HIPAA Compliant | ISO 27001 Ready | SOC 2 Ready
Live at Valley Diabetes & Obesity — 3+ months in production

Your staff shouldn't spend 90 minutes a day on eligibility checks

Check Medicare, Medicaid, and commercial insurance eligibility in seconds. The agent verifies coverage across 1,300+ payers before patients walk in — automatically, every day, with exceptions flagged for your team to review.

Look up your payers — payer IDs, response fields, and what a live check returns.

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HIPAA compliantNo credit card requiredFirst check in 5 minutes
$149K

saved per provider, per year

Your staff logged into 12 payer portals before lunch today. Half returned errors. One missed a coverage change. You won't find out until the denial hits — 6 weeks from now.

Your EHR says “active”

Agentman tells you if that patient will cause a denial. It navigates payer portals, interprets coverage details, and flags referral or PCP mismatches before the visit.

Production results

90 → 10 minutes of daily staff time. 65% fewer eligibility-related denials. 4–10x ROI within the first quarter.

The problem

Manual eligibility costs more than you think

Before every appointment, someone logs in to payer portals, checks coverage, confirms PCP assignment, and updates your PM system. Multiply that across 30+ patients a day. When it slips, denials follow.

90 minutes lost, daily

Per doctor, staff spend up to two hours checking eligibility across a dozen payer portals — every single day.

$50–80K in preventable denials

Missed eligibility means claims denied downstream. Per practice, that’s $50–80K a year in lost revenue.

$40–50K for a dedicated resource

Most practices hire a full-time person just for eligibility and prior auth. That’s a big line item before benefits.

Patients seen without coverage

When verification slips, patients are seen without valid insurance. The practice absorbs the cost.

How it works

Five days ahead, every payer, every patient

The eligibility agent runs automatically each day — checking upcoming appointments against 1,300+ payers. Exceptions surface to your command center. Valid patients flow through untouched.

1

Pull the schedule

Each morning, the agent reads upcoming appointments — typically five days out — from your practice management system.

2

Verify every patient

Coverage, PCP assignment, referral requirements, and active status are checked across all contracted payers.

3

Flag the exceptions

Invalid coverage, payer mismatches, and expired policies surface in the Medman command center for staff review.

4

Retry automatically

Payer APIs go down — especially in Q1. The agent retries with built-in logic so staff don’t track which checks failed.

The three ways practices do it today

How to check Medicare eligibility

There are three ways to confirm a patient's Medicare coverage before their visit. Every practice uses at least one of them. The difference is what each costs in staff time.

1

The payer portal

Log in, enter the patient's MBI — the Medicare Beneficiary Identifier on their red, white, and blue card — and read the benefits screen. It's free, but a portal check takes 10–15 minutes of staff time per patient, and you repeat it for every patient on tomorrow's schedule.

2

The phone

Call the payer's provider line, wait on hold, and read back the same MBI. Counting staff time, CAQH benchmarks a manual eligibility check at $7.97 in provider cost (2023 CAQH Index). Multiply that by 30 patients a day and the cost stops feeling free.

3

An automated real-time check

Send the patient's name, date of birth, and MBI to Medicare's payer ID — CMS — through a real-time eligibility connection. The answer comes back in seconds: Part A and Part B status, deductible remaining, QMB status, and any Medicare Advantage enrollment. That last field matters most. Billing Original Medicare when the patient actually has an MA plan, and billing cost-sharing to a QMB patient, are the two mistakes that turn into denials weeks later. Medman runs this check automatically for every patient on your schedule, from $0.50 per check.

Full field details for Medicare are in our payer directory.

How to verify Medicaid eligibility

Medicaid works differently: it's run by each state, so verification starts with your state's Medicaid program and its provider portal — the login, the fields, and even what “active” means vary state to state. Coverage can also change month to month, so a check from three weeks ago is not a check. Verify close to the date of service, every time. Medman handles state Medicaid plans the same way it handles Medicare: an automated check per patient, in seconds, with exceptions flagged for your team. Look up your state's plan in the payer directory.

Your team stays in control

Agents assemble. Humans approve.

The eligibility agent does the checking. Your staff does the deciding. Every result is visible, reviewable, and auditable.

Full visibility

Every check, every result, every retry — visible in the command center with timestamps and payer responses.

Complete audit trail

Data lineage from patient record to payer response. Know exactly where data came from and where it went.

Human-in-the-loop

Staff approve, escalate, or override. Nothing goes out without a person signing off.

What your EHR eligibility tool can't do

Works where APIs don't exist

Navigate payer portals

40%+ of payers don’t support EDI. Your EHR returns an error. Our agents log into the portal and verify.

Covers the 40% gap

Interpret coverage, not just check it

PCP correct? Secondary payer? Plan changed since last visit? The nuances that actually cause denials.

Intelligence, not lookup

Flags referral & PCP issues before check-in

Catches missing referrals, wrong PCP assignments, and authorization gaps — before the patient sits down.

Prevents denials at the source

Production numbers

Three months of live data from a real practice

Valley Diabetes & Obesity deployed the eligibility agent in October 2024. These numbers are from their first 12 weeks.

