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Insurance Discovery: Finding a Patient's Coverage

Insurance Discovery helps you find a patient's or prospect's insurance coverage when you don't know the payer, member ID, or other coverage details. Instead of calling the patient, searching payer portals, or asking for an insurance card, you submit basic demographic information and VerifyTx searches for active coverage.

 Before you begin

Insurance Discovery must be turned on for your account, and your account needs available Insurance Discovery credits. If you don't see Insurance Discovery in the left navigation, contact your account manager or Support.

Insurance Discovery credits are separate from your VOB and Claims credits.

What you need to search

Required:

  • Name
  • Date of birth
  • State

Optional, but they improve your chances of finding coverage:

  • Phone number
  • Postal (ZIP) code
  • Social Security number
  • Address (including address line 2 and city)
  • Gender
  • Client status

The more accurate information you include, the better the odds of a match.

Run a discovery search

  1. Click Insurance Discovery in the left navigation.
  1. Click New Discovery.
  1. Enter the required information and any optional details you have.
  1. Submit the search.

The result is saved to your Insurance Discovery list with a status of Found or Not Found.

How credits are used

  • Every submitted search uses one Insurance Discovery credit, whether or not coverage is found. The search itself has a cost even when no coverage is returned.
  • Re-Discover uses a new credit each time.
  • Save and Discover from the Edit window uses a new credit.
  • Save from the Edit window, which only updates stored details, does not use a credit.

If coverage is not found

A message tells you that coverage was not found, and the search is still saved in your list with a Not Found status.

To improve your chances on the next try:

  1. Open the discovery and click Edit.
  1. Add or correct details, especially phone number, ZIP code, and Social Security number.
  1. Click Save and Discover to search again. This uses another credit.

Check spelling and date of birth first. A small error can prevent a match.

Using the API

Insurance Discovery is available in the VerifyTx web app and through the V2 API. Searches submitted by API appear in the same Insurance Discovery list and use credits the same way. It is not available through the Production V1 API.

The Insurance Discovery list

The list shows each saved search with the name, insurance company, status, date of birth, facility, and date verified. You can search the list and filter by:

  • Insurance company
  • Insurance status
  • Client type
  • Last run date
  • User
  • Archive