Coverage Insight™

An analytics-driven solution for providers that want to identify undisclosed coverage for patients presenting as self-pay or underinsured, while adhering to anti-phishing regulations.

Identify Undisclosed Coverage

Help increase revenue by detecting undisclosed reimbursement sources within 2-24 hours.

Pay only for accounts that yield a net gain via a percent or fixed-fee per benefit unit.

Minimize the risk of PHI compromise by using a solution designed to meet the anti-phishing mandates of CMS and payers.

Help increase patient satisfaction by identifying coverage that reduces out-of-pocket costs.

Help reduce the risk of bad debt associated with accounts mislabeled as self-pay or charity care.

Facilitate time-and-cost savings by helping to reduce backend collections.

Tap New Sources of Reimbursement

Choose an intelligent solution

  • We use advanced data mining, machine-learning algorithms, predictive analytics, our expansive network of payers, and more than 600 internal and external sources to identify existing insurance coverage.
  • Our solution helps to verify data accuracy using direct payer and third-party connections to confirm a patient’s benefits and the applicability of all discovered information.
  • Irrelevant information is suppressed by screening the byproduct of self-pay and eligibility processes to determine which information has historically been useful.

Reduce anti-phishing risk

  • Intelligent analytics create an in-depth demographic profile of each patient using both historical and current data such as names, addresses, employers, prior insurance coverage, MVA reports, etc.
  • Algorithms look for trending elements to compare against historical data, such as income strata and carriers associated with specific residential areas, to predict coverage and create an insurance profile.
  • Coverage Insight validates the demographic and insurance profiles are one-and-the-same. Our suppression feature rejects an average 40% of accounts due to identity risk to deliver highly-reliable data back to the provider.

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