Insurance (Eligibility) Verification
Verify coverage and benefits automatically, before service, so fewer claims fail for eligibility reasons.
What the team is doing right now.
Staff manually check payer portals and eligibility responses, re-key coverage and benefit detail, and miss secondary coverage and benefit changes — driving downstream denials and write-offs that no one ever traces back to intake.
Scope.
- 01Automated eligibility and benefit verification across payers
- 02Coverage and benefit-change detection between encounters
- 03Exception surfacing for human review on ambiguous responses
- 04Structured write-back into the billing system and EHR
Inputs → steps → HITL gate → outputs.
Standard systems and EDI sets only.
Primary value vector: Revenue recovery.
Recover dollars that are leaking today because no one has the capacity to chase them — denials, underpayments, missed coverage, mis-routed claims.
No RCM Kit performance number is stated on this page. Industry-benchmark ranges shown in the home page problem framing and ROI Estimator are illustrative only.
Payer-mix and benefit nuances common in long-term and post-acute coverage, including dual-eligible and managed-plan patterns.
SNF is our flagship proof of depth, not the limit of scope. The same agent extends across broader healthcare RCM.
Where this agent pairs.
Insurance Discovery
On the roadmapFind billable coverage that would otherwise be written off as self-pay or unfunded.
Insurance Optimization
On the roadmapEnsure each encounter is billed to the right payer in the right order for the best compliant outcome.
Claim Management
On the roadmapClean, complete claims out the door faster — fewer first-pass denials.
Honest answers to the obvious objections.
We've heard most of these. Here's where we stand.
How do you handle accuracy and hallucination risk?
Every output with regulatory or financial exposure is reviewed by a person before it leaves the system. Agents must clear evaluation gates before they go live and to stay live, and autonomy expands only as measured confidence accrues for that agent on that workflow.
How is data and PHI handled?
Agents handle protected health information per HIPAA-aligned practices: data segregation, least-privilege access, encryption in transit and at rest, and complete audit logging. Security and compliance are part of the architecture, not bolted on. See the Security page for full detail.
How heavy is the integration lift?
Agents execute the workflow inside your existing systems — EHR/EMR, billing, clearinghouses, payer channels. Deployment is phased, agent by agent, often shadow-running before any autonomy. You are not adopting a new operating system; you are deploying a workforce inside the one you have.
What's available now vs. on the roadmap?
Payment Posting is available today. Accounts Receivable & Follow-Up is in active development with an early-access cohort forming. The other 16 agents are on the roadmap — the waitlist is how you get in early and influence priority.
How does pricing work?
There is no public pricing yet. Early-access conversations are how we shape pricing with the first cohort. Join the waitlist and we will be in touch.
How is this different from RCM AI tools that failed before?
Prior generations were sales-led, horizontal, shallow on domain, and uncontrolled — autonomy without a safety story. RCM Kit is specialized (SNF-flagship, extending across healthcare RCM), deeply integrated into the systems where the work actually happens, and control-first: human-in-the-loop, evaluation gates, full audit. Different architecture, different result.
Notify me when the Insurance (Eligibility) Verification agent is live.
We're rolling out the suite agent by agent. The early-access cohort is small by design — early onboarding, priority on roadmap influence, and a direct line to the team building it.
- → Onboarding before general availability
- → Roadmap influence on which agents ship next
- → Direct access to the build team — no SDR layer