$3.7B
$3.7 Billion Lost to Manual Eligibility Verification — Most of It Preventable.
AI Eligibility Verification Agent
Insurance eligibility verification software with real-time 270/271 queries, benefits extraction, COB detection, PA pre-screening, and patient financial estimation.
Book Your Free Demo
See it working on your own workflows. We reply within 24 hours.
Trusted by startups and global leaders
Six Capabilities of the AI Eligibility Verification Agent
Six capabilities — 270/271 transactions, benefits normalisation, COB detection, PA pre-screening, patient financial estimation, and worklist automation — running autonomously before every appointment, across every payer.
Real-Time 270/271 Eligibility Transactions Across 900+ Payers
Automated ANSI X12 270/271 eligibility checks to every payer — primary, secondary, and tertiary — via direct Availity, Waystar, and Change Healthcare / Optum connections. Returns coverage status, term dates, plan type, member ID, and network tier in under 3 seconds.
Benefits Detail Extraction & Normalisation
Pulls full benefits from every 271 response and payer portal — deductibles, co-pay and co-insurance by service type, out-of-pocket maximums with year-to-date accumulators, visit limits, and benefit reset dates — all normalised into one consistent schema regardless of payer format.
Coverage Gap & Coordination of Benefits Detection
For patients with multiple active policies, applies COB rules — Birthday Rule, Medicare Secondary Payer, and state Medicaid third-party liability — to set primary/secondary payer order and flag conflicts before submission, preventing improper payments, recoupments, and MSP compliance violations.
Prior Authorisation Pre-Screening
Real-time PA detection: ordered CPT and HCPCS codes are matched against the payer's current prior authorisation rules at scheduling — flagging which services need PA, referral, or step therapy, and which are PA-exempt — so the PA workflow starts at scheduling, not at claim submission.
Patient Financial Responsibility Estimation
Combines verified benefits — deductible met, co-pay/co-insurance by service type, out-of-pocket accumulator, and network tier — with expected CPT codes and fee schedules to estimate patient cost share before the visit. Delivered to front-desk staff as a range, setting transparent expectations and avoiding post-service billing disputes.
Exception Worklist & Payer Portal Automation
AI-powered RPA fallback: when a 270/271 transaction fails — payer timeout, EDI rejection, non-participating clearinghouse — the agent navigates the payer's web portal directly, replicating manual verification with no staff effort. Covers Aetna, BCBS, Cigna, UnitedHealth / Optum, and state Medicaid portals, so every scheduled patient gets verified.
85%
$3.7 Billion Lost to Manual Eligibility Verification — Most of It Preventable.
AI Eligibility Verification Agent
Manual insurance eligibility verification increases administrative costs, claim denials, and revenue loss for healthcare practices.
Get Your Eligibility Denial Assessment
The $3.7 Billion Eligibility Problem Draining Every Revenue Cycle
Every number comes from production revenue-cycle deployments — measured live, not projected in a pitch deck.
80%
reduction in eligibility-driven claim denials achieved when verification is automated, moved upstream, and applied to every patient encounter rather than…
100+
Enterprise customers trusting Bonami X AI for mission-critical healthcare and revenue cycle operations.
24/7
Autonomous monitoring with real-time alerts — continuous automated intervention across every workflow.
Our Process
Why Revenue Cycle Leaders Deploy Bonami's AI Eligibility Verification Agent
Drag, click, or use the dots to walk through each reason.
Eligibility Errors Caught Before Service — Not After the Denial Arrives
The most expensive eligibility failure pattern is not the verification that was wrong — it is the verification that was performed too late, after the service was rendered, leaving the practice with a denied claim and a patient who cannot…
56% of Checks Still Manual — AI Eliminates the Verification Queue Entirely
CAQH's 2023 Index data reveals a striking lag: despite the availability of standardised 270/271 electronic eligibility transactions for more than two decades, 56% of providers still perform eligibility verification manually — by phone…
Patient Financial Clarity Before the First Appointment — Not the First Bill
The post-service billing surprise — a patient who expected a $30 co-pay and received a $400 bill because their deductible had not been met — is one of the most reliable predictors of payment delay, patient dissatisfaction, and bad debt…
EHR & Clearinghouse Integrations
Certified connectors for leading EHR platforms, clearinghouses, and patient financial solutions — writing verified coverage data directly back to your systems, no parallel workflows or manual re-entry.
Epic
Oracle Health
athenahealth
Availity
Waystar
Change Healthcare / Optum
Phreesia
From the Desk of Our Esteemed Clients
Real results from enterprises that have deployed Bonami's AI solutions across industries.
Bonami's AI platform revolutionized our content creation process. Their natural language generation tools helped us scale our content production by 300% while maintaining exceptional quality and brand voice.
85%
Stop Accepting 24–30% of Your Claims Being Denied for Preventable Eligibility Errors
Every eligibility-driven denial is a claim that could have been billed clean the first time.
