating increasingly complex workflows.
The Annual Reverification Surge
Reverification season arrives at the worst possible time. While teams are navigating holidays, limited staffing, and vacation schedules, employers are completing benefit renewals and patients are moving to new plans. Policies terminate on December 31, deductibles reset on January 1, and out-of-pocket maximums change overnight.
For practices, that translates into intense financial and operational pressure. If eligibility and benefits are not updated, denials follow. Cash flow slows, patient collections become more challenging due to higher January patient responsibility, and many patients hesitate to schedule care once they realize their costs have reset.
On top of that, payer portals and clearinghouses are also strained. Volumes spike, systems lag or go down, and data often takes days or weeks to be fully updated. The result is a short but brutal window where organizations need temporary surge capacity that they often do not have in-house.
How Prepared Practices Manage the Wave
The most successful organizations treat reverification as a seasonal event that demands proactive planning, not last-minute scrambling. They start in December, targeting January appointments and patients with coverage expiring at year end. They request updated insurance cards early, flag high-risk accounts in the work queue, and design workflows that prioritize payers and portals that update sooner.
Some practices temporarily adjust scheduling strategies, for example seeing more Medicare patients in early January and delaying high-risk commercial visits until benefits are confirmed. Others rely heavily on outsourced support to manage the spike in manual work.
The common thread is intentional planning and workflow optimization, rather than reactive, one-off phone calls.
Where Intelligent Automation Fits Today
According to Jonathan Aguiar, reverification is not more complex from a procedural standpoint than everyday eligibility and benefits verification. The complexity is all about volume, timing, and payer variability. That is where intelligent automation and tech-enabled services create real leverage.
Infinx’s Patient Access Plus automation platform uses intelligent payer mapping to reconcile payer names between client systems and Infinx’s extensive payer database, improving data quality and reducing manual clean-up. Their insurance discovery workflows uses a combination of robotic process automation, AI, analytics, and large public and private data sets to identify active coverage that patients may not even realize they have, including primary and secondary insurance.
Eligibility and benefits checks are orchestrated through queues that validate required data and then route transactions through EDI 270/271, multiple clearinghouses, and RPA-driven portal automation. For PT and related specialties, a meaningful portion of reverification volume can be automated, returning details like authorization requirements, network status, and plan type with minimal latency into the EMR or PT platform.
On the prior authorization side, cases move through determination, initiation, follow-up, and final status, logic-driven and AI-supported workflows determining when prior auth is required and then choosing the fastest available path, whether API, RPA, or manual staff.
Human and Digital Agents Working Together
A key principle in Infinx’s approach, as both Lora and Jonathan emphasized, is orchestration. The system is agnostic to who completes the work. It constantly chooses the path of least resistance, assigning tasks to digital agents where automation is possible and handing off to human specialists when portals are down, data is incomplete, or a phone call is required.
That seamless handoff is what allows practices to handle the January surge without overwhelming staff, while still maintaining accuracy, speed, and payer compliance.
The Future: Predictive AI and Proactive Patient Communication
Looking forward, both leaders see predictive modeling as the next major frontier. With enough historical data across specialties, payers, procedures, and demographics, AI can forecast which patients are most likely to experience coverage changes, which cases are most likely to require new authorizations, and which encounters are at highest risk for denial.
That intelligence can drive smarter workforce management, prioritizing reverification queues, flagging high-risk accounts, and even recommending rescheduling strategies before a claim is at risk.
Another powerful future application is proactive patient communication. AI-driven workflows could monitor upcoming benefit resets, trigger outreach via text, email, or portals, and collect updated insurance details long before the visit date. Combined with insurance discovery, this would dramatically reduce last-minute surprises at the front desk and protect both revenue and patient experience.
Getting Ahead of Next January
Reverification season is not going away. It arrives at the same time every year, and it will only grow more complex as payer rules, plan designs, and patient expectations evolve.
Practices that thrive will be those that blend proactive planning, intelligent automation, and strategic staff augmentation rather than relying on manual processes and hope.
The conversation around reverification is shifting. The question is no longer whether automation belongs in the process, but how thoughtfully it’s applied. Contact us today! We would love to hear your story!