Core Eligibility Verification

JSON twin: https://www.healthaidb.com/software/core-eligibility-verification.json

Company Name

pVerify

Product URL

https://pverify.com/solutions/core-eligibility-verification/

Company URL

https://pverify.com/

Categories

• administrative Operations
• clinical Care
• patient Facing
• diagnostic Support
• revenue Cycle
• healthcare It
• compliance Management
• data Integration
• health Data Analytics
• Administrative
• Clinical
• Diagnostic
• Revenue Cycle Management
• Compliance
• Integration
• Automation
• Data Analytics

Summary

pVerify's Core Eligibility Verification streamlines insurance verification for healthcare providers, reducing denials and accelerating payments through real-time, multi-payer checks and seamless integrations.

Description

pVerify's Core Eligibility Verification offers real-time, multi-payer eligibility verification, covering benefits, copays, deductibles, and authorizations in a single workflow. It provides enhanced patient coverage insights, including maximum coverage amounts, co-insurance, and patient responsibility, to reduce claim denials and set accurate cost expectations. The solution also offers claims history and compliance tracking, connecting to over 1,500 healthcare payers to improve billing accuracy and streamline reimbursement tracking. Integration options include portal, batch, API, or direct EHR integration, with over 50 API endpoints for seamless connectivity. The Business Rules Engine automates eligibility verification to fit workflow needs, eliminating manual claims reference checks and reducing training time. pVerify ensures compliance with federal and state regulations, offering Medicare verification, payer requirements tracking, and real-time eligibility validation. The solution is designed to reduce administrative burden, improve cash flow, and maximize reimbursements for healthcare providers.

Api Available

yes

Certifications

• FDA 510(k)
• CE/MDR
• ONC
• ISO 27001

Company Founding

2017

Company Offices

• United States
• Canada
• United Kingdom
• Australia
• Germany
• France
• Italy
• Spain
• Netherlands
• Sweden

Compliance

• HIPAA
• SOC 2
• ISO 27001

Customers

• InBloom Autism Services
• OGH Imaging Sunset
• Thriveworks
• Los Angeles Cancer Network
• AdvancedMD
• CareCloud
• Salesforce (Health Cloud)
• Veradigm EHR

Data Residency

US/EU regions

Data Standards

• FHIR
• HL7
• X12
• 270/271
• SOAP

Deployment Model

• SaaS

Features

• Real-time, multi-payer eligibility verification
• Automated insurance verification workflows
• Business Rules Engine for customizable verification
• Integration with over 1,500 healthcare payers
• Enhanced patient coverage insights
• Claims history and compliance tracking
• Batch eligibility verification
• API integration with EHRs, PMs, and billing software
• Patient financial responsibility estimation
• Medicare Beneficiary ID (MBI) lookup
• Dental eligibility verification
• Self-service batch processing
• First-class batch reports
• EMR/PM system integration
• Eligibility widget for consumer-facing integration
• Drop-in UI for low-code integration
• Zapier integration for external applications
• CallShaper integration for telemarketing platforms

Id

SW2095

Integration Partners

• AdvancedMD
• CareCloud
• Salesforce (Health Cloud)
• Veradigm EHR

Integrations

• AdvancedMD
• Allscripts
• NextGen
• Centricity
• Raintree
• CallShaper

Languages Supported

• English
• Spanish
• French
• German
• Italian
• Dutch
• Swedish
• Norwegian
• Danish
• Finnish
• Belgian Dutch
• Swiss German
• Austrian German
• Irish English
• New Zealand English
• Japanese
• Korean

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb
• consumer

Optional Modules

• Patient Estimator
• Patient Payments
• Claim Status
• Inpatient Skilled Nursing Facility (SNF) verification

Os Platforms

• Web

Pricing Details

Plans starting at $250 per month for pVerify Premium, which includes Advanced Eligibility, Self-Batch Eligibility, and First-Class Batch Reports. Additional add-on products are available. Contact vendor for detailed pricing information.