Book an Eligibility Denial AI Demo
Six Capabilities of the AI Eligibility Verification Agent
Six capabilities — 270/271 transactions, benefits normalisation, COB detection, PA pre-screening, patient financial estimation, and worklist automation — running autonomously before every appointment, across every…
01
Real-Time 270/271 Eligibility Transactions Across 900+ Payers
Automated ANSI X12 270/271 eligibility checks to every payer — primary, secondary, and tertiary — via direct Availity, Waystar, and Change Healthcare / Optum connections. Returns coverage status, term dates, plan type, member ID, and network tier in under 3 seconds.
02
Benefits Detail Extraction
Pulls full benefits from every 271 response and payer portal — deductibles, co-pay and co-insurance by service type, out-of-pocket maximums with year-to-date accumulators, visit limits, and benefit reset dates — all normalised into one consistent schema regardless of payer format.
03
Coverage Gap
For patients with multiple active policies, applies COB rules — Birthday Rule, Medicare Secondary Payer, and state Medicaid third-party liability — to set primary/secondary payer order and flag conflicts before submission, preventing improper payments, recoupments, and MSP compliance violations.
04
Prior Authorisation Pre-Screening
Real-time PA detection: ordered CPT and HCPCS codes are matched against the payer's current prior authorisation rules at scheduling — flagging which services need PA, referral, or step therapy, and which are PA-exempt — so the PA workflow starts at scheduling, not at claim submission.
05
Patient Financial Responsibility Estimation
Combines verified benefits — deductible met, co-pay/co-insurance by service type, out-of-pocket accumulator, and network tier — with expected CPT codes and fee schedules to estimate patient cost share before the visit. Delivered to front-desk staff as a range, setting transparent expectations and avoiding post-service billing disputes.
06
Exception Worklist
AI-powered RPA fallback: when a 270/271 transaction fails — payer timeout, EDI rejection, non-participating clearinghouse — the agent navigates the payer's web portal directly, replicating manual verification with no staff effort. Covers Aetna, BCBS, Cigna, UnitedHealth / Optum, and state Medicaid portals, so every scheduled patient gets verified.
Get in touch
Ready to Eliminate Eligibility-Driven Revenue Leakage?
Get a live demo against your actual payer mix and a denial impact assessment showing what your current verification process is costing.
Response within 24 hours
Your data is protected & secure
Free consultation, no obligation
Frequently Asked Questions
[ 1 ]
What is an AI Eligibility Verification Agent?
An autonomous system that runs ANSI X12 270/271 transactions to 900+ payers, normalises benefits data, detects COB conflicts, pre-screens for prior authorisation, generates patient financial estimates, and routes exceptions — all before every appointment, without staff involvement.
[ 2 ]
How does AI eligibility verification reduce claim denials?
Eligibility errors cause 24–30% of initial denials due to four failure modes: too late (check-in vs. 72 hours pre-service), too narrow (primary only, missing COB), missed PA requirements, and inconsistent application.
[ 3 ]
Which payers and clearinghouses does the agent connect to?
900+ commercial payers, Medicare (Parts A/B/C/D), and all 50 state Medicaid programmes via ANSI X12 270/271 EDI through Availity, Waystar, and Change Healthcare / Optum.
[ 4 ]
How does the agent handle coordination of benefits (COB)?
The agent queries every payer on the patient's record simultaneously, applies COB sequencing rules, and flags cases for review. Birthday Rule for dual employer-sponsored dependents; Medicare Secondary Payer (MSP) rules for Medicare-eligible patients with employer or retiree coverage; correct Medicare-primary / Medicaid-secondary sequencing for dual-eligibles; retroactive Medicaid triggers a re-verification and rebilling workflow.
[ 5 ]
Is eligibility verification data HIPAA-compliant?
Yes. TLS 1.3 in transit, AES-256 at rest. Full HIPAA-compliant audit log of every transaction, portal query, RPA action, and staff override — exportable for compliance reviews and payer audits.
[ 6 ]
How does the agent integrate with Epic and Oracle Health (Cerner)?
Epic: FHIR R4 Coverage and Patient APIs for reading/writing coverage records; scheduling APIs and ADT HL7 v2.x for real-time appointment events; PA pre-screening surfaced via SmartForms or Best Practice Advisories in the clinical workflow.
[ 7 ]
How does the agent support No Surprises Act compliance?
The agent automates NSA good-faith estimate generation for every uninsured and self-pay encounter — CPT-itemised charges using your fee schedule, required regulatory disclosures, and delivery via print, patient portal, or email.
[ 8 ]
How long does implementation take and what ROI can we expect?
Standard deployment is 3–5 weeks. Weeks 1–2: clearinghouse EDI credentials, EHR API connections, and payer portal RPA configured. Week 3: payer connection testing, 271 format validation, exception routing rules, and PA pre-screening rules loaded.
Global presence