pVerify is a cloud-based, HIPAA-compliant SaaS solution that specializes in real-time and batch patient insurance eligibility and benefits verification for medical, dental, and vision providers. Founded in 2006, its primary focus is to streamline the front-end revenue cycle management (RCM) process to maximize practice revenue and minimize insurance denials.
The platform offers a fully-customizable Eligibility Portal for manual checks and a robust set of over 140 APIs for seamless integration with existing systems. Key solutions include Core Eligibility Verification, Enhanced Patient Coverage Insights, Insurance Coverage Discovery, Claim Status, and Medicare-focused solutions (SNF, Same or Similar, CMN). The Patient Estimator tool is also included to help providers calculate patient financial responsibility upfront.
pVerify targets a wide range of organizations, including clinical providers, hospital systems, DME suppliers, pharmacies, labs, Health IT/EHR/EMR vendors, and RCM/billing companies. The company emphasizes a service-oriented approach with hands-on support and compliance, having successfully completed a SOC2 Type II audit to ensure data security and PHI protection.
Key Capabilities:
- Real-Time & Batch Verification: Instant eligibility checks across a network of over 1,500 payers.
- API-First Approach: Offers 140+ APIs (including REST, HL7, FHIR, ANSI X12) for deep integration into EHR/PM systems.
- Compliance & Security: HIPAA and SOC2 Type II compliant with data encryption and hardware firewalls.
- Financial Transparency: Patient Estimator for calculating copays, deductibles, and co-insurance.