Eligibility Checking
Eligibility Checking products provide healthcare providers with tools to verify a patient’s insurance coverage, including in-network status and covered services. They can also assess the cost of procedures in advance, enhancing transparency. Some of these products support the creation of Good Faith Estimates (GFEs), aiding patients and providers in making informed financial decisions regarding care.
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Sohar Health
Claimed
Sohar Health
Company Info
Founded: 2023
Headcount: 1-10
Customers
Verified Customers: 4
Customers Served: Digital Health Provider, Ambulatory Practice
Product Overview
1 ReviewsSecurity and Compliance Certifications: HIPAA
Sohar Health enables eligibility verification and AI-powered medical coding for behavioral health providers. Sohar offers integration with EHR systems and APIs, enhancing workflow efficiency and enabling easy integration into existing systems.
Nirvana
Claimed
Nirvana
Company Info
Founded: 2020
Headcount: 11-50
Customers
Verified Customers: 15
Customers Served: Digital Health Provider
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA
Nirvana offers AI-powered tools for healthcare providers, primarily focusing on simplifying insurance verification and claim management for mental and behavioral health practices. Key products include the OneVerify platform for real-time insurance eligibility checks, a coverage API that integrates directly with EHR systems, and tools for continuous coverage monitoring to reduce claim denials. Their technology helps automate administrative tasks, ensuring accurate cost estimates and reducing manual errors, which improves patient intake and engagement.
Silna Health
Claimed
Silna
Company Info
Founded: 2023
Headcount: 11-50
Customers
Verified Customers: 10
Customers Served: Ambulatory Practice, Digital Health Provider
Product Overview
Security and Compliance Certifications: HIPAA
Silna Health focuses on helping specialty healthcare providers manage prior authorizations, benefits, and eligibility checks. It is designed for use in physical therapy, speech therapy, and behavioral health. Silna automates the authorization process using AI, provides regular benefit and eligibility checks, and sends reminders for expiring authorizations to prevent lapses in care.
SuperDial
Claimed
SuperDial
Company Info
Founded: 2021
Headcount: 1-10
Customers
Verified Customers: 9
Customers Served: Digital Health Provider, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
SuperDial is a platform for AI-enabled payer phone calls for insurance verification, prior authorization, credentialing and enrollment, and claim follow-ups. It offers a low-code UI for configuring call flows, placing calls, and viewing call results.
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PVerify
PVerify
Company Info
Founded: 2006
Headcount: 11-50
Customers
Verified Customers: 19
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
1 ReviewsSecurity and Compliance Certifications: SOC 2 Type 2, HIPAA
pVerify specializes in verifying patient insurance eligibility and benefits across a wide range of payers, including Medicare, Medicaid, and commercial providers. It supports diverse healthcare sectors through advanced eligibility checks, batch verification, and integration with electronic health records and practice management software.
Waystar
Waystar
Company Info
Founded: 2017
Headcount: 1001-5000
Customers
Verified Customers: 6
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
1 ReviewsSecurity and Compliance Certifications: HITRUST CSF, HIPAA
Waystar is an end-to-end revenue cycle management company, offering eligibility verification, claims submission, payment posting, denials management, and analytics.
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Aarogram
Aarogram
Company Info
Founded: 2022
Headcount: 11-50
Customers
Customers Served: Ambulatory Practice, Digital Health Provider
Product Overview
Security and Compliance Certifications: HIPAA
Aarogram is a healthcare platform focused on automating insurance verification and providing real-time patient financial estimates. It is designed to streamline revenue cycle management for various medical specialties, including sleep centers, neurology, and telehealth providers. Aarogram uses AI to generate accurate patient payment estimates and enhance insurance verification processes, reducing administrative burdens and improving financial transparency for patients. The platform is HIPAA compliant.
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Availity
Availity Essentials
Company Info
Founded: 2001
Headcount: 1001-5000
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan
Product Overview
Security and Compliance Certifications: HITRUST CSF, HIPAA
Availity Essentials is an end-to-end RCM solution for providers. It offers a range of features aimed at improving efficiency and accuracy in tasks such as eligibility and benefits verification, claims management, and prior authorization.
Clearwave
Clearwave
Company Info
Founded: 2004
Headcount: 51-200
Customers
Verified Customers: 32
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Clearwave is a comprehensive healthcare platform designed to optimize patient engagement and administrative efficiency in hospitals and health systems. Its core capabilities include the automation of critical processes such as patient scheduling, registration, and eligibility verification for insurance. Additionally, Clearwave's system supports real-time eligibility verification with payers, facilitates a contactless check-in experience, and offers a digital front door for scheduling.
