Insurance Verified, Prior Auths Tracked, Denials Worked -- All Before the First Patient Arrives
Verification time from 25 min to 3 min, 42 eligibility checks daily, denial recovery rate up 40%
The problem
Insurance verification is the most universally despised task in healthcare administration. Before a patient can be seen, staff must confirm active coverage, verify the specific plan and benefits, check deductible and copay amounts, confirm prior authorization requirements, and ensure the provider is in-network. For a single patient, this process takes an average of 20-25 minutes when done via phone -- most of which is spent on hold. Multiply that across 30-50 patients per day, and the math becomes staggering.
The cost of getting verification wrong is even higher than the cost of doing it slowly. A claim denied for eligibility issues after the patient has already been seen means the practice absorbs the cost of the visit, spends additional staff time on appeals, and potentially damages the patient relationship. Eligibility-related denials account for nearly 25% of all claim denials, representing billions in recoverable revenue that practices simply write off because the appeal process is too labor-intensive.
Prior authorizations compound the problem. A practice managing 15-20 active prior auths at any time -- for MRIs (CPT 72148), specialist referrals, and high-cost medications -- spends 5-10 hours per week on auth submissions, status checks, and peer-to-peer review scheduling. When an auth lapses because nobody tracked the expiration date, the procedure gets cancelled, the patient waits another two weeks, and the provider loses a procedure slot that cannot be filled.
Vera is your AI Insurance & Billing Ops specialist. She runs batch eligibility checks at 6 AM via 270/271 transactions through Availity, flags lapsed coverage before the patient arrives, tracks every prior authorization from submission to approval, and works denied claims by analyzing denial codes (CO-4, CO-16, CO-197, PR-1), identifying root causes, and either auto-correcting and resubmitting clean claims or escalating complex denials to your billing manager with a full analysis and recommended appeal strategy.
How it works
How Vera works, step by step
Each step is automated. Vera only escalates when human judgment is required.
Vera runs 270/271 eligibility transactions for all patients scheduled within the next 48 hours, confirming active coverage, copay amounts, deductible status, in-network status for the rendering provider, and any prior authorization requirements for the scheduled service
Vera immediately flags the patient and appointment, generates a patient-facing summary of the issue and available options (updated insurance card, self-pay rates, financial assistance), and alerts billing staff to contact the patient before the appointment
Vera checks the status of every outstanding prior authorization via payer portals and CoverMyMeds, flags approvals that are expiring within 14 days, identifies auths that have been pending longer than the payer's typical turnaround, and escalates denials with the specific denial reason and recommended next steps
Vera analyzes the denial reason code, identifies the root cause (missing modifier, incorrect NPI, timely filing, medical necessity), and determines if the claim can be auto-corrected and resubmitted or requires manual appeal. Auto-correctable denials (CO-4 missing modifier 25, CO-16 missing NPI) are fixed and resubmitted same day
Vera drafts the appeal letter with supporting clinical documentation, the relevant denial code explanation, and the specific contractual or regulatory basis for the appeal. The letter is queued for billing manager review and provider signature
Vera generates a billing digest: total claims submitted, denial rate by payer, top denial codes, recovered revenue from resubmissions, pending prior auths, and aging A/R analysis. Delivered to the billing manager and practice administrator via Slack
What Vera handles vs. what stays with you
Clear boundaries. Vera works autonomously within defined limits and escalates everything else.
- ✓ Vera runs 270/271 eligibility transactions for all patients scheduled within ...
- ✓ Vera immediately flags the patient and appointment, generates a patient-facin...
- ✓ Vera checks the status of every outstanding prior authorization via payer por...
- ✓ Vera analyzes the denial reason code, identifies the root cause (missing modi...
- ■ Billing staff review and resolve all patient financial discussions -- Vera does not communicate coverage issues directly to patients
- ■ Prior authorization submissions requiring clinical peer-to-peer review are scheduled by Vera but conducted by the provider
- ■ Financial hardship assessments, payment plan arrangements, and charity care decisions are handled by authorized staff exclusively
- ■ Vera does not override payer system responses or estimate benefits beyond what is explicitly confirmed by the payer
- ■ Any discrepancy between RTE data and payer portal data is flagged for manual verification rather than auto-resolved
Integrations
Works inside your existing tools
Vera connects to the platforms you already use. No new software to learn.
Implementation
From zero to Vera
Vera is deployed gradually with measurable checkpoints at every stage.
- ✓ Clearinghouse credentials (Availity, Change Healthcare) for 270/271 and ERA/835 transactions
- ✓ EHR billing module API access with claim submission and remittance capabilities
- ✓ CoverMyMeds account for prior authorization submission and tracking
- ✓ Payer-specific prior authorization rules by CPT code and service type
- ✓ Provider credentialing data and payer contract fee schedules for denial analysis
Pilot targets the practice's top five payers by volume (typically covering 70%+ of patients) over six weeks. Vera runs eligibility checks in parallel with manual verification for two weeks, comparing accuracy and completeness.
Your AI team
Works alongside Vera
These AI employees share data and coordinate with Vera to cover your full operation.
Deploy Vera for your healthcare operations
Start with a 90-minute discovery session. We will assess whether Vera is the right fit for your workflows and show you exactly what changes.