Vendor for Insurance Coverage Detection

This is not in place with PRN team and is currently in beta with organizations working with Waystar as their clearinghouse.

Coverage detection is an option that is offered with clearinghouse partners as a method to review for active coverage with payors within the connection channels for that clearinghouse. This is used when coverage has ended or is not known for a patient to review if there is potentially an alternate policy that they are covered under.

This is a forward looking requirement to help take this off of the workload of a real person who would have to navigate this as a conversation with the patient or family.

• With Waystar the prerequisites were that they were already using the eligibility results being retrieved from Waystar and that contracting with Waystar as the clearinghouse was updated to include coverage detection.
• As the offering would become expanded to Availity and beta groups are reviewed the PRN team should be considered as a group to work with the beta offering.

Pending beta review

Christina said this is a pain point for them. She noted that patients will argue with them about the insurance they have for example if they think they have Medicare, but instead have a Medicare replacement policy.