VerifyTX

What VerifyTX does

VerifyTX (legal entity SystemsTX LLC) operates a cloud-based real-time insurance eligibility verification platform purpose-built for behavioral health and adjacent healthcare providers. The platform connects to 1,700+ payers including commercial, Medicare, Medicaid, and marketplace plans, returning verification results in under 60 seconds with coverage status, deductibles, co-pays, exclusions, authorization requirements, and behavioral health carve-out details. Core modules include Instant VOB, Batch Verification for automated census re-verification, Insurance Discovery for locating coverage from incomplete patient data, Payer Alerts for capturing institutional knowledge, Claims Management, Denial Management, and Custom Branded PDF Exports. Distribution channels include a web application, native iOS and Android mobile apps, a native Salesforce AppExchange integration, and a REST API with webhooks for embedding into EHR and CRM systems.

VerifyTX generates revenue through tiered monthly SaaS subscriptions (Essentials at $299/month, Professional at $579/month, custom High Volume and Enterprise tiers, plus a $99/month SNF-specific plan), usage-based overage charges ranging from $0.50 to $1.50 per verification, and a one-time $1,500 Salesforce app add-on fee. Pricing is month-to-month with a 30-day money-back guarantee, lowering buyer friction. The company serves 4,000+ behavioral health providers across the United States, with additional focus verticals in Skilled Nursing Facilities and Durable Medical Equipment providers. Go-to-market combines PLG-style self-serve adoption via the website and mobile apps, demo-driven inside sales with ROI modeling, API-first distribution for technical buyers, and direct-to-provider content marketing. The company is privately held, founder-led (Mark Gerhardt, CEO), with no disclosed external funding, M&A activity, or institutional investors.

The platform claims measurable customer outcomes including 40-60% reductions in eligibility-related denial rates, 45-65% declines in write-offs, and 25-40% improvements in inquiry-to-admission conversion rates within 90 days of implementation. Notable customers include Foundations Recovery Network, Low Country Behavioral Health (UHS), and Harmarville, with case studies reporting $180,000 in annual savings at an 80-bed SUD residential facility and $410,000 in annual EBITDA improvement at a 120-bed facility within six months.

Name

VerifyTX

Legal name

SystemsTX LLC

Website

https://verifytx.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

1–10 employees

Short description

VerifyTX is a cloud-based real-time insurance eligibility verification platform serving 4,000+ behavioral health, skilled nursing, and DME providers across the United States, with native Salesforce integration and mobile apps.

Ownership category

akta.pro rank

Product category

Healthcare Insurance Verification Software

NAICS

Custom Computer Programming Services (541511)

SIC

Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Eligibility & Benefits Verification (HLACACAD)

Keywords

• Insurance verification software
• Eligibility verification platform
• Behavioral health software
• Revenue cycle management
• Claims management software

Headquarters

HQ city

Delray Beach

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Subscription - Essentials Plan: Entry-level subscription at $299/month (billed annually at $249/month). Includes 120 verifications per month, 12 discovery credits, 5 users, 2 facilities, and 100 claim status checks. Overage charges apply at $1.50 per additional verification, $3.00 per discovery credit, and $0.25 per claim status check.
2. Subscription - Professional Plan: Mid-tier subscription at $579/month. Includes 300 verifications per month, 30 discovery credits, unlimited users and facilities, and 150 claim status checks. Overage at $0.99 per verification. Webforms included. Most popular tier for growing teams.
3. Subscription - High Volume Plan: Custom high-volume tier for larger verification needs. Includes 600-1,000+ verifications per month, 60-100+ discovery credits, higher claim status volume, webforms included, and advanced workflow support. Overage at $0.60-$0.70 per verification.
4. Subscription - Enterprise Plan: Enterprise custom tier with 2,000+ verifications per month, 200 discovery credits, Salesforce app access, custom exports, custom integrations, integrated claim status visibility, SLA options, and dedicated CSM. Monthly pricing customized based on organization requirements.
5. Salesforce App Add-on: One-time $1,500 fee for Salesforce native application access on any plan. Enables CRM-embedded verification workflow with real-time data writeback.
6. SNF-Specific Plan: Skilled nursing facility specific plan at $99/month. Includes 50 verifications, national payer connectivity, clearinghouse access, up to 3 users, web and mobile access, HIPAA compliance, and onboarding support. Additional verifications at $2.00 each.
7. Usage Overage Charges: Incremental revenue from usage beyond plan allocations. Per-verification overage charges range from $0.50 (Enterprise) to $1.50 (Essentials) depending on plan tier.

