Cloud Services

Patient Eligibility

Real time Medicare, Medicaid & private health plan insurance eligibility verification.

Verify your patients' Health Insurance Eligibility instantly, easily, and affordably through our online Medicare, Medicaid & Private Health Plan Insurances.

Eliminate timely phone calls and hold times

Maximize payments and minimize errors

Access hundreds of Health Insurance Payers

Increase your chances of being reimbursed quickly and efficiently

What is Health Insurance Eligibility Verification?

Real-Time Medicare, Medicaid & Private Health Plan Insurance Eligibility Verification is a fast and secure method to instantly retrieve patient insurance information from over 800 Health Insurance Payers from a single point of access.
All Payer Batch Eligibility Verification is now available

You can send a batch of requests and receive responses as quick as a few minutes later, depending on the number of requests

Coverage Information

Use Cortex EDI Medicare, Medicaid & Private Health Plan Insurance Eligibility Verification to get information about services for your patients. Medicare responses will receive Medicare Part A and Medicare Part B Entitlement/Term Dates.

Primary Insurance Information

Find out the primary insurance information if Medicare is the secondary payer.

Co-payment Amounts

Get the Co-payment amounts required for each Service Type. (In and Out of Network).

Co-Insurance Amounts and Percents

Get the detailed Co-Insurance Amounts for each Coverage Level and Service Type.

Determine the patient’s Primary Care Provider

In some cases, the payer will give you information about the patient’s Primary Care Provider, including physician name and phone number.

Skilled Nursing Facility Data

Retrieve Skilled Nursing Facility Days Remaining and Coinsurance Days Remaining.

Medicare Part D Data (Pharmacy)

Receive patient’s Pharmacy Plan Name, Contract Number, Plan Number, Phone Number and Enrollment/Dis-enrollment Dates.

Physical, Speech, and Occupational Therapy Data

Find out the patient’s cap amount for Physical and Speech Therapy, and Occupational Therapy.

Patient Information

Retrieve patient information, including patient address based on Payer’s records.

Deductible Amounts

Get the dedictuble amounts applied and remaining per year for each Coverage Level.

Out of Pocket (Stop Loss) Amounts

Determine the out of pocket (stop loss) amounts for each Coverage Level and Service Type for plans in and out of network.

Limitations

Determine the patient’s medical coverage limitations.

Hospital Data

Get Hospital Days Remaining and Hospital Coinsurance Days Remaining.

Home Health and Hospice Data

Find out if your patient has had a Home Health Episode, or a Hospice Episode, and the dates of those episodes. Also gives information about the Payer for those episodes.

Medicare Secondary Payer and Medicare HMO Data

If a patient has Medicare Secondary, or HMO Plan, you will see the Plan Name, Contract Number, Plan Number, Phone Number and Enrollment/Dis-enrollment Dates.

Updated Medicare Insured ID

Receive patient’s updated (current) Medicare Insured ID when submitting patient’s old Medicare Insured ID.

Instant Responses

Automated response returns in just seconds.