Patient Insurance
Real-time eligibility verification, multi-policy management, prior authorization workflows, and end-to-end claims tracking.
Insurance Verification
Real-time eligibility checks for major payers before appointments
Validates coverage status, copays, deductibles, and remaining benefits
Batch verification — check eligibility for all patients on tomorrow's schedule in one click
Reduces claim denials by catching coverage issues before the visit
Policy Management
Multiple policies per patient — primary, secondary, tertiary
Track policy effective dates, termination dates, and group numbers
Subscriber information — subscriber name, ID, relationship to patient
Payer directory — pre-loaded payer IDs for major insurers
Coordination of benefits — automatic primary/secondary determination
Prior Authorization
Automated prior auth requests with status tracking
Authorization vault — track authorized units vs. utilized units in real-time
Expiration alerts — notifications when authorizations are approaching expiry
Appeal workflow — generate appeal letters from templates when authorizations are denied
CPT-specific — link authorizations to specific procedure codes
Claims Tracking
End-to-end lifecycle — from submission through remittance
Status tracking — submitted, accepted, pending, paid, denied, appealed
Denial management — automated resubmission for common rejection codes
ERA (835) processing — electronic remittance auto-posted to patient accounts
Aging reports — track outstanding claims by age (30/60/90/120+ days)
Supported Formats
EDI 837P — electronic claims for professional services
EDI 270/271 — eligibility inquiry and response
EDI 276/277 — claim status inquiry and response
ERA 835 — electronic remittance advice