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.
Official services partner of the platforms defining AI
NVIDIA
Anthropic
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.
Verification labor is a line item, not a given.
What we have measured inside healthcare back offices. Your numbers will differ — the two-week audit puts figures on yours before anything gets built.
From anonymized engagements — hospice revenue cycle, hospital-facing eligibility services
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.
Asked by revenue-cycle and back-office leaders.
The straight answers, before you book anything.
No. Verification vendors staff the portals and phones for you and charge per verification. We encode your eligibility and benefits rules into checks that run inside your workflow — automatically, before the visit. Your team works the exception queue, and the documented rule set stays with you. Nobody on your staff is replaced; the manual portal work is.
Commercial payers, Medicare, and state Medicaid portals — including portals with no API, where checks run through the same screens your team uses today. Results write back into the PMS or EHR fields you already run; there is no new system for staff to learn. Your payer mix gets mapped in the first two weeks.
Prior authorization is adjacent, not identical, and the same encoded-rules approach applies: authorization requirements flagged at the eligibility check, submissions prepared, status chased across payer portals. Scope depends on your payers and specialties — the two-week audit identifies which authorization rules are stable enough to encode and which stay with your team.
Clearinghouses and eligibility software return raw 271 responses; someone still reads them, applies your rules, and re-keys the result into your system. We encode what your team does with the answer — which fields matter, what counts as a problem, where it gets written. The software is the pipe; the encoded rules are the workflow.
Read access to your verification worklists, your payer mix, and two hours a week with whoever knows the exceptions — which plans need calls, which portals fail, which fields matter. The two-week audit produces the rule map and a payback estimate before you commit to a build.
Engagements run under a business associate agreement, inside your environment and access controls. The work touches back-office workflow data — eligibility, benefits, claim status — never clinical records, and we give no medical advice. Access is scoped, logged, and revoked at handover.
Start with one workflow.
Tell us where your team loses hours. We will come back with a straight answer on whether AI can help, what it would take, and what it would pay.