Maximize Collections with Complete Eligibility Verification

Customers

pVerify’s Premium Batch Eligibility solution offers unprecedented capability to customize the Eligibility & Benefits Results to suit specific needs of individual practice/healthcare organization. By combining advanced parsing technology with our proprietary blended process, we are able to return CPT-specific benefits across all the payersseamlessly. The net result is that we can guaranteethat the Benefits Summary Reports we return are COMPLETE and CONTEXTUAL to your specific needs. This can entirely eliminate the labor-intensive, telephone-based verification that Physician Offices are forced to deal with even when they subscribe to electronic verification solutions from our competitors.

pVerify’s clients include some of the largest medical groups, IPA/MSOs and Medical Billing companies. We have very strong presence in PRIMARY CARE, PEDIATRIC THERAPY (speech, occupational and physical) , ORTHOPEDICS, SLEEP CENTERS, IMAGING CENTERS, ORTHOPEDICS ETC. The following are some of the specialty-specific pVerify Solutions with key points highlighted:

OPTHALMOLOGY:

• Validation of ‘Routine Eye Exam’ benefits
• Coverage of ‘Refraction Test’ (CPT 92015
• Identification of Medicare HMO and Medicare Secondary Patients
• PCP name and details for HMO patients

ONCOLOGY:

• Chemo-specific Benefits
• Chemo Auth Required (Y/N)
• Coverage of specific J codes
• Identification of Medicare HMO and Medicare Secondary Patients
• Identification of Medicaid patients who have switched to HMO Plan
• PCP name and details for HMO patient

ULTRASOUND/MAMMOGRAPHY/IMAGING CENTERS:

• CPT specific benefit validation
• Routine versus Diagnostic Mammography Benefits
• Accurate determination of patient obligation at the time of visit (Patient Payment Estimator)

BARIATRIC SURGERY:

• Validation of specific Bariatric Surgery Coverage ( Bypass, Band Sleeve) and Min. BMI requirements etc.
• Medical Criteria incl. durations (e.g. Psychiatric, Nutritional evaluation)
• Pre-cert requirements and telephone numbers
• In-network and out-of-network benefits