Helping patients access therapy as efficiently as possible is critical to improving outcomes. This is just one of the reasons electronic benefit verification (eBV) solutions are popular – they represent a streamlined approach to getting the data that makes medication access possible.

But with so many options on the market, and as technology and AI rapidly advance, it can be difficult to evaluate eBV solutions. 

Read on for strategies for how to evaluate benefit investigation services. 

Types of electronic benefit investigation services

Some eBV providers serve solely as HIPAA-compliant “bridges” to payor data. These providers, clearinghouses, or third-party vendors have access to real-time plan beneficiary eligibility data that commercial and government payors are required to make accessible via API. While efficient and inexpensive, the solutions that access this data are limited in what they are able to return. Generally, these services provide basic information – most offer only patient eligibility, some add practice participation. But often, this data alone is not enough for a patient to access therapy. 

Other solutions are able to provide additional information through alternative methods of data acquisition (more on this below). These providers can go beyond the data available via 270/271 transaction. Infinitus, for example, is able to provide customers with prior authorization requirements and product coverage for a patient’s plan, which are frequently necessary for a patient to start treatment. 

How does electronic benefit verification work?

Most eBV vendors make use of the basic plan beneficiary eligibility data referenced above, which the government requires be made available and accessible by API in real time. Some solutions only acquire data in this way. Those that provide additional information can acquire it in a few different ways.

Some real-time benefits investigation services incorporate an added layer of logic that enables the collection of coverage guidelines at the group level. While more sophisticated than the basic information collected by some providers, as PharmExec points out, “stale data can still lead to inaccuracies” in this method.

Others employ AI and machine learning. Infinitus, as an example, uses models that learn plan information over time based on calls completed by the Infinitus AI agent. The Infinitus knowledge graph, which contains up-to-date intelligence on commercial and government payor rules and guidelines, helps make our eBV+ solution possible.

Which electronic benefit verification solution is best?

The right solution depends on your specific situation. For some healthcare providers or prescribers, it’s often already known from experience if a prior authorization will be required for certain expensive drugs under common insurance plans. In those cases, the provider may just need the information available via 270/271 to validate the patient’s plan.

However, this is not the case in many, if not most, instances. For those in this camp, basic information isn’t enough to get patients access to therapy, and solutions that provide additional information are needed in order to realize the benefits of electronic benefit verification. When evaluating prospective vendors, you should be sure to ask about the percentage of the time they’re able to return data like prior authorization requirements and product coverage. While a number of vendors offer the ability to collect this information, they may not be able to return it a significant amount of the time.

Go further than traditional eBV with Infinitus

With eBV+ from Infinitus, you can unlock commercial or Medicare Part B medical coverage in seconds. These critical details help healthcare providers give patients the most detailed information possible, while cutting the time it takes to access medication. And, if more information is necessary, we can seamlessly transition tasks to the Infinitus AI agent.


Learn more about our eBV+ solution for Medicare Part B or commercial insurance, or reach out to our team directly.