At Develop Health, our Benefit Verification service is meticulously designed to support healthcare providers in navigating patient coverage complexities. For any given patient and a list of prescribed drugs, this service effectively determines if each drug is covered under the patient’s plan, whether prior authorization is required, and the estimated financial responsibility of the patient. This comprehensive approach streamlines the verification process, ensuring that healthcare providers can make informed decisions and manage patient care more effectively.

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Process and Technology

The Benefit Verification process at Develop Health integrates several key components, seamlessly combining technology and practicality:

  • PBM Search: Employs Optical Character Recognition (OCR) to accurately extract and analyze data from patient insurance cards for identifying the appropriate Pharmacy Benefit Manager (PBM).

  • AI Calling: This automated system conducts sophisticated calls to PBMs, leveraging state-of-the-art voice technology to facilitate natural and efficient information gathering.

  • Human Fallback: Ensures the utmost accuracy in complex cases with skilled human intervention, adding an extra layer of reliability to the process.

  • Transcript Parsing: Converts call content into structured, easy-to-understand data, simplifying the review and decision-making process for providers.

These elements work collaboratively to provide a streamlined and comprehensive benefit verification experience, whether accessed through our intuitive user interface or programmatically for more customized integration.

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Real-Time Updates and Accessibility

Our system provides real-time updates on the verification status, offering detailed insights into coverage for each medication, potential prior authorization requirements, and patient financial obligations. This information is crucial for healthcare providers to navigate the prescribing and treatment processes effectively.

Providers can easily access the full details of the verification, either through our user-friendly platform interface or programmatically through our REST API, POST and GET, and webhooks, catering to various operational needs and preferences.

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Conclusion

Develop Health’s Benefit Verification service represents our dedication to using innovative solutions to simplify healthcare procedures. By ensuring easy access to crucial information on drug coverage, prior authorization requirements, and patient financial responsibility, we empower healthcare providers to focus more on delivering quality patient care and less on administrative burdens. Our service is integral to fostering a more efficient, responsive, and patient-centered healthcare system.

IntroductionPBM Search