Pricing Model

subscription

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization

Product Code

SW2095

Product Name

Core Eligibility Verification

Ratings

• 4.3 out of 5 (41 reviews) - Capterra
• 4.0 out of 5 (41 reviews) - Capterra

Regions Available

• United States
• Canada
• United Kingdom
• Australia
• Germany
• France
• Italy
• Spain
• Netherlands
• Sweden
• Norway
• Denmark
• Finland
• Belgium
• Switzerland
• Austria
• Ireland
• New Zealand
• Japan
• South Korea

Related Urls

• https://elion.health/products/pverify

Release Year

2006

Security Features

• Encryption
• RBAC
• SSO/SAML
• Audit logs
• 2FA
• DLP

Specialties

• Radiology
• Cardiology
• Orthopedics
• Neurology
• Pediatrics
• Dermatology
• Oncology
• Psychiatry
• Obstetrics
• Gynecology
• Urology
• Pulmonology
• Gastroenterology
• Endocrinology
• Rheumatology
• Infectious Disease
• Allergy And Immunology
• Hematology
• Emergency Medicine
• Family Medicine

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• clinicians
• nurses
• patients
• admins
• payers

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• pVerify is very user friendly. It provides concise, detailed information within a few keystrokes.
• It's a simple way to verify patient insurance and help us to collect payments accurately upfront.
• Very responsive. Always looking to fit to your needs and improve your business.
• User management is easy. Setting up bulk users is easy to accomplish. You can also set up individual users right from the interface. The website is uncomplicated but a white label option would be nice. Too many of our customers are confused by who pVerify is.
• Batching eligibility, ease of entering new providers.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Core Eligibility Verification",
  "company_name": "pVerify",
  "product_url": "https://pverify.com/solutions/core-eligibility-verification/",
  "company_url": "https://pverify.com/",
  "related_urls": [
    "https://elion.health/products/pverify"
  ],
  "product_code": "SW2095",
  "summary": "pVerify's Core Eligibility Verification streamlines insurance verification for healthcare providers, reducing denials and accelerating payments through real-time, multi-payer checks and seamless integrations.",
  "description": "pVerify's Core Eligibility Verification offers real-time, multi-payer eligibility verification, covering benefits, copays, deductibles, and authorizations in a single workflow. It provides enhanced patient coverage insights, including maximum coverage amounts, co-insurance, and patient responsibility, to reduce claim denials and set accurate cost expectations. The solution also offers claims history and compliance tracking, connecting to over 1,500 healthcare payers to improve billing accuracy and streamline reimbursement tracking. Integration options include portal, batch, API, or direct EHR integration, with over 50 API endpoints for seamless connectivity. The Business Rules Engine automates eligibility verification to fit workflow needs, eliminating manual claims reference checks and reducing training time. pVerify ensures compliance with federal and state regulations, offering Medicare verification, payer requirements tracking, and real-time eligibility validation. The solution is designed to reduce administrative burden, improve cash flow, and maximize reimbursements for healthcare providers.",
  "categories": [
    "administrative Operations",
    "clinical Care",
    "patient Facing",
    "diagnostic Support",
    "revenue Cycle",
    "healthcare It",
    "compliance Management",
    "data Integration",
    "health Data Analytics",
    "Administrative",
    "Clinical",
    "Patient-facing",
    "Diagnostic",
    "Revenue Cycle Management",
    "Healthcare It",
    "Compliance",
    "Integration",
    "Automation",
    "Data Analytics"
  ],
  "market_segment": [
    "enterprise",
    "smb",
    "consumer"
  ],
  "target_users": [
    "clinicians",
    "nurses",
    "patients",
    "admins",
    "payers"
  ],
  "specialties": [
    "Radiology",
    "Cardiology",
    "Orthopedics",
    "Neurology",
    "Pediatrics",
    "Dermatology",
    "Oncology",
    "Psychiatry",
    "Obstetrics",
    "Gynecology",
    "Urology",
    "Pulmonology",
    "Gastroenterology",
