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Insurance eligibility verification for therapy practices. Real-time eligibility verification via ClaimMD. Batch runs at intake and pre-authorization. Coverage details, copays, and benefit limits surface automatically.
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Eligibility is the first thing that breaks therapy billing, and the last thing most EMRs bother to get right. MyTherapyWizard runs eligibility as a first-class workflow, not a spreadsheet export, so you know coverage, copay, deductible, and benefit limits before the first visit hits the schedule.
Eligibility checks run through a direct API call to ClaimMD's /services/eligdata/ endpoint, no file exports, no X12 file upload, no clearinghouse portal round-trip. MyTherapyWizard builds the payload from the patient's insurance record, submits it, parses the structured benefit response in real time, and displays coverage, copay, deductible, out-of-pocket, and benefit codes (96 for occupational therapy, PT for physical therapy, UC, 50) inline. For intake and monthly re-verification, admins build a saved patient list, trigger a batch run, and MyTherapyWizard submits one call per patient with a 600ms rate-limit queue.
Changed patients sort to the top of the results view, unchanged patients collapse, so admin review is minutes, not hours. Name mismatches between the eligibility response and the MyTherapyWizard patient record surface inline with both values side by side. Every verified benefit set can be pushed to the patient's insurance record as a timestamped, attributed, non-destructive history entry. When a payer denies claims six months later claiming no coverage on a specific date of service, you can answer that question definitively from the audit trail.
Product screens, workflow diagrams, and example outputs. Replace each slot with a real screenshot or illustration.
The technical architecture, API integration points, and data model that make this feature work the way it does.
Per-patient real-time calls for single-patient checks (intake, insurance change). Batch mode queues up to the full caseload with a 600ms delay between requests to respect the 100-requests-per-minute rate limit. Results parse and display in seconds.
Every push from eligibility inserts a new row, never overwrites. Fields: ins_name_l, ins_name_f, coverage_start, coverage_end, copay, deductible, plan_number, group_number, secondary_payer_id, source (manual | eligibility_push), updated_by, updated_at. Answer 'what was this patient's coverage on Feb 14?' instantly.
Compares ins_name_l, ins_name_f, ins_dob from the eligibility response against the patient record (case-insensitive, whitespace-trimmed). Admin can accept the insurance-verified name, keep MyTherapyWizard as-is with a note, or flag for investigation. The mismatch event is logged to history regardless of the choice.
After eligibility parse, MyTherapyWizard checks the returned secondary payer against the org's in-network payer list. Flag type COB_IN or COB_OON is written with the same architecture as ELIG_CHANGE and service-stop flags, surfacing in the Needs Action tab with review, flag, and service-action options.
Real-time verification catches lapsed coverage, new primary payers, and plan changes before a session is delivered, not three weeks later when the denial arrives.
When eligibility returns a secondary payer, MyTherapyWizard cross-references the org's in-network list and flags it as COB-IN or COB-OON. Both require admin review before billing; neither slips through silently.
Save a patient list, trigger the batch, review the diff. Only patients whose eligibility has changed require attention, the rest are already good.
Book a 30-minute walkthrough with our clinical team. We will show the exact workflow for your discipline and caseload.