Pricing tiers

Go-to-market motion3 records

Distribution channels5 records

Marketing channels6 records

Core offering

VerifyTX sells a cloud-based SaaS platform (also marketed as VerifyTreatment) that delivers real-time health insurance eligibility and benefits verification across 1,700+ payers, aimed primarily at behavioral health treatment centers and other healthcare providers. It bundles batch census re-verification, payer alerts, coverage discovery, custom PDF exports, native iOS and Android mobile apps, Salesforce CRM integration, and a REST API with webhooks for embedded verification into existing clinical and billing workflows.

Product overview

VerifyTreatment is a comprehensive health insurance verification platform purpose-built for behavioral health and healthcare providers. The platform operates as a unified system combining multiple integrated modules: the core Instant VOB engine for real-time eligibility verification across 1,700+ payers, the Insurance Discovery module for locating coverage from incomplete data, Batch Verification for automated census re-verification, Payer Alerts for capturing institutional knowledge, Custom Exports for branded PDF reporting, Medicaid Eligibility Verification, Claims Management for tracking submission status, Denial Management for prevention, the native Mobile App (iOS/Android), Team Collaboration Tools, Client Dashboard, Webforms for lead capture, Salesforce Integration as a native CRM embed, and a REST Insurance Verification API for custom integrations. The platform also includes specialized solutions for Skilled Nursing Facilities (SNF) and DME providers. Pricing tiers include Essentials ($299/mo), Professional ($579/mo), High Volume, and Enterprise plans, with month-to-month flexibility and no long-term contracts.

Differentiator

Problem solved

Functional benefit

Products and services

• VerifyTreatment Platform Unified SaaS platform combining real-time eligibility verification, batch re-verification, payer intelligence, claims management, denial management, and team collaboration tools for behavioral health and healthcare provider admissions and RCM teams.
• Instant VOB Real-time eligibility and benefits verification returning coverage information in under 30 seconds across 1,700+ payers, including behavioral health-specific carve-outs, co-pays, deductibles, exclusions, and authorization requirements, available 24/7/365 via web and mobile.
• Insurance Discovery Coverage discovery tool that locates active insurance coverage for patients even when only name, DOB, location, or partial plan information is available; searches commercial, Medicaid, and Medicare Advantage payers to identify correct policies and prevent lost admissions.
• Payer Alerts Customizable notes and 1-to-5 star risk ratings that surface during eligibility checks to flag payer-specific authorization quirks, denial patterns, and network limitations, guiding admissions and intake decisions with captured institutional knowledge.
• Batch Verification Automated census re-verification that checks eligibility for hundreds to thousands of clients at once via CSV upload or EHR sync, with scheduled recurring runs (daily, weekly, monthly) and automated alerts when coverage changes or policies lapse.
• Custom Exports Branded PDF export capability for verification of benefits results with customizable sections, change-aware data highlighting differences between runs, reference numbers, verification timestamps, and facility branding for audits and billing handoffs.
• Medicaid Eligibility Verification Real-time Medicaid eligibility verification with deep payer logic for behavioral health carve-outs, covering state Medicaid programs, Medicaid Managed Care, and multi-state management with automated lapse detection across all 50 states.
• Claims Management Claim status tracking and visibility for behavioral health billing teams, monitoring claims through received, in process, pending, paid, or denied statuses with ERA alerts and issue visibility to catch problems early before denials occur.
• Denial Management Denial prevention and management capabilities combining batch verification for policy lapses, team collaboration to prevent handoff errors, custom webforms for clean data capture, and payer intelligence to avoid authorization mistakes.
• Mobile App (iOS and Android) Native iOS and Android mobile application enabling insurance verification anywhere with two-factor authentication, member lookup, VOB execution, insurance card capture, teammate tagging, push notifications, and seamless sync with the web platform.
• Team Collaboration Tools HIPAA-compliant in-context messaging, mentions, shared notes, and notifications within patient records, with real-time chat, teammate tagging for task routing, and activity feeds to keep admissions, billing, and clinical teams aligned across shifts and sites.
• Client Dashboard Centralized census visibility with live status, facility filtering, client type management (prospect, lead, client, discharge), bulk actions, re-verification scheduling, owner assignment, and lightweight CRM functionality for intake tracking.
• Webforms Embeddable branded intake forms for websites that capture insurance and contact information, trigger instant VOB on submission, and route qualified leads to appropriate locations, programs, or staff with in-app and email notifications.
• Salesforce Integration Native Salesforce application available on AppExchange that embeds verification of benefits capability directly within CRM record pages, runs verification with one click from any lead, contact, account, or custom object, and writes coverage details back automatically with reporting dashboard support.
• Insurance Verification API REST API with webhooks for integrating real-time eligibility verification into custom applications, portals, or workflows, returning structured coverage data including status, payer and plan details, accumulators, and reference numbers, with a sandbox environment for development and testing.
• SNF Insurance Verification Specialized insurance verification software for Skilled Nursing Facilities including Medicare Part A days remaining, Managed Care specifics, coverage discovery for secondary payers when Part A exhausts, and Same-or-Similar rental logic for Medicare Advantage.
• DME Insurance Eligibility Verification Insurance eligibility verification software for Durable Medical Equipment and Home Medical Equipment providers, including Same-or-Similar equipment checks, rental cap tracking, copay and deductible verification, and patient financial responsibility details to prevent ship-and-deny scenarios.
• NPI Lookup Free standalone tool for searching National Provider Identifier numbers for healthcare professionals and organizations, querying the publicly available NPPES database with individual, organization, and bulk search support.