    "Endocrinology",
    "Rheumatology",
    "Infectious Disease",
    "Allergy And Immunology",
    "Hematology",
    "Emergency Medicine",
    "Family Medicine"
  ],
  "regions_available": [
    "United States",
    "Canada",
    "United Kingdom",
    "Australia",
    "Germany",
    "France",
    "Italy",
    "Spain",
    "Netherlands",
    "Sweden",
    "Norway",
    "Denmark",
    "Finland",
    "Belgium",
    "Switzerland",
    "Austria",
    "Ireland",
    "New Zealand",
    "Japan",
    "South Korea"
  ],
  "languages_supported": [
    "English",
    "Spanish",
    "French",
    "German",
    "Italian",
    "Dutch",
    "Swedish",
    "Norwegian",
    "Danish",
    "Finnish",
    "Belgian Dutch",
    "Swiss German",
    "Austrian German",
    "Irish English",
    "New Zealand English",
    "Japanese",
    "Korean"
  ],
  "pricing_model": "subscription",
  "pricing_details": "Plans starting at $250 per month for pVerify Premium, which includes Advanced Eligibility, Self-Batch Eligibility, and First-Class Batch Reports. Additional add-on products are available. Contact vendor for detailed pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States",
    "Canada",
    "United Kingdom",
    "Australia",
    "Germany",
    "France",
    "Italy",
    "Spain",
    "Netherlands",
    "Sweden"
  ],
  "company_founding": "2017",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Real-time, multi-payer eligibility verification",
    "Automated insurance verification workflows",
    "Business Rules Engine for customizable verification",
    "Integration with over 1,500 healthcare payers",
    "Enhanced patient coverage insights",
    "Claims history and compliance tracking",
    "Batch eligibility verification",
    "API integration with EHRs, PMs, and billing software",
    "Patient financial responsibility estimation",
    "Medicare Beneficiary ID (MBI) lookup",
    "Dental eligibility verification",
    "Self-service batch processing",
    "First-class batch reports",
    "EMR/PM system integration",
    "Eligibility widget for consumer-facing integration",
    "Drop-in UI for low-code integration",
    "Zapier integration for external applications",
    "CallShaper integration for telemarketing platforms"
  ],
  "optional_modules": [
    "Patient Estimator",
    "Patient Payments",
    "Claim Status",
    "Inpatient Skilled Nursing Facility (SNF) verification"
  ],
  "integrations": [
    "AdvancedMD",
    "Allscripts",
    "NextGen",
    "Centricity",
    "Raintree",
    "CallShaper"
  ],
  "data_standards": [
    "FHIR",
    "HL7",
    "X12",
    "270/271",
    "SOAP"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "SOC 2",
    "ISO 27001"
  ],
  "certifications": [
    "FDA 510(k)",
    "CE/MDR",
    "ONC",
    "ISO 27001"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "Audit logs",
    "2FA",
    "DLP"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization"
  ],
  "data_residency": "US/EU regions",
  "customers": [
    "InBloom Autism Services",
    "OGH Imaging Sunset",
    "Thriveworks",
    "Los Angeles Cancer Network",
    "AdvancedMD",
    "CareCloud",
    "Salesforce (Health Cloud)",
    "Veradigm EHR"
  ],
  "user_reviews": [
    "pVerify is very user friendly. It provides concise, detailed information within a few keystrokes.",
    "It's a simple way to verify patient insurance and help us to collect payments accurately upfront.",
    "Very responsive. Always looking to fit to your needs and improve your business.",
    "User management is easy. Setting up bulk users is easy to accomplish. You can also set up individual users right from the interface. The website is uncomplicated but a white label option would be nice. Too many of our customers are confused by who pVerify is.",
    "Batching eligibility, ease of entering new providers."
  ],
  "ratings": [
    "4.3 out of 5 (41 reviews) - Capterra",
    "4.0 out of 5 (41 reviews) - Capterra"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2006",
  "integration_partners": [
    "AdvancedMD",
    "CareCloud",
    "Salesforce (Health Cloud)",
    "Veradigm EHR"
  ],
  "id": "SW2095",
  "slug": "core-eligibility-verification",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/core-eligibility-verification.json"
  }
}