Maximize Collections with Complete Eligibility Verification

FAQ

1. We already have access to Availity and many free payer sites; how is pVerify any different?

pVerify ™ is a single portal to verify eligibility instantly from 560+ insurance companies and it even covers non-EDI payers (through delayed verification process). Combination of our advanced parsing technology and proprietary process ensures that all the relevant information is available across all payers… We also provide unique, color-coded Eligibility Summary Reports in Excel Spreadsheet format that makes it easy for your front-office to take appropriate actions. Furthermore, once verified, results are stored for 1 year in a searchable PDF format in case you need to access it again.

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2. What are EDI and non-EDI payers

EDI (electronic data interchange) refers to the structured transmission of data between organizations by electronics means. Most of the large, national payers support EDI eligibility transaction set 270/71 but there are many smaller and regional payers who still do not. pVerify™ is the only automated eligibility service provider to support non-EDI payers as well.

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3. What is ‘parsing’?

Parsing refers to the process of extracting key benefits data such as co-pays, deductibles (in-network and out-of-network) etc. Only pVerify guarantees full parsing of data specific to your specialty. Once parsed, the data is then presented in a spreadsheet format where you can filter the data based on what you are looking for (e.g. sorting all patients with HMO plan or patients win inactive coverage).

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4. What is ‘dashboard’?

PVerify Dashboard view provides quick view of the key benefits data so that you don’t have to scroll through multiple pages of eligibility report that typical payer portals results have. Dashboard view can help you easily spot patients who have switched to Medicare Risk HMO plans, patients with Inactive coverage etc.

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5. How long does it take pVerify to verify eligibility?

While doing instant verification, pVerify takes as little as 3 to 5 seconds to verify eligibility. However, it takes longer for batch verification, since batch verification includes parsing as well as quality control.

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6. What is the information that I require to carry out eligibility verification?

You can verify eligibility with as little information as the subscriber ID and date of birth. However, this would vary from payer to payer. For some it might be the patient’s SSN # and date of birth and for some it might be the patient’s name and date of birth. Some offer multiple search criteria.

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7. Will I be able to calculate the patient responsibility for a particular visit?

Yes, pVerify lets you calculate the patient responsibility for a particular visit for the services that you provide based on payer fee schedules. PVerify Premium has a feature called patient estimator which lets you do this.

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8. I do not have the fee schedules for the various payers and hence will not be able to use this estimator properly. How can pVerify be of any help?

Estimator has the Medicare fee schedules pre-loaded for your use. What you can do is to mark up the fee schedules from Medicare base rate or load payer specific fee schedules.

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9. Can I collect the patient responsibility that I calculated using estimator from pVerify ?

Yes, Pverify lets you collect the patient responsibility at the point of care. You will have to open merchant account with us for that. The patients can pay by cash, check or credit card. Pverify has a PCI compliant Card-on-File feature that lets you process post-visit patient balances and hence relieves you of the hassle of mailing statements and chasing patients for balances. .

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10. My clinic has a lot of patients checking in and out every day. Is pVerify of any help to track this flow of patients ?

Yes, Pverify facilitates tracking of daily patients through its patient flow feature. It lets you filter the flow of patients as per the location of your clinic, payers, status of verified patients etc. It also lets you know at a glance the number of patients verified on a given date, the number of patients whose responsibility has been estimated, the patients who have paid their dues by cash, check or credit card.

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11. Does pVerify offer any guarantees for its performance?

pVerify comes with a money back guarantee. If the return on investment is not as per the specified norms within 60 days of fully deploying pVerify, all the fees including the set-up fees will be returned to you.

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12. What is card-on-file feature of your patient payment processing module?

PVerify is integrated with leading PCI compliant payment gateway and lets you to capture the credit card or check information from a patient with his/her proper authorization. This information is used to receive payment for the future dues of a patient.

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13. How is the eligibility report shown in pVerify brochure different from the reports of the other online payer verification services?

The eligibility report from pVerify not only gives you the parsed benefits data such as co-pay and deductible but it also has a link called ‘Details’, clicking on which would show you the entire details of the pVerify eligibility screen.

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14. What does your free trial offer cover?

Signing up for the free trial would give you a feel of pVerify eligibility solution and to a limited degree, its Patient Estimator solution. It would give you full access to about 277 participating payers. On request however, pVerify can process limited transactions for payers such as Medicare, Blue Cross etc. which are not covered typically in trial period. This is subject to your NPI being approved. All the other payers will be available to you after you sign up.

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