Insurance Verification Bot

Overview

An end-to-end insurance verification system for medical practices, urgent cares, and hospital front desks. The system scans a paper or digital insurance card via mobile or desk-scanner OCR, hits the payer's real-time eligibility API (270/271), confirms coverage status, validates copay, deductible, out-of-pocket max, and coinsurance, flags prior-auth requirements for the specific CPT code being billed, and writes a clean structured record back into the EHR or PMS. It works across the major payer ecosystem (Aetna, BCBS, Cigna, UHC, Humana, Kaiser, Anthem, Medicare) with a single integration layer.

The Challenge

Insurance verification is conceptually simple and operationally a mess. Card layouts vary by issuer and constantly change. Payer 270/271 APIs return data in inconsistent formats with confusing payer-specific codes. Prior-auth rules are CPT-specific and payer-specific and change without notice. The front-desk UX has to be dead simple because staff don't have time to debug. And the system has to be HIPAA-eligible end to end — encrypted at rest and in transit, audit logged, with verified business associate agreements in place.

Our Approach

We build the verification layer with two engines in series. First, a tuned OCR pipeline reads the insurance card and extracts member ID, group, payer, plan, and effective dates with confidence scoring. Second, an eligibility engine normalizes 270/271 responses across payers into a clean canonical schema your front desk can read at a glance. Prior-auth rules are pulled from a maintained ruleset we update monthly. The whole pipeline runs in a HIPAA-eligible architecture with audit logging. Integration into your EHR (Epic, Athena, eClinicalWorks, NextGen, custom) is via FHIR or vendor-specific API. Staff get a clean approve / needs-review / denied screen in 45 seconds.

Key Features

• Card OCR via mobile or desk scanner (98%+ accuracy)
• Real-time 270/271 eligibility checks across major payers
• Normalized output schema — no payer-specific quirks for staff
• CPT-aware prior-auth flagging
• EHR / PMS write-back (Epic, Athena, eClinicalWorks, custom)
• HIPAA-eligible architecture with audit logging
• Mobile-friendly UX for tablet- or phone-based intake
• Configurable thresholds for needs-review vs. approve

Results

Try It Yourself