Find every patient hidden insurance coverage in under 60 seconds — no calls, no chases, no write-offs.
Recover 5-15% of self-pay revenue your team has already written off. Auto-identify a patient active payer, plan, and member ID in seconds — before the claim ships.
AI insurance discovery at a glance
- What it is: AI insurance discovery that finds active payer, plan, and member details for accounts that look self-pay or underinsured.
- Who it is for: Front-desk, billing, and RCM teams that need coverage checks without manual payer chasing.
- Recovery range: Designed to help recover 5-15% of eligible self-pay balances through automated discovery and validation.
- Go-live: Typical implementation reaches production in 1-2 weeks after access, BAA, and eligibility credentials are ready.
What is insurance discovery in healthcare?
Insurance discovery is the process of identifying active or previously unknown insurance coverage for patients who present as self-pay, uninsured, or underinsured. Up to 10% of self-pay patients have active insurance that was not captured during registration, resulting in billions of dollars in lost revenue for US healthcare organizations annually. QuickIntell's AI insurance discovery automatically queries multiple discovery vendors (Experian, Change Healthcare, and TransUnion-class data sources) plus state Medicaid portals, Medicare Advantage payers, and commercial endpoints to find billable coverage for patients flagged as self-pay. The system runs eligibility sweeps on scheduled and retroactive accounts, identifies Medicaid, Medicare Advantage, commercial, and workers' compensation coverage, and routes discovered policies back to the billing workflow for claim submission. Healthcare organizations using QuickIntell report recovering 3-8% of previously written-off self-pay revenue within the first 90 days of deployment.
Built for
Coverage discovery teams across the revenue cycle
You're stuck with unknown coverage at check-in, returned/denied claims for inactive plans, and slow, manual eligibility lookups. It costs days in A/R, 5–12% avoidable denials, and 30–60 minutes of staff time per patient with missing coverage.
Insurance Discovery uses probabilistic data matching + real-time 270/271 eligibility + payer graph AI so you auto-surface the most likely active payer/plan and validate it—before the claim goes out.
Key Benefits
Transform your revenue cycle with automated insurance discovery that delivers measurable results from day one.
Recover revenue at the front door
Reduce "no-coverage" denials by 40–70% and capture revenue before it's lost.
Shorten A/R cycle
Collect 7–14 days faster on previously "self-pay" visits with automated coverage discovery.
Shrink manual workload
Save 20–40 minutes per account and reassign staff to higher-value work.
How It Works
Get started in four simple steps and see results in weeks, not months.
Connect
Securely connect PMS/EHR and clearinghouse; ingest demographics & visit data.
Configure
Set match thresholds, payer priority rules, and verification steps by line of business.
Run
AI matches patient to likely payer/plan, auto-submits 270, validates 271, and writes back coverage.
Measure
Track found-coverage rate, denial reduction, and staff time saved in real-time dashboards.
Discovery review controls
Verify/Dismiss workspace
Every found coverage moves through a workspace where staff verify the patient, active dates, and member ID before coverage is written back to the EHR or dismissed with an audit reason.
Discovered coverage card
Medicare Advantage candidate
Payer, plan, member ID, group number, vendor source, and effective dates stay visible while the reviewer decides.
Identity check
Name and DOB match the patient record before any write-back.
Dates check
Effective dates cover the open dates of service being rebilled.
No conflict check
The discovered member ID is not already attached to the account.
Caption: Reviewers confirm identity, active dates, and no-conflict member ID; below 60 is hidden, 60-84 routes to manual review, and 85+ is a strong candidate before Verify or Dismiss.
Confidence-score routing
Scores below 60 are suppressed by default, scores from 60-84 need manual review, and scores at 85 or higher become strong candidates for verification.
Automated sweep
Weekly automated batch + retroactive sweep
The Sunday 3 AM UTC cron queues self-pay accounts over the $100 threshold, skips patients searched in the last 30 days, and lets AR teams run retroactive bulk sweeps outside the weekly cadence.
Bad debt prevention
Pull accounts back from collections before commission is owed
When coverage appears on a placed account, Discovery sends a recall event so the balance can move from agency placement back into active insurance AR.
See Collections automationUnit economics
CPDR calculator example
Cost Per Dollar Recovered makes the pricing comparison concrete against legacy discovery vendors that hide recovery economics.
Proven Outcomes & Performance
Real data from real healthcare organizations showing measurable impact.
Denial Reduction
In 60 days or credit 2 months
Time to Answer
P95 < 3 minutes
Hit Rate Target
First 90 days, per customer mix
Match Precision
At default threshold
Hit Rate Target by Mix
Medicaid-heavy clinics
Commercial-heavy
MA-heavy
Time-to-value: Contract → first recovered claim posted in 10 business days (median)
Insurance Discovery Result Patterns
Common outcomes revenue cycle teams model when converting self-pay accounts into verified coverage workqueues.
A multisite primary-care group reworked self-pay mystery visits into verified coverage workqueues, finding coverage on 62% of unknown accounts and cutting eligibility denials by 54% in 90 days.
Composite Result Snapshots
Primary care group (18 providers)
62% coverage found, 54% drop in CO-16 denials, 8.2 days A/R reduction
Dental support organization (41 locations)
49% coverage found, $412k incremental collections/Q
Orthopedic group (27 providers)
66% coverage found, 38 min staff time saved/case
Multi-specialty MSO (220 providers)
71% coverage found on historical batch; $3.8M A/R recovered in 90 days
FQHC network (9 sites)
64% coverage found; Medicaid match precision 97.6%
Our Guarantee
Reduce "no-coverage/unknown payer" denials by ≥45% in 60 days, or credit 2 months of platform fees.
