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