PayerLenz Real-Time Eligibility

Run the benefit. See the reimbursement context.

Enter the patient's name, date of birth, member ID, and payer. PayerLenz returns the live electronic eligibility response in seconds and places relevant reimbursement benchmark data beside it.

Your admissions team gets the coverage answer it expects, plus the rate context it usually has to chase through old EOBs, spreadsheets, or billing staff.

Run an eligibility check Book a demo

The PayerLenz realtime eligibility check form and its result — An eligibility check and its response, with benchmark context attached.

What the check returns

Coverage status

See whether the electronic payer response reports the member as active for the requested date. The response stays attached to the check record for review.

Deductible and out-of-pocket detail

Review available in-network and out-of-network amounts, including:

Deductible total
Deductible met
Deductible remaining
Out-of-pocket maximum
Out-of-pocket met
Out-of-pocket remaining

Fields depend on what the payer returns. PayerLenz presents the available response; it doesn't fill missing payer data with an estimate.

Behavioral health cost-share

See the copay or coinsurance information returned for the relevant behavioral health benefit — mental health and substance-use facility benefits, inpatient and outpatient, kept distinct from general medical detail.

Authorization and carve-out indicators

Identify returned prior-authorization requirements and signs that behavioral health benefits are administered by another organization. PayerLenz scans the response for known behavioral health administrators — Optum, Magellan, Beacon/Carelon, ComPsych, Evernorth — and flags the carve-out with its source. When a carve-out is detected, a one-click follow-up reruns the check against the carve-out administrator, threaded under the original.

Reimbursement benchmark context

Review expected out-of-network reimbursement context for the matched payer, state, and level of care from the PayerLenz benchmark pool. The rate information is based on adjudicated claims. It isn't part of the payer's eligibility response and isn't a guarantee of claim payment.

One workflow instead of two disconnected lookups

Standard eligibility result	PayerLenz result
Active or inactive coverage	Active or inactive coverage
Available deductible and out-of-pocket fields	Available in-network and out-of-network detail
General cost-share fields	Behavioral health cost-share context
Authorization fields when returned	Authorization and carve-out indicators when returned
No view of what comparable claims paid	Relevant reimbursement benchmark on the same screen

Coverage and reimbursement remain different facts. PayerLenz shows them together without pretending they came from the same source.

Built for the first admissions conversation

The caller wants to know whether insurance can be used. Your team needs to know more:

Is coverage active?
What cost-share information did the payer return?
Is behavioral health carved out?
Is prior authorization indicated?
What have comparable claims from this payer paid?
Does this case need a live call before anyone relies on the answer?

PayerLenz gives staff a structured way to answer all six. When the electronic response is incomplete, move the case to Live VOB rather than improvising around a missing field.

Keep a usable record

30 days of check history. Reopen recent results when a patient calls back or another team member takes over. Checks are kept for 30 days, then permanently deleted — export any result to keep it.
Export-ready results. Save any check, benchmark cards included, as a PNG or JPEG, or print it to PDF for the patient file.
Included monthly checks. Every paid plan includes a monthly allotment of eligibility checks, with transparent per-check pricing beyond it.
One account across facilities. Paid plans include pooled seats and unlimited facilities, so teams can apply the same verification process across locations.
Benchmark methodology in view. Follow the trust score back to the volume and recency behind the rate context.

Know when to use electronic eligibility and when to call

Use Real-Time Eligibility when you need a fast coverage response and the payer returns enough structured detail to proceed.

Use Live VOB when:

The payer has limited electronic connectivity
Key behavioral health fields are missing or unclear
A carve-out needs to be traced
The plan's authorization rules need verbal confirmation
The response conflicts with information from the member or payer

An electronic eligibility response is not a guarantee of coverage or payment. Benefits can change, payer data can be incomplete, and the claim remains subject to plan terms and adjudication.