Annual Reverification
Annual reverification is a regulatory requirement for patient support programs (PSPs) to confirm ongoing patient eligibility for financial assistance . Patients are asked to resubmit key documents—such as proof of income and insurance status and prescriptions—typically once every 12 months.
Manual processes often lead to missed deadlines, high drop-off rates, and compliance gaps. Our Gen AI powered intelligent reverification solution automates this process from end to end—delivering a seamless experience for both patients and case teams.
Challenges
Low Patient Completion Rates
Patients often fail to complete reverification due to confusing instructions, limited outreach, or lack of clarity on documentation.
Operational Overload
Case teams spend countless hours chasing documents, verifying submissions, and managing fragmented workflows.
Compliance Risk
Missing or expired documentation can result in audit flags and potential program disruptions.
Benefits
Increased Patient Retention
Early and automated reminders ensure patients complete reverification on time—minimizing drop-offs and preserving program continuity.
Reduced Manual Workload
Smart workflows and automated validations eliminate repetitive tasks for case managers, freeing up time for higher-value activities.
Higher Completion Rates
Clear instructions and user-friendly document upload tools drive better patient engagement and faster submission.
Real-Time Tracking & Visibility
Program teams gain instant insight into reverification status across territories — enabling quick follow-ups and proactive support.
End-to-End Compliance
The solution is fully HIPAA compliant, with configurable rules aligned with manufacturer, legal, and program guidelines.
Seamless Integration
Syncs effortlessly with your existing CRM, FRM, or case management systems—ensuring reverification workflows doesn't disrupt other operations.
How We Streamline the Annual Reverification Process
Patient & HCP Engagement
We begin by identifying patients due for annual reverification (AR).
- Outreach to Patients: We educate them on the reverification process and request updated insurance details.
- Outreach to HCPs: We engage healthcare providers (HCPs) with tailored instructions to support patient insurance updates.
- Automated Reminders: Multiple reminders are sent to both patients and HCPs to ensure timely response.
Insurance Status Update
Once updates are received.
- Insurance Change Detected: If new insurance details are submitted, the system automatically updates the patient profile.
AI-Powered Coverage Verification
We run the updated insurance details through our Gen AI Tool, integrated with payer gateways, to instantly determine coverage status.
Determine Coverage Outcome
Covered
- Our team confirms benefits by directly contacting the payer.
- Coverage details are documented.
- Approval letters are sent to both HCPs and patients.
Denied
- We document the denial reasons.
- Denial letters are issued.
- Our system triggers the appeals process to re-engage coverage.
Covered with Restrictions
- We initiate prior authorization (PA) using pre-filled forms.
- Our team works closely with HCPs to submit PA requests.
- We follow up with the payer until the approval is secured.
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