The verifications an automated lookup cannot finish

CASE STUDY

The verifications an automated lookup cannot finish

At an office working mostly Medicaid managed care and Medicare Advantage, 70% of verifications cannot be completed from the electronic response alone. The portals return answers that are fast, technically correct, and wrong often enough that somebody still has to pick up the phone. The only question is who.

Project Details

Practice

Anthony Dental and Sol Smiles Dental — two sites operating as one office, with shared providers and staff

Location

Anthony, Texas

Type

General and family dentistry

Locations

Two sites, one team

Providers

Two

Practice management system

ThriveCloud

Payer mix

Roughly 70% Medicaid managed care and Medicare Advantage, 30% PPO

Verifications per month

~520

Running Iverifai since

April 2026

of verifications needed manual follow-up

0 %

verifications returned to the practice unresolved

still delivered complete and ahead of appointment

0 %

This office works a payer mix weighted heavily toward Medicaid managed care and Medicare Advantage. Those are the plans electronic eligibility handles worst: managed-care assignment is frequently wrong or missing from the response, benefit detail is thin, portals are unreliable, and a plan showing inactive is often active under a different managed-care organisation.

The practice had previously worked from electronic responses alone. The responses arrived quickly and were technically correct, but incomplete often enough that the front desk was still making calls — which meant the office had absorbed the cost of the tool and kept the cost of the work.

Iverifai treats the electronic response as the first step rather than the answer. Every patient is checked electronically; anything incomplete, ambiguous or inconsistent is escalated to a specialist who resolves it by portal or by phone before delivery. The practice never sees a partial breakdown, and never receives a verification with a note asking them to follow up.

At this office, 70% of verifications require that second step. Across the wider group the figure is around 50%, and at a PPO-only specialty practice it is still above 40%. The payer mix moves the number, but it does not create the problem. UHC Dual Complete plans are the clearest example: the portal frequently returns the wrong carrier, so the only reliable way to establish coverage is to call and ask.

SPECIFICS

A typical month at this office

364

verifications requiring work beyond the electronic response

90

Medicaid managed-care assignment issues identified and resolved

80

plans showing inactive electronically that were active on verification

No

verifications handed back to the practice for them to finish

"Our plans are the ones the automated systems give up on. Half the time the portal says inactive and the patient is perfectly well covered under a different plan. What matters to me is that nothing comes back with a note telling me to call somebody. It comes back finished."

— Office Manager, Anthony Dental

Every scheduled patient arrives with a complete breakdown, including the 70% that no automated tool would have finished.
90 managed-care assignment issues a month resolved before the patient arrives, rather than discovered at the front desk or at claim adjudication.
80 patients a month who would have been told their plan was inactive are correctly identified as covered.
Zero verifications returned unresolved — the front desk never picks up work that was sent out.
~520 verifications a month, all delivered ahead of appointment.
Two sites, shared staff, one verification standard across both schedules.

What happened next

Seven in ten verifications the portals could not finish

At an office working mostly Medicaid managed care and Medicare Advantage, Iverifai treats the electronic response as the first step rather than the answer — and the practice never receives a verification with a note asking them to follow up.

WORK WITH OUR SYSTEM

Whatever your practice runs, we work with it. Iverifai fits directly into your existing workflow so your team does not need to reconfigure anything, install anything, or learn a new interface. Everything is designed to work without disruption.

Iverifai integrates seamlessly with leading practice management systems to support your existing workflow.

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CASE STUDY