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Surescripts
Empower patient access and support programs
Help patients start their prescribed therapy sooner by making it easy to verify their pharmacy benefit coverage and out-of-pocket costs—without faxes, phone calls or analyzing past claims. With a streamlined method of getting accurate benefit information directly from health plans and pharmacy benefit managers (PBMs), patient access and support programs can accelerate speed to therapy.
Virtually all
insured Americans represented in our Master Patient Index1
Seconds
to receive patient-specific pharmacy benefit information2
99.995%
network uptime3
What can Electronic Benefit Verification do for you?
See how Electronic Benefit Verification can help you streamline the process of verifying pharmacy benefits and getting patients started on medication.
Replace calls and faxes with one electronic solution
Streamline intake and enrollment for your patient access and support programs with up-to-date pharmacy benefit information from PBMs and health plans—including patient-specific cost and coverage details. Electronic Benefit Verification can help reduce administrative costs for your organization and delays in therapy for the patients you serve.
Support patient care and satisfaction
Provide an integrated solution that expedites access to patient pharmacy benefit information, helping patients get started on their prescribed therapy sooner.
Match patients based on demographics
Case managers can receive a patient’s accurate pharmacy benefit information without submitting a Social Security number.
Securely transmit information
Connect case managers to pharmacy benefit information directly within existing workflows, ensuring data stays secure from end to end.
Access more benefit details
View cost and coverage information for specific patients and medications, including whether prior authorization is required.
How it works for life sciences companies
At enrollment and patient intake, a case manager obtains patient authorization.
Once the patient provides authorization, the case manager can initiate Electronic Benefit Verification.
The case manager electronically submits patient demographics to Surescripts.
Surescripts requests benefit information from the patient’s health plan or PBM.
The health plan or PBM sees the request in real time and sends a benefit response.
Interconnected systems speed up the process of sending and receiving the patient’s benefit information.
The case manager is enabled to perform patient access services without delay.
Electronic Benefit Verification empowers case managers to help patients get connected to the care they need.
Find out more about Electronic Benefit Verification
What is Electronic Benefit Verification? Is it the same as Eligibility?
Electronic benefit verification matches patients to their correct benefit plan based on their demographics. With Surescripts, this does not require a Social Security number. Unlike Surescripts Eligibility, which is designed for providers, Electronic Benefit Verification is designed specifically to meet the needs of the patient access and support programs of life sciences companies.
What is the advantage of using electronic transactions to verify a patient’s benefits?
Electronic transactions simplify the process of verifying a patient’s benefits. They help case managers avoid the need for phone calls, faxes or analyzing past claims. Instead, the entire verification process can be conducted within a single electronic workflow that facilitates real-time benefit requests and responses via a direct connection to health plans and PBMs.
How does Electronic Benefit Verification handle benefit information if a patient is covered by multiple plans?
Electronic Benefit Verification shows a patient’s full benefits, including whether insurance coverage is government or commercial and if a plan would be considered primary, secondary or tertiary coverage.
Will Electronic Benefit Verification coverage expand over time?
Yes. As we partner with additional health plans and PBMs, Electronic Benefit Verification will expand to include data for more and more patients.
Keep pace with healthcare innovation
- Surescripts, “2023 National Progress Report,” March 2024.
- Surescripts internal data, 2024.
- Surescripts, “2023 National Progress Report,” March 2024.
Connect with our team to explore how we can partner to increase patient safety, reduce costs and ensure quality care.
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