CPT-LEVEL
INSURANCE CHECKS &
CLAIMS AUTOMATION,
DONE BY AI
Checking portals, calling payers, and chasing denials is a huge administrative strain on your team. Fuse verifies benefits at the CPT level and automates claims from pre-submission validation to post-denial correction, so you don't have to.
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HIPAA-Compliant Healthcare Automation Platform
Frequently asked questions
How does CPT code level verification improve accuracy?
CPT code level verification checks benefits for each specific procedure, not just general eligibility and coverage by STC (Service Type Code). This prevents claim denials caused by missing coverage details or authorization requirements for the specific procedure.
Why combine portal checks with payer calls?
Portals provide basic coverage information, but calls reveal specifics like prior authorization requirements, visit limits, and the copays and coinsurances that apply to that specific CPT code. Using both portals and calls ensures complete, accurate benefits verification.
What does Fuse claims automation include?
Fuse learns payer-specific approval and denial patterns and applies them across three stages of the revenue cycle: pre-visit verification, pre-submission claim validation, and post-denial correction. It runs inside your EMR, so your team only looks at the dashboard when they need to.
Can Fuse fix denied claims automatically?
Yes. Post-denial, Fuse auto-corrects and retries claims based on what each payer actually approves, and escalates to your team only when a claim needs human judgment.
How are payer discrepancies identified and resolved?
Fuse compares portal and call results to identify inconsistencies. Discrepancies are flagged for review in our dashboard and in the summary that we produce for each check that can be inputted into your EMR/EHR.
Can this system identify coverage limitations?
Yes, Fuse identifies coverage limitations, prior authorization requirements, and visit limits at the CPT code level, reducing costly eligibility-related claims denials by pulling detailed benefit information from both payer portals and direct calls.
How can network status be confirmed?
Fuse uses direct verification calls to confirm network status and make sure there are no surprises when claims are adjudicated and patients need to be billed for rendered services.
How much time can I save by automating benefits checks?
Manual eligibility and benefits checks can take billing teams anywhere from 15 minutes to 2 hours depending on data complexity and payer hold times. Fuse automates this entire process, reducing administrative time by up to 95%.
What is the financial benefit of automating benefits checks?
Benefits include admin overhead savings of up to 30 min per patient, prevention of up to 20% of denials caused by incorrect eligibility checks, and faster patient intake to help grow revenue.