Quantifiable outcome

• Inquiry-to-assessment conversion improves 25%-40% within 90 days of implementation
• +16 more outcomes

Named customers15 records

Segments7 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

AI capability4 records

Feature10 records

Partnerships

Three partnerships are on record, tiered core and minor.

• SalesforcecoreTechnology or IntegrationNative Salesforce application (AppExchange) integrating real-time insurance verification directly into Salesforce CRM workflows. One-click VOB execution from any lead, contact, account, or custom record with results written back including coverage status, payer details, reference numbers, and accumulators. Supports Salesforce Classic and Lightning, standard and custom objects. Control access via profiles and permission sets following Salesforce sharing rules.
• EHR/EMR Integration PartnerscoreTechnology or IntegrationAPI-based integration with Electronic Health Record and Practice Management systems through REST endpoints and webhook callbacks. Supports connection to Dazos, HelloAlleva, Sunwave, HubSpot and other platforms. Integration enables eligibility data to flow directly into existing clinical and billing workflows.
• NAATP (National Association of Addiction Treatment Providers)minorOthersVerifyTX is listed as a member/vendor with NAATP. Company displays NAATP membership badge on website indicating industry association participation and compliance with NAATP standards.

Scale indicators9 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Availity: Largest U.S. health information network providing real-time eligibility, claims, and prior authorization between providers and payers. Comparable to VerifyTX as a multi-payer eligibility platform, but operates at vastly greater scale and serves a broad provider base rather than specializing in behavioral health.
• Experian Health: Enterprise healthcare RCM and eligibility-verification suite covering payer connectivity, claims management, and identity verification. Comparable as a generic eligibility competitor to VerifyTX, but with a broader provider focus and substantially larger engineering and sales footprint.
• Waystar: Cloud-based RCM platform with eligibility verification, claims management, and patient payment capabilities serving hospitals and large provider groups. Comparable on eligibility and broader RCM functionality, but Waystar targets enterprise health systems rather than behavioral health specialists.
• Change Healthcare (now Optum): Major healthcare technology and clearinghouse network offering eligibility, claims, and payment solutions to providers and payers nationwide. Comparable to VerifyTX in eligibility and clearinghouse connectivity, with far greater scale and payer reach but less behavioral health specialization.
• Inovalon: Cloud-based healthcare analytics and RCM platform that provides eligibility, claims, and quality analytics to providers and payers. Comparable in providing payer connectivity and eligibility data at scale, though it focuses more on enterprise analytics than behavioral health workflows.
• Trizetto (Cognizant Healthcare): Enterprise healthcare management software including eligibility verification, claims processing, and payer connectivity for hospitals and large provider organizations. Comparable on the eligibility and RCM axis, but oriented toward large health systems rather than specialty behavioral health providers.
• athenahealth: Cloud-based EHR and RCM platform with integrated real-time eligibility checks, claims submission, and denial management. Comparable as an eligibility competitor for behavioral health groups, with significantly greater scale but less behavioral-health-specific carve-out logic than VerifyTX.

Emerging players

• eClinicalWorks: Ambulatory EHR and practice management vendor with built-in eligibility verification and clearinghouse connectivity. Comparable for ambulatory behavioral health practices that prefer integrated EHR-plus-eligibility workflows rather than a standalone verification tool like VerifyTX.
• Edifecs: Healthcare data interoperability and payer-provider connectivity vendor with eligibility, prior authorization, and value-based care solutions. Comparable in providing payer connectivity infrastructure that competes for the same eligibility workflow use cases as VerifyTX.

Direct peers

• Office Ally: Healthcare clearinghouse and practice management platform offering eligibility verification, claims processing, and remittance to providers. Comparable as a direct competitor to VerifyTX in serving small and mid-sized provider offices with self-service eligibility workflows.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/vtxsupport
• LinkedInlinkedin.com/company/verifytreatment

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

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 VerifyTX