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.
Product Usage: The reviewer uses the Sohar platform for benefit and eligibility checks for their telehealth company.
Strengths: The Sohar platform excels in accuracy, speed of result delivery, and cost efficiency regarding software updates.
Weaknesses: Some gaps are present in the API documentation, and accuracy issues can occur with certain payers.
Overall Judgment: The reviewer is satisfied with the Sohar platform’s performance and believes that it was the correct choice for their company.
Product Usage: The product is used at their company to get members’ year-to-date spend information with their insurance, enabling them to build a price transparency tool within their product.
Strengths: PVerify has excellent customer service, a solid API, good payor coverage (although not the broadest), and easy-to-use technology.
Weaknesses: The product sometimes struggles with standardizing data due to varied formats from different insurance companies, and it does not quite match the payor coverage of some other options.
Overall Judgment: Despite some minor issues, the product is well-regarded, easy to use, and technologically advanced, making it a good choice for their company.
Product Usage: Waystar is used for daily automated claims submissions, ERA enrollment, and eligibility checking.
Strengths: Waystar is user-friendly and simple to navigate with a robust search functionality.
Weaknesses: Waystar’s reporting functionality is lacking, requiring extensive use of spreadsheets for data analysis and tracking; support responsiveness and issues with deeper engineering aspects were highlighted.
Overall Judgment: Despite its user-friendly interface and features, Waystar might not be the best solution for those companies seeking robust reporting capabilities and flawless engineering support.