Documentation Index
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Category: Revenue Cycle & Operations · Signals: Patient demographics · Insurance card · Payer eligibility API · Service codes
Overview
The Eligibility Verification Agent queries the payer eligibility API in real time, identifies covered services and gaps, and surfaces the result to the front desk and the patient. Every verification is documented in the chart for audit and billing.How this agent works
Configuration
This agent takes the following configuration from your practice settings:- Connected payer eligibility endpoints
- Service code set per visit type
- Patient communication policy
- Coverage-gap escalation tree
Execution
At runtime, the agent executes the following steps:- Pulls patient demographics and insurance from the chart
- Queries the payer eligibility API
- Identifies covered services, copays, and gaps
- Surfaces coverage gaps before the visit
- Documents the verification result in the chart
Composable experts
The Eligibility Verification Agent bundles the following experts from the registry:| Expert | Role |
|---|---|
| Eligibility API Expert | Payer endpoint integration and retry |
| Coverage Gap Expert | Service code coverage analysis |
| Copay Calculator Expert | Patient cost estimation |
| Documentation Expert | Eligibility result logging |
Typical use cases
- Verify benefits before the visit, not after the bill
- Surface coverage gaps to the patient with rationale
- Calculate accurate copays from real-time eligibility
- Document verification for audit and billing
Compliance & safety guarantees
- Verification is real-time, not cached past policy expiration
- Coverage gaps surface before the visit
- Patient cost estimates are sourced from eligibility, not estimates
Tags
Eligibility · Benefits · Coverage · Copay
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