Verify the benefit you are about to bill.
An active medical plan does not establish coverage for every service. Check carve-outs, payer order, and patient-cost estimates before the visit.
Resolve conflicting benefit responses.
A single clearinghouse response may be incomplete. Show which sources agree and what still needs verification.
Independent sources are reconciled into a single eligibility result.
A confidence score shows how much support the answer has.
Multiple clearinghouses can be used without re-enrolling the payer.
Find the behavioral-health benefit.
Identify benefits administered by a separate vendor. Route the inquiry to that payer and check coverage for the specific service.
Establish payer order before billing.
Resolve primary, secondary, and tertiary coverage and flag conflicts. After primary adjudication, generate the secondary claim with the required adjudication details.
Separate an estimate from an adjudicated balance.
When patient cost depends on adjudication, show a confidence-scored estimate before the visit and the actual responsibility after processing.