Insurance Verification
Insurance verification services without the verification vendor.
We encode your eligibility and benefits rules into AI that checks the payer portals directly — your team works exceptions, not hold music.
Built with the leading AI platforms
NVIDIA
Anthropic
The verification queue
Every payer, a different portal. Every portal, a different answer.
From healthcare back offices we have sat inside: coverage verified by hand — payer portals, phone queues, re-keying into the PMS.
A different portal for every payer
Each payer has its own portal, login, and layout — some need an authenticator code. Checking one patient means logging in, navigating, copying the answer out.
The phone call when the portal fails
When the portal is down or the answer looks wrong, someone calls the payer and waits. Hold times eat the afternoon while the schedule fills up unchecked.
Benefits re-keyed into the PMS
What the portal shows gets typed into the practice system field by field. Every re-key is a chance to transpose a digit that surfaces later as a denial.
Redeterminations nobody followed up
Medicaid patients renew coverage every twelve months. The state mails the patient; the missed renewal surfaces weeks later, on your denial report.
The denial that started at registration
A lapsed plan, a transposed member ID, a benefit that excluded the service. The claim bounces weeks after the visit and the rework lands on the same team.
What manual costs
Verification labor is a line item, not a given.
Reported operating examples show where manual work adds up. Your audit establishes the workload, error rates, and costs in your business.
From anonymized engagements — hospice revenue cycle, hospital-facing eligibility services
How it works
We encode your verification rules.
No new system for your team to learn. The rules your best verifier carries in their head become the checks.
- 01
Map the rules
We write down every rule a verification gets judged by: payer mix, portal quirks, which fields matter, when a 271/272 answer suffices and when someone calls.
- 02
Encode the checks
Eligibility checks run against payer portals and clearinghouse responses automatically. Benefits are extracted and written into your PMS or EHR fields; failures land in a queue.
- 03
Work the exceptions only
Your team touches only what the rules cannot clear: failed pings, demographic mismatches, prior-authorization flags. Verification stops being the job and becomes the queue.
Verification vendors take the calls. Encoded rules take the portals.
Verification outsourcing firms staff the phones and portals for you — at per-verification prices, with your rules re-learned through their turnover. The work leaves; the knowledge goes with it.
We do not take over verification. We encode your eligibility rules into AI that checks payer portals directly and writes results into your system — your team keeps the exceptions and the revenue.
Led by Peter Enestrom.
Questions
Asked by revenue-cycle and back-office leaders.
The straight answers, before you book anything.
What’s holding your business back?
A workflow ready for automation. An AI product you want to build. A problem that has sat on the roadmap for years. Let’s talk about what it would take to solve it.
Talk to Zaigo