What pVerify does

pVerify is a healthcare technology company founded in 2006 that provides real-time insurance eligibility verification, insurance discovery, claims status tracking, and prior authorization automation. The company's core platform is a cloud-based SaaS offering exposing 50+ REST API endpoints and supporting healthcare data standards including FHIR, HL7, SOAP, and ANSI X12 270/271, with infrastructure capable of processing up to 4 billion transactions annually. pVerify connects to over 2,200 payers (medical, dental, and vision, including both EDI and non-EDI) and has processed over 300 million electronic verifications historically. The platform is differentiated by an AI-powered parsed data engine that transforms raw 271 eligibility responses into discrete, specialty-specific benefit data, complemented by a Business Rules Engine that embeds institutional verification knowledge into automated workflows.

pVerify serves four primary customer segments: healthcare providers and suppliers (hospitals, medical groups, specialty practices, DME suppliers, home health, urgent care), pharmacies and labs (independent pharmacies, diagnostic labs, imaging centers), health IT developers (EHR vendors, practice management software providers, API developers), and RCM/billing companies. Pricing is tiered by subscription volume with annual contracts: Advanced Eligibility ranges from $125/month (Standard, 500 transactions) to $395/month (Enterprise, 1,500 transactions), Insurance Discovery from $120-$390/month, MBI Lookup from $50-$200/month, and Claim Status from $40-$70/month. Distribution is primarily API-first with OEM/embedded partnerships, supplemented by direct enterprise sales and a self-serve portal for smaller customers.

pVerify was acquired by DoseSpot in April 2025 and subsequently became part of Interra Health, formed in March 2026 through the merger of DoseSpot and Arrive Health with Bain Capital Tech Opportunities as majority owner and PSG, Providence, and UPMC Enterprises as minority investors. The combined Interra Health platform is projected to exceed $100M in revenue in 2026 and serves 800,000+ providers, with pVerify operating as a subsidiary providing embedded eligibility verification capabilities across the parent's e-prescribing and revenue cycle management ecosystem. The company is headquartered in Boston (PRN Software LLC) with a California office in Tustin.

Name

pVerify

Legal name

PRN Software LLC

Website

https://pverify.com

Company type

Private

Founded year

2006

Operating status

Operating

Headcount range

11–50 employees

Short description

pVerify is a healthcare SaaS platform providing real-time insurance eligibility verification through 50+ APIs across 2,200+ payers, serving 25,000+ healthcare providers, pharmacies, labs, and EHR vendors as a subsidiary of Interra Health.

Ownership category

akta.pro rank

Product category

Healthcare Insurance Eligibility Verification Software

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518), Computer Systems Design and Related Services (54151)

SIC

Services-Computer Processing & Data Preparation (7374)

akta.pro primary industry

Eligibility & Benefits Verification (HLACACAD)

Keywords

• Healthcare eligibility verification
• Insurance benefit verification
• Real-time eligibility APIs
• Patient coverage insights
• Healthcare revenue cycle

Headquarters

HQ city

Tustin

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Infrastructure, Marketing or Sales, Operations

Revenue model

1. Subscription-based SaaS: Monthly subscription tiers with tiered pricing based on transaction volume. Standard and Enterprise tiers with different transaction limits and feature access.
2. Usage-based Transactions: Transaction-based pricing where customers pay per eligibility verification, insurance discovery lookup, MBI lookup, or claim status check based on their usage within the subscription tier.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels6 records

Core offering

pVerify is a cloud-based SaaS platform that delivers real-time healthcare insurance eligibility and benefits verification across 2,200+ medical, dental, and vision payers via 50+ REST API endpoints. Its core solutions include Core Eligibility Verification, Enhanced Patient Coverage Insights, and Claims History & Compliance Tracking, supplemented by modular offerings such as Insurance Discovery, MBI Lookup, Claim Status, Prior Authorization, and a Business Rules Engine that automates verification workflows for healthcare providers, pharmacies, labs, EHR vendors, and RCM companies.

Product overview

pVerify is a SaaS platform specializing in patient healthcare insurance eligibility and benefits verification. The platform operates as a unified solution with three core products (Core Eligibility Verification, Enhanced Patient Coverage Insights, Claims History & Compliance Tracking) supported by modular add-ons including Insurance Discovery, MBI Lookup, Claim Status, and Prior Authorization. The ecosystem includes specialized vertical products (pVerify for Dental), developer tools (Drop-in UI, 50+ API endpoints), and free utilities (NPI Lookup, Payer List). The platform connects to 2,200+ payers (medical, dental, vision) and supports integration with EHR/EMR systems, practice management software, Salesforce, WebPT, and standard healthcare data protocols (HL7, FHIR, ANSI X12). pVerify became a subsidiary of DoseSpot (2021) which subsequently merged with Arrive Health (March 2026) to form Interra Health.

