Verification time from 25 minutes to 3. 42 eligibility checks daily. Denial recovery rate up 40%.
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, and confirm prior-authorization requirements. For a single patient, this process takes an average of 20-25 minutes 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 10% of all claim denials, representing billions in recoverable revenue that practices simply write off because the appeal process is too involved to be worth it.
Prior authorizations compound the problem. A practice managing 15-20 active prior auths at any time — for MRIs, CT scans, specialty referrals, and high-cost medications — spends 6-10 hours per week on submission, resubmission, status checks, and peer-to-peer review scheduling. When an auth lapses because nobody tracked the expiration date, the procedure gets billed as denied and the revenue does not just cost a procedure and its downstream care.
Vera is your AI Insurance & Billing Operations specialist. She confirms eligibility checks on a batch every morning before the first appointment, flags lapsed coverage before the patient arrives, tracks every prior-authorization from submission to approval, and works denied claims by identifying root causes and drafting appeal packages. When a submission needs a peer-to-peer or resubmission, she surfaces it to the billing manager with a full analysis and recommended appeal strategy.
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, copays, deductibles, and 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 front-desk to contact the patient before the appointment.
Vera monitors the status of every outstanding prior authorization via payer portals and CoverMyMeds, flags approvals that are expiring within 30 days, identifies auths that have been pending longer than the payer’s typical turnaround, and escalates the ones with the specific denial reason and recommended next steps.
Vera analyzes the denial reason code, classifies the root cause (missing modifier, incorrect NPI, timely filing, medical necessity), and determines if the denial can be auto-corrected and resubmitted or requires manual appeal. Auto-correctable denials (CO-4, missing modifier) are fixed and resubmitted; the rest are escalated.
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: clean-claim submitted, denial rate by payer, denial reasons recovered, appeals in progress, and aging A/R analysis — delivered to the billing manager and practice administrator via Slack.
Clear boundaries. Vera works autonomously within defined limits and escalates everything else.
Vera connects to the platforms you already use. No new software to learn.
Vera is deployed gradually, with measurable checkpoints at every stage.
Shadow/monitoring mode first, then a gradual rollout.
Pilot begins with eligibility verification for a single payer mix. Vera runs alongside the billing team, verifying benefits in shadow mode and drafting appeal packages for review, with accuracy and denial-recovery rate validated before full deployment.
These AI employees share data and coordinate with Vera to cover your full healthcare operation.
Start with a 90-minute discovery session. We evaluate whether Vera is the right fit for your workflows and show you exactly what changes.