~90%
Automated
1,300+
Payers
real-time eligibility
5 days
Ahead of schedule
Zero
Manual clicks

Modeled from Production Data

Valley Diabetes & Obesity — Modesto, CA

Independent practice · 1–5 providersDownload Case Study
90 → 10

Minutes per day
on eligibility

65%

Fewer eligibility
denials

4–10×

Return on
investment

“It saves me potentially $50 to $80,000 a year that I'd lose to a denial downstream because a patient didn't have insurance.”

— Sachin Gangupantula, VP Agentic Healthcare & Practice Owner

Agent skills

Gets smarter with every practice

Every clinic contributes skills to a shared library. Eligibility rules for Cigna. Exception patterns for AllCare. Each skill makes the agent faster — for everyone.

Skills are codified instructions in plain English that capture payer-specific workflows. Versioned, editable, always improving.

CignaEligibility Verification

Trading partner rules and coverage confirmation

Blue CrossPCP Assignment Check

Referral requirement detection before submission

AetnaException Handling

Smart retries with alternate strategies

MedicareCoverage Verification

Part A/B/C/D and secondary payer detection

HumanaGuideline Updates

Auto-incorporates latest payer rule changes

Integration

Connects to your existing systems

Plugs into the PM and EHR systems your team already uses. No rip-and-replace.

AdvancedMD

● Live

DrChrono

● Live

Athena Health

In progress

Cover My Meds

● Live

42+ connectors

New EHR in 1–2 days

MCP

One workflow. $87,600 saved. Now multiply.

Calculate eligibility verification savings—just the first of six agents available. Full automation delivers 3-5x more.

Your practice details

500
100/mo2,000/mo
12 min
5 min30 min
$25
$15/hr$50/hr
10%
5%20%

Your annual savings with Agentman

Time saved annually

984 hours

From 1,200h to 216h per year

Labor cost savings

$24,600

82% reduction in verification time

Revenue protected via denial prevention

$63,000

420 denials prevented annually

Total Annual Savings

$87,600

$7,300/month average ROI

Based on real practice data: These calculations use 75-85% time reduction and 60-80% denial prevention from California practices. Additional savings from faster prior auth processing, reduced claim rework, and improved cash flow are not included.

That's just ONE agent. Full suite potential: $250K+

That's just insurance verification. Here's what else we automate:

Prior Auth: +$45,000/year
Patient Comms: +$35,000/year
Claims Coding: +$40,000/year
Denial Management: +$30,000/year
Refill Management: +$25,000/year

Total potential: $250,000+ annually

Most practices recover their investment in the first month through time savings and denial prevention alone.

Pricing

Simple, transparent pricing

Choose pay-as-you-go or a predictable monthly plan. Either way, you save 85%+ versus manual verification.

  • Pay-as-you-go from $0.50/check
  • Predictable plans from $225/provider/mo
  • No setup fees or long-term contracts
  • Savings calculator included
See full pricing

FAQ

Common questions about eligibility checks

You need the patient's Medicare Beneficiary Identifier (MBI), the 11-character ID on their Medicare card. With it, you can check through a payer portal (10–15 minutes of staff time), by phone, or through a real-time eligibility check that returns in seconds. A real-time check against Medicare's payer ID, CMS, confirms Part A and B status, deductible remaining, QMB status, and any Medicare Advantage enrollment. Medman runs these checks automatically for every scheduled patient, from $0.50 each.

Medicare's payer ID for eligibility checks is CMS. A check to that ID requires the patient's MBI and returns Part A and B status, deductible remaining, and whether the patient is enrolled in a Medicare Advantage plan. If the response shows an MA plan, bill the MA plan — not Original Medicare. That mix-up is one of the most common preventable denials. Payer IDs for other plans are in Medman's payer directory.

Manually, 10–15 minutes per patient: log into the payer portal, find the member, read the benefits, update your PM system. An automated real-time check returns in seconds. That difference is why Valley Diabetes & Obesity went from 50 hours of verification work a month to 7 — the agent checks every scheduled patient up to five days ahead, and staff only touch the exceptions.

Start with your state's Medicaid program — each state runs its own provider portal, and the process varies by state. Because Medicaid coverage can change month to month, verify close to the date of service rather than at scheduling. An automated check does this without portal logins: Medman verifies state Medicaid plans in seconds, every day, for every patient on the schedule, and flags anyone whose coverage has lapsed before they reach the front desk.

A manual check costs about $7.97 in staff time, per the CAQH benchmark — the portal is free, the 10–15 minutes aren't. An automated check with Medman starts at $0.50. At 30 patients a day, that's the difference between roughly $200 a day in staff time and $15 in checks. Valley Diabetes & Obesity's automation, with eligibility as the anchor, works out to $107–149K in annual savings.

Medman's real-time eligibility network covers 3,662 payers, and about 1,300+ of them — including Medicare (CMS), state Medicaid plans, and the major commercial carriers — return real-time checks in seconds. The rest is why automation usually stalls: over 40% of payers don't support electronic eligibility at all. For those, Medman's agents log into the payer's portal and verify the same way your staff would.

Get your free eligibility audit.

We'll run your schedule through Agentman and show you exactly what your EHR is missing.