Insurance eligibility verification, payer by payer

Real-time eligibility verification runs across 1,300+ payers, within a directory of 3,600+ payers in total. That covers Medicare and Medicare Advantage, Medicaid, and commercial plans, including the regional plans and IPA networks that are usually the ones missing from a smaller network.

Tell us which one. The directory reflects the payers we can verify against today, and it grows — a payer that is missing is a gap we can usually close rather than a permanent no. Coverage is also worth checking by plan rather than by brand, since a national carrier’s Medicaid and commercial lines can behave differently.

Active coverage status, plan and benefits, copay, deductible and remaining deductible, and whether the service needs a prior authorization — normalized into the same shape regardless of which payer answered. Normalization is the part that saves the time: your staff read one format instead of learning each portal’s.

Checks are performed in real time against the payer when you run them, so a result reflects the coverage at that moment rather than a cached copy. The per-payer pages describe what that payer supports; the check itself is always live.

For eligibility, generally not — the agent goes to the payer rather than routing through a per-transaction clearinghouse fee. Claims submission is a separate decision, and the claims agent works with clearinghouses and direct payer connections either way.