Powerful Features for Complete Control
Everything you need to automate insurance discovery, collaborate with your team, control workflows, and measure success.
Automate
- AI-driven payer & plan matching (name/DOB/phone/address fuzzy match, household & employer hints)
- Auto-270 submission with multi-payer retries; 271 parsing to member ID, group #, copay, PCP, COB flags
Collaborate
- Work queues for exceptions with reason codes (e.g., ambiguous match, identity confidence < threshold)
- One-click patient outreach (SMS/IVR) to confirm DOB/ZIP or upload card images
Control
- Granular rules: payer whitelist/blacklist, confidence thresholds, line-of-business workflows (MA/Medicaid/Commercial)
- Audit trails on every lookup, edit, and export for compliance
Report
- Coverage-found rate, denial delta, and A/R impact by site/provider/payer
- ROI calculator: staff time saved, incremental collections, and unit economics per visit
Seamless Integrations
Works with your existing EHR, PMS, and clearinghouse systems.
Compatible Systems
Epic
Athenahealth
eClinicalWorks
NextGen
DrChronoWhat It Enables
Write-back verified payer/plan/member ID to the patient's chart
Trigger automated eligibility checks at scheduling, check-in, or claim-prep
Enrich prior auth and COB workflows with real-time coverage context
Plans built around your discovery volume
Choose the plan that fits your organization's needs. All plans include core AI matching and 270/271 verification. Credit-based: 25 credits per discovery search; volume discounts at Growth and Scale.
For single clinics & small groups (up to 5 providers)
- Up to 1,000 lookups/month
- Core AI matching + 270/271
- Standard dashboards & email support
For MSOs/DSOs & multi-site practices
- Up to 10,000 lookups/month
- Advanced rules & queues, SSO, webhooks
- Priority support & success reviews
For health systems & RCM vendors
- Unlimited lookups with volume pricing
- Multi-tenant controls, custom SLAs, sandbox
- Dedicated CSM, compliance package (BAA)
Available Add-ons
Patient outreach, OCR card capture, batch historical discovery, custom payer connectors
Security & Compliance
Enterprise-grade security protecting your patient data at every layer.
Encryption
AES-256 at rest, TLS 1.2+ in transit
Access
SSO/MFA, role-based permissions, field-level controls
Audits
Immutable logs, IP allowlists, data retention policies
Compliance
HIPAA/BAA, least-privilege access, quarterly penetration tests
OIG Exclusion
Every discovered payer and provider passes through the OIG exclusion list before any claim is submitted.
Review OIG Exclusion screeningWe take security seriously. Our platform is built with enterprise-grade security protocols and is fully compliant with healthcare industry standards.
Frequently Asked Questions
Get answers to common questions about Insurance Discovery.
Minimum: patient name + DOB. Confidence improves with address, phone, prior payer, employer, or card photo.
Typical precision 96–98% at the recommended threshold; you can tune sensitivity per payer or workflow.
Yes—state Medicaid portals and MA payers are supported via 270/271 and payer-specific endpoints where available.
Absolutely—upload a CSV or connect your data source; many clients recover 8–15% of "self-pay" balances.
Each discovery search costs 25 credits, deducted from the organization-wide credit balance. Failed searches are refunded automatically.
Yes. If hidden coverage surfaces before agency commission is owed, Discovery sends a collections recall signal so the account can move back to insurance AR and be rebilled.
We surface primary/secondary indicators from 271 and flag suspected COB cases for your rules engine.
Staff open the Verify/Dismiss workspace, cross-check identity, active dates, and duplicates, then verify coverage or dismiss it with a required reason.
Yes. Every discovered payer is screened through the OIG Exclusion workflow before a claim goes out; possible exclusions pause the workflow for review.
Bulk previews for 200 or more patients show an approval-required banner and route the batch to a user with INSURANCE_DISCOVERY:APPROVE permission before it starts.
Real-time for most payers (<60 seconds). Batch jobs process thousands of patients overnight.
Dashboard tracks coverage-found rate, denial reduction, minutes saved, and incremental collections vs. baseline.
No—keep your existing clearinghouse. We plug in and enrich your workflows.
A short BAA, read-only access to demographics, and API/SFTP credentials for eligibility. Go live in 1–2 weeks.
Yes—enable "review required" for specific payers or confidences; otherwise it's fully autonomous.
End-to-end encryption, audit logs, least-privilege roles, network isolation, and customer-controlled data retention.
Related QuickIntell Products
AI Eligibility Verification
Verify patient insurance eligibility in real time before every encounter to prevent claim denials.
QuickRCM
End-to-end AI-powered revenue cycle management that automates billing from charge capture to collections.
AI Claims Processing
Automate claim creation, scrubbing, and submission to reduce rejections and accelerate reimbursement.
AI Accounts Receivable
Prioritize and automate A/R follow-up with AI-driven worklists and intelligent payer outreach.
OIG Exclusion Screening
Screen discovered payers and providers before claims move forward to protect the compliance workflow.
Collections
Suppress and recall agency placements when discovery surfaces billable coverage on self-pay balances.
Coordination of Benefits
Route new coverage into downstream payer-order logic and secondary claim workflows.
EHR Integration
Write verified coverage back to the chart so billing, front desk, and RCM teams share one source of truth.
Ready to cut "no-coverage" denials and get paid faster?
Join 180+ healthcare organizations that have transformed their revenue cycle with automated insurance discovery. Start seeing results in weeks, not months.