Eliminate Eligibility Denials with AI-Powered Verification
Discover hidden coverage, automate COB determination, and ensure financial clearance before every patient visit. Reduce denials by 75% and recover millions in missed revenue.
Complete Eligibility Lifecycle Management
From initial coverage discovery to financial clearance, our platform automates every step of the eligibility verification process.
Coverage Discovery Engine
Automatically find hidden insurance for self-pay patients. Search 1,200+ payers with minimal data (name + DOB).
COB Automation
Automated Coordination of Benefits with Birthday Rule, Medicare MSP rules, and real-time primacy determination.
Three-Touch Verification
Automated eligibility checks at scheduling, 48 hours before service, and at check-in.
Financial Clearance
FPL screening, Propensity-to-Pay scoring, and Good Faith Estimates with No Surprises Act compliance.
Intelligent Eligibility Verification Engine
Event-driven workflows that automate the entire eligibility verification lifecycle — from real-time insurance checks to batch processing and automated patient notifications.
Real-Time Verification
Instant 270/271 eligibility checks triggered by scheduling events, patient check-in, or on-demand requests.
Batch Processing
Scheduled nightly or weekly batch verification of upcoming appointments to catch coverage lapses early.
Coverage Discovery
AI-powered search across multiple payers to find active coverage for uninsured or underinsured patients.
Benefits Extraction
Automated parsing of benefit details including copays, deductibles, coinsurance, and out-of-pocket maximums.
Patient Notifications
Automated alerts to patients about coverage issues, financial responsibility estimates, and required actions.
Analytics Dashboard
Real-time metrics on verification rates, coverage gaps, denial predictions, and workflow performance.
Three-Touch Verification Workflow
Automated eligibility verification at every critical touchpoint ensures no coverage gaps slip through the cracks.
At Scheduling
Initial eligibility verification triggered automatically
48h Before Service
Re-verification with coverage change detection
At Check-In
Final confirmation with real-time benefits
Financial Clearance
Patient responsibility estimation & payment collection
Intelligent Coverage Analysis
Our Coverage Coordinator AI provides evidence-based insights with full citation support and hallucination prevention.
Coverage Coordinator AI
Evidence-based AI agent that provides eligibility verification, COB determination, prior auth checking, and cost estimation with citations for every statement.
Eligibility Scoring Engine
Proprietary scoring system that evaluates eligibility confidence with configurable factors and thresholds.
Predictive Eligibility
AI-powered prediction of coverage changes before they impact claims, enabling proactive intervention.
Why Choose Our Eligibility Solution
Built for enterprise healthcare with compliance, accuracy, and automation at its core.
Evidence-Based AI
Every AI statement includes citations. No hallucinations allowed.
Multi-Payer COB
Support for primary, secondary, and tertiary coverage coordination.
Real-Time 270/271
Direct clearinghouse integration for instant eligibility response.
Propensity-to-Pay
Predictive scoring for patient payment likelihood and collection strategy.
GFE Compliance
Automated Good Faith Estimates with 3-business-day delivery tracking.
Direct Payer APIs
Native connections to UHC, Anthem, Aetna, Cigna, and Humana.
Transform Your Revenue Cycle
- Recover 30-40% of self-pay revenue through coverage discovery
- Reduce eligibility-related denials by up to 75%
- Cut verification time from 10+ minutes to under 2 minutes
- Eliminate $1,200+ per member COB errors
- Ensure 100% No Surprises Act compliance
Enterprise-Grade Compliance
Ready to Eliminate Eligibility Denials?
See how our AI-powered eligibility verification can transform your revenue cycle. Schedule a personalized demo today.
