pVerify
Real-time insurance eligibility and benefits verification for healthcare providers.
Overview
pVerify is a cloud-based SaaS platform providing real-time health insurance eligibility and benefits verification for healthcare providers. Founded in 2006, the company built a comprehensive eligibility verification system connecting to over 1,500 medical, dental, and vision payers through both EDI and non-EDI connections. Its primary customer base includes medical billing companies, physical therapy and occupational therapy practices, dental practices, health systems, and healthcare software developers.
The platform delivers eligibility checks through a web-based portal, batch verification tools, and a library of 140+ REST APIs that integrate with EHR, practice management, and billing software. It supports multiple data exchange standards including HL7, FHIR, and ANSI X12. The system is HIPAA-compliant and SOC 2 certified, and includes modules for insurance discovery, prior authorization workflow, and claims submission integration.
pVerify was acquired by DoseSpot in June 2023. DoseSpot is a PSG-backed healthcare technology company. pVerify continues to operate independently within that portfolio. In December 2024, pVerify expanded into the dental market with automated insurance eligibility software for dental practices.
Products & Services
Real-Time Eligibility Verification
Instant patient insurance eligibility and benefits verification at the point of care, connecting to 1,500+ payers across medical, dental, and vision plans.
Key Features
- Single-transaction eligibility checks across multiple payers
- Real-time coverage status and benefits detail
- Reduces claim denials by identifying coverage gaps before service
Target Users: Healthcare providers, front-desk staff, medical billing companies
Batch Eligibility Verification
Bulk eligibility processing for scheduled patients, enabling pre-visit eligibility sweeps across multiple payers.
Key Features
- High-volume batch processing
- Pre-appointment coverage validation
- Multi-payer support in a single batch run
Target Users: Health systems, billing companies, large group practices
Eligibility Portal
Web-based, customizable portal for manual eligibility checks by administrative staff, with patient self-service capabilities.
Key Features
- Role-based access for front-desk and billing users
- Configurable to match practice workflows
- Patient self-service interface option
Target Users: Front-desk staff, billing administrators
REST API Platform (140+ Endpoints)
Comprehensive API library for deep integration with practice management, EHR, and billing software.
Key Features
- 140+ REST API endpoints
- Support for HL7, FHIR, and ANSI X12 standards
- Enables custom eligibility workflows within third-party systems
Target Users: Healthcare software developers, EHR vendors, billing platform providers
Insurance Discovery
Tools for identifying unknown or secondary insurance coverage for patients to maximize reimbursement.
Key Features
- Secondary coverage identification
- Coordination of benefits support
- Reduces write-offs from undetected coverage
Target Users: Revenue cycle management teams, billing companies
Prior Authorization Workflow
Integrated prior authorization tools combined with eligibility data for streamlined authorization management.
Key Features
- Eligibility-to-authorization workflow integration
- Reduces administrative burden on clinical staff
- Supports pre-service authorization requirements
Target Users: Medical practices, health systems
At a Glance
- Founded
- 2006
- Headquarters
- Tustin, California, USA
- Employees
- 11-50
- Funding
- Acquired
Category & Focus
- Category
- Insurtech Infrastructure
- Subcategories
- Eligibility Verification API Platform Healthcare Data Exchange
- Insurance Verticals
- Health Group Benefits
- Target Customers
- TPAs, Carriers, Agents/Agencies
Customers
- WebPT (real-time eligibility integration partner)
- Veradigm (Allscripts) -- integration partner
- Etactics -- claims submission integration partner
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Last updated: 2026-06-05