Agentic Intelligence for Benefits Verification
Curious about Susan's capabilities?
Patient Coverage Check
Susan starts by checking if insurance information is present in the patient's records, including member ID & provider details. If any crucial information is missing, Susan automatically notifies the intake team.
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Insurance Discovery
When member ID isn't available, Susan automatically searches across insurance databases to find active coverage. Sam checks multiple sources including Medicare and Medicaid to ensure no coverage is missed.
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Real-time Eligibility Verification
Susan verifies insurance coverage in real-time, checking if the specific services are covered under the patient's plan. This includes confirming the provider network status and service type coverage.
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Benefits Summary
Susan generates a comprehensive benefits summary showing copays, deductibles, out-of-pocket maximums, and covered services. If multiple insurance policies are found, Sam flags this for proper coordination of benefits
Next-Gen Verification: Where Speed Meets Scale
Automated insurance verification via direct payer phone calls, handling IVR systems and multi-factor authentication
Simultaneous multi-patient verification across payers, scaling to enterprise volumes
Single interface for all major payer portals with automated credential management
Self-improving verification workflows that adapt to payer portal changes and rule updates
Automated handling of complex login flows including One Healthcare ID and ID.me with 2FA support
Sub-second benefit extraction from portal interfaces with >99% accuracy
Proactive coverage validation and missing information detection before claim submission
End-to-end encryption and secure credential management
90% reduction in manual verification time with automated portal navigation
Near-zero error rates in benefit verification through automated data validation
Linear performance scaling from 100 to 100,000+ verifications/day
Real-time dashboard tracking verification success rates, processing times, and cost savings