Differentiator

Problem solved

Functional benefit

Products and services

• Core Eligibility Verification Real-time, multi-payer insurance eligibility verification covering benefits, copays, deductibles, and authorizations for healthcare providers at point of care, with Business Rules Engine support for customizable automated workflows.
• Enhanced Patient Coverage Insights Patient financial responsibility estimator providing detailed views of maximum coverage amounts, co-insurance, deductibles, and patient out-of-pocket responsibility to reduce claim denials and set accurate cost expectations at point of care.
• Claims History & Compliance Tracking Real-time claims history tracking and compliance monitoring for Medicare, Medicaid, and commercial payers, including Same or Similar History APIs to prevent duplicate claim submissions and ensure billing accuracy.
• Insurance Discovery Identifies missing or unknown insurance coverage using only a name and date of birth. Standard tier covers commercial payers plus Medicare; Advanced tier includes state Medicaid.
• MBI Lookup Medicare Beneficiary Identifier lookup tool that retrieves Medicare coverage details in real time using basic patient information (SSN, DOB, or age), enabling verification of Medicare coverage and access to plan details including Medicare Advantage options.
• Claim Status Electronic claim inquiry and tracking tool that automatically monitors submitted claims, processing updates, financial data, and billing exceptions to reduce follow-up time and accelerate reimbursement.
• Prior Authorization (pAuth/Fast-PAAS) Prior authorization automation solution that removes the burden of manual prior authorization processes by leveraging EMR connections and payer/PBM connectivity to resolve prior authorizations at point of care.
• pVerify for Dental Dental-specific insurance eligibility and benefits verification software that integrates with dental practice management systems via APIs to 1,500+ payers, providing customized eligibility results rather than generic plan benefits and supporting dental eligibility from both medical and dedicated dental payers.
• Healthcare Eligibility & Medical APIs RESTful API platform with 50+ endpoints for eligibility verification, insurance discovery, claim status, and prior authorization; HIPAA compliant and scalable up to 4 billion transactions annually, supporting REST API, FHIR, HL7, and 270/271 standards for EHR/EMR vendors, PM software providers, and API developers.
• Patient Demographic Validator (PDV) Validates key patient demographic and eligibility details using minimal information such as name and location while maintaining data integrity and privacy, helping offices with limited patient information verify coverage details.
• Business Rules Engine (BRE) Customizable rule-based automation engine that appends standard information and verification specialists' archival knowledge into eligibility returns, enabling automated verification based on plan details, codes, UMOs, capitation facilities, and payer hierarchy.
• CallShaper Telemarketing platform integrated directly into existing software, enabling agents to verify Medicare eligibility status (including HMO/PPO, QMB, and Medicare Advantage plans) with a single click directly within their workflow.
• Patient Estimator Cost estimation tool powered by eligibility results and unique fee schedules that provides quick and easy out-of-pocket cost estimates for patients at point of care.
• NPI Lookup Free National Provider Identifier lookup tool that allows searching the NPI Registry for healthcare provider identification information used in standard HIPAA transactions.

Quantifiable outcome

• Reduced claim denials by up to 50%
• +5 more outcomes

Named customers10 records

Segments5 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

AI capability3 records

Feature9 records

Partnerships

Four partnerships are on record, tiered core, strategic and minor.

• Arrive HealthcoreStrategic or Co-development Partner · 2 March 2026Arrive Health merged with DoseSpot (pVerify's parent) to form Interra Health, combining Arrive Health's coverage and pricing network with DoseSpot's e-prescribing capabilities. Arrive Health provides real-time medical and pharmacy benefit information integrated with EHR and e-prescribing vendors.
• EtacticsstrategicTechnology or Integration · 31 October 2023Strategic partnership to bring end-to-end revenue cycle management capabilities. Etactics offers claims submission and denials management capabilities, allowing pVerify customers to connect to a clearinghouse with thousands of claims connections.
• WebPTstrategicTechnology or Integration · 10 May 2022Partnership to integrate pVerify's Advanced Eligibility Solution into WebPT's Electronic Benefit Verification (eBV) product. pVerify provides extensive key benefit details for all EDI payers with over 900 real-time EDI payers covered.
• MPE: Leaders Conference (formerly MGMA Annual Conference)minorOthers · 26 October 2021pVerify participated in the MPE: Leaders Conference in San Diego to showcase enhanced ANSI X12 technology and release of Prior Authorization and Business Rules Engine products.

Scale indicators7 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• Availity: The largest real-time health information network connecting providers, health plans, and technology partners. Directly comparable to pVerify as a multi-payer eligibility and data-interchange platform serving providers and EHR vendors.
• Edifecs: Healthcare data interoperability and payer-provider integration specialist supporting EDI X12, FHIR, and HL7 workflows. Comparable to pVerify on payer connectivity, API platforms, and value-based care data exchange.
• Infinx: Provider of eligibility verification, prior authorization, and patient access solutions for hospitals, specialty groups, and ambulatory practices. Closely comparable in go-to-market and product scope to pVerify.
• ABILITY Network: Healthcare technology company delivering eligibility, claims, and remittance workflows to hospitals, ambulatory centers, and post-acute providers. Directly comparable to pVerify's eligibility and claims status offerings.

Broad incumbents

• Experian Health: Broad healthcare RCM suite offering eligibility verification, claims management, identity management, and analytics. Overlaps with pVerify's eligibility and insurance-discovery capabilities but as part of a wider portfolio.
• Waystar: End-to-end revenue cycle management platform for hospitals and health systems, with eligibility verification as a module alongside claims, denials, and patient estimation. Competes with pVerify on the front-end patient access layer.
• Optum (Change Healthcare): Massive payer-and-provider healthcare technology platform offering eligibility, claims, and clearinghouse services. Already a pVerify customer, illustrating the overlap between pVerify's eligibility product and broader RCM suites.
• Phreesia: Patient intake, eligibility, and payments platform serving specialty practices, hospitals, and life sciences. Overlaps with pVerify on patient access and insurance verification, though Phreesia's front-end intake orientation is broader.

Emerging players

• Akasa: AI-driven revenue cycle automation for healthcare providers, including eligibility and prior authorization workflows. An emerging competitor in the same front-end RCM space where pVerify's Business Rules Engine and APIs operate.

Others

• DoseSpot: ePrescribing platform that acquired pVerify in 2025 and is now part of Interra Health. A parent and partner rather than direct competitor, but the most operationally adjacent company given shared distribution and customers.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/pVerify
• Facebookfacebook.com/patienteligibilityverification
• LinkedInlinkedin.com/company/pverify
• Instagraminstagram.com/pverify.inc

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about pVerify