Develop Health
Develop Health
Company Info
Founded: 2022
Headcount: 1-10
Customers
Verified Customers: 4
Customers Served: Digital Health Provider, Ambulatory Practice
Product Overview
Security and Compliance Certifications: HIPAA
Develop Health is an AI-enabled eligibility checking and prior authorization platform for medication. It automates benefit verification, clinical eligibility checks, and prior authorization form completion, and automatically calls payers to get benefit details. By integrating patient insurance data and clinical history, the platform increases first-time approval rates and reduces delays in accessing medications.
Eligible
Eligible
Company Info
Founded: 2011
Headcount: 11-50
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HITRUST CSF, SOC 2 Type 2
Eligible provides APIs for streamlining insurance billing, including eligibility checks, insurance verifications, real-time cost estimations, and filing of insurance claims. Eligible offers a REST API that uses JSON, as well as Ruby, C#, Java, and Node.js SDKs.
Experian
Experian Insurance Verification
Company Info
Founded: 1980
Headcount: 5001-10000
Customers
Verified Customers: 3
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA, GDPR
Experian Insurance Verification automates eligibility and coverage checks for providers. Beyond coverage checks, it supports Medicare reimbursements by offering an automated MBI Lookup Service that identifies missing or invalid MBIs along with Medicare benefit coverage.
FinThrive
Finthrive Patient Access
Company Info
Founded: 2016
Headcount: 1001-5000
Customers
Verified Customers: 2
Customers Served: Hospital / Health System
Product Overview
Security and Compliance Certifications: HITRUST CSF, HIPAA
FinThrive Patient Access is designed to enhance the patient financial experience by improving price transparency, streamlining digital check-ins, and increasing efficiency in revenue collection. It enables patient scheduling and intake, eligibility checking, payment collection, and price estimates.
Health Harbor
Health Harbor
Company Info
Headcount: 1-10
Customers
Verified Customers: 2
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
Health Harbor is an AI agent that calls insurance companies for eligibility and claim status checks.
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MaxRTE
maxRTE
Company Info
Headcount: 11-50
Customers
Verified Customers: 20
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA
MaxRTE provides insurance verification software to assist with real-time eligibility and insurance discovery.
Orbit Healthcare Inc
Orbit Healthcare Inc
Company Info
Founded: 2009
Headcount: 11-50
Customers
Customers Served: Hospital / Health System, Ambulatory Practice
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA
Orbit Healthcare Inc. provides AI-powered solutions for healthcare providers, focusing on insurance data capture, verification, prior authorization, and revenue cycle management. Their platform automates insurance card data extraction, prior authorization tracking, and claims processing to reduce errors and denials. Additional capabilities include document processing, patient scheduling, and coverage discovery. These services are designed to optimize administrative workflows and improve overall efficiency for healthcare organizations.
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Pledge Health
Pledge Health
Company Info
Founded: 2022
Headcount: 1-10
Customers
Verified Customers: 6
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
Pledge Health offers an automated patient billing and payments platform, focusing on insurance benefit verifications, patient cost estimates, patient statements, and payment processes to enhance the financial experience for both healthcare providers and their patients
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Rivet
Rivet Patient Pricing
Company Info
Founded: 2018
Headcount: 51-200
Customers
Verified Customers: 5
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
Rivet Patient Pricing generates accurate patient cost estimates in compliance with the No Surprises Act, allowing patients to see their deductible and out-of-pocket costs. The system integrates with EHR and practice management systems, automating eligibility checks, and aligning contracted rates with insurance benefits. It provides customizable payment terms, batch communication, and upfront payment collection.
TruBridge
TruBridge Patient Access
Company Info
Founded: 1979
Headcount: 1001-5000
Customers
Verified Customers: 2
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
TruBridge Patient Access streamlines patient registration processes, automates real-time insurance eligibility checks, and provides patient estimation, which allows providers to offer precise cost estimates to patients before services are rendered. This includes considering factors such as insurance coverage, co-pays, and deductibles, helping patients understand their financial obligations upfront. Additionally, TruBridge facilitates upfront collections for patients.
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314e
Veritable
Company Info
Founded: 2004
Headcount: 501-1000
Customers
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: SOC 2 Type 2
Veritable is a healthcare IT solution focused on insurance eligibility verification and claim status checks. It allows medical practices to access information from over 1,500 insurance payers, reducing administrative burdens and improving operational efficiency. The platform helps avoid claim denials and delays by confirming coverage before services are provided.
Wendi
Wendi
Company Info
Founded: 2017
Headcount: 11-50
Customers
Verified Customers: 1
Customers Served: Digital Health Provider, Ambulatory Practice
Product Overview
Security and Compliance Certifications: HIPAA
Wendi is an AI-powered digital assistant for patient engagement from initial contact through scheduling and eligibility checking.
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