Do electronic verification of benefits work?

Within the past 5 years there have been several electronic verification of benefits tools that have come onto the market. Examples include Pverify, Eligible, Myndshft, amongst others. 

Electronic eligibility was made possible due to Availity offering an API which allows developers to pull eligibility information and display the information pulled in a digestible format. This made it possible for software companies to offer electronic eligibility checks to many payors all at once. However, the problem with relying exclusively on Availity is that 1) not all payors are on Availity and 2) Availity doesn’t always display all the information you need. Sometimes it may say preauthorization is unknown or it may display both coinsurance and copay amounts for in network, leaving you confused which one is correct. 

Availity is a great starting point but unfortunately electronic verification of benefits do not provide a complete and accurate picture of the patient’s responsibility. Because of that, you still are required to call the insurance company to gather the missing information. This is the issue with all of the electronic verification of benefits tools. They only display the information that is available online, mostly on Availity. 

One Body has solved for this by combining software and humans in order to provide you with the most complete eligibility solution. With One Body, you will never have to call an insurance company again for eligibility purposes. No more hours on the phone with Blue Shield. No more wondering what the ambiguous health benefits report actually means. One Body provides you with the exact information you need – you and your patients will know exactly what the patient’s responsibility is.