EBV
Our Gen AI-powered Electronic Benefit Verification (EBV) solution streamlines the process of verifying patient insurance benefits in real time. Built for speed and accuracy, it helps providers make faster decisions by eliminating manual checks and reducing delays in patient onboarding or medication access.
Challenges
Delays in Insurance Benefit Verification
Traditional verification processes often involve phone calls, faxes, or manual portal checks, leading to significant delays in confirming patient eligibility and benefits.
Manual Errors and Inconsistent Processes
Reliance on manual data entry across different teams increases the risk of inaccuracies, leading to claim denials, rework, and revenue leakage.
Lack of Transparency in Coverage Details
Incomplete or outdated benefit information makes it difficult to determine copays, deductibles, and authorization requirements, impacting care decisions.
Workflow Inefficiencies and Long Turnaround Times
Disconnected systems and redundant steps slow down the overall verification process, burdening support staff and delaying treatment initiation.
Benefits
Real-Time, Automated Benefit Checks
Instantly verifies patient eligibility, copays, deductibles, and plan coverage through direct payer connections and clearinghouses.
Faster Patient Onboarding and Treatment Initiation
Streamlines the intake and access process, helping patients receive prescribed therapies without unnecessary delays.
Improved Accuracy and Reduced Administrative Burden
Automates data capture and validation, minimizing manual input and reducing the risk of human error.
Scalable Solution Integrated with Leading EHR/CRM Systems
Easily integrates with your existing tech stack, enabling seamless workflows across multiple programs and teams.
How we do it
Instant Eligibility Checks
Retrieve real-time insurance eligibility, benefit details, copays, deductibles, and coverage limits — instantly and accurately.
Gen AI-Driven Accuracy
Eliminate manual errors with intelligent data extraction and validation, improving billing accuracy and reducing rework.
Seamless Integration
Integrates smoothly with your existing EHR and workflow systems — no disruptions, just enhanced efficiency.
Faster Access, Less Admin
Automated verification reduces administrative tasks and accelerates patient access to care.
HIPAA-Compliant Security
Built with robust data privacy and security measures to ensure full compliance.
Prior Authorization Insights
Receive real-time benefit data to identify PA needs early — enabling timely adjustments to treatment plans and reducing delays in therapy.
Success Story: Transforming Benefit Verification with Gen AI for a National Specialty Pharmacy
Client Profile
A leading national specialty pharmacy serving over 100,000 patients annually across multiple therapeutic areas, including oncology, immunology, and rare diseases.
Client Requirements
The client needed a scalable solution to
- Accelerate insurance benefit verification turnaround time.
- Reduce dependency on manual calls and payer portals.
- Eliminate delays in prior authorization and patient onboarding.
- Achieve >95% accuracy in eligibility and coverage validation across commercial and government payers.
Challenges Faced
- Highly manual and fragmented benefit verification workflows across decentralized teams.
- Inconsistent data capture and long cycle times (24–72 hours) leading to delayed treatments.
- Frequent payer portal changes and complex formulary rules for specialty medications.
- Lack of real-time visibility into BV status across pharmacy, hub, and provider networks.
Our Solution
We deployed Gen AI-powered eBenefit Verification (EBV) across their intake and coordination workflows.
- Automated intake of patient and insurance data from referrals, EMRs, and faxed documents.
- Real-time API integrations with payer portals and clearinghouses to extract benefit and coverage data.
- Gen AI models trained on therapeutic-specific rules to identify medical vs. pharmacy benefit, step therapy, co-pay assistance eligibility, and prior auth triggers.
- Smart prioritization engine to flag high-risk cases needing manual intervention.
Results Delivered
Dashboards
Live dashboards and Gen AI summaries improved transparency for provider and patient queries.
2–3 days
Accelerated time-to-treatment by 2–3 days for critical oncology therapies.
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