Review possible insurance coverage for self-pay accounts
Investigate payer, plan and member details, review possible matches, and resolve coverage questions before the billing handoff. Identified coverage is not a payment guarantee.
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.
- Outcome review: Track verified coverage, claim decisions and collections separately against your own baseline; a possible match is not a recovered payment.
- Go-live: Agree on access, BAA, eligibility credentials and validation requirements before setting an implementation schedule.
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. A possible coverage match needs verification before the billing handoff and does not establish that a claim will be paid. 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. Evaluate verified coverage and actual collections separately against your own baseline. For a specialty-specific path that keeps post-service discovery, accident details, and payer-order review distinct, see the emergency department insurance discovery workflow.
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. Measure the related review time, claim rework and unresolved balances in your own workflow before estimating an impact.
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.
Workflow Review Priorities
Use your own account history and review process to define what an insurance discovery evaluation should measure.
Review unresolved coverage
Identify accounts needing coverage review and confirm possible matches before deciding the next billing action.
Follow the billing handoff
Track what happens after coverage review, including claims submitted, payer responses and collections received.
Evaluate staff workload
Measure touches, review time and unresolved exceptions against your current process before estimating a benefit.
How It Works
Review the connection, configuration, operating and measurement steps before agreeing on your deployment scope.
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
Define the Cost Per Dollar Recovered
Use actual costs, an agreed attribution method and a defined observation window. If no collections are attributed, this ratio is undefined, not zero. This is a planning formula, not a measured customer result or quoted price.
Plan an Insurance Discovery Evaluation
Start with your own coverage-review baseline and agree on what an evaluation should measure.
Choose a dated set of accounts, document the existing review process and assign an owner for unresolved cases. Use the same definitions when evaluating any proposed workflow change.
Evaluation Inputs
Starting cohort
Define which self-pay or unresolved-coverage accounts are in scope, along with the service dates and available records.
Coverage review
Record which possible matches need payer verification and which accounts remain unresolved. A possible match is not a payment guarantee.
Staff workload
Measure review time, follow-up touches and exceptions against your starting process rather than assuming a time saving.
Billing follow-through
Keep coverage findings separate from claims submitted, payer decisions and collections actually received.
Measurement period
Agree on the observation window, denominators, exclusions and review owner before comparing outcomes.
Agree on Evaluation Criteria
These are planning inputs, not customer results or a performance guarantee. Confirm the proposed scope, success criteria and any commercial terms before starting a pilot.
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.
Validate possible matches against patient identifiers, active dates and payer responses. Measure precision on your reviewed cohort; no universal match-accuracy rate is stated here.
Yes—state Medicaid portals and MA payers are supported via 270/271 and payer-specific endpoints where available.
CSV imports or connected data can supply historical accounts for review. Track verified coverage and actual collections separately; no recovery percentage is promised.
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.
Completion time depends on the payer response, available data, batch size and exceptions. Confirm expected processing times and follow-up responsibilities for your deployment.
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.
Agree on BAA, demographics access, eligibility credentials and validation requirements before setting an implementation schedule.
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.
Plan Your Insurance Discovery Workflow Review
Discuss the accounts you want to review, the available data and the handoffs that need an owner. Agree on scope and evaluation criteria before starting a pilot.