Benefits Verification

Know coverage before you fill. Every time.

Coverage surprises cost specialty pharmacies patient trust and fill revenue. Medsync's real-time BV check delivers formulary status, copay estimates, and deductible position before you dispense — not after the claim rejects.

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BV Capabilities

The complete coverage picture — in seconds

Medsync runs a full benefits verification check and surfaces every data point your team needs before committing to fill.

Formulary Status

Real-time tier confirmation for the specific drug, strength, and quantity. Includes step therapy requirements, quantity limits, and exceptions noted.

Copay & Coinsurance Estimation

Patient cost-share calculated based on current plan year position. Accurate estimates reduce surprise at pickup and improve patient satisfaction.

Deductible Tracker

Current deductible position, out-of-pocket maximum status, and accumulated spend — so your team can counsel patients on cost before they leave the counter.

PA Requirement Flag

BV check automatically flags when a PA is required for the drug — and triggers the PA filing workflow simultaneously so there's no delay between learning about the requirement and starting the process.

Benefits verification data connection diagram showing real-time payer eligibility check
BV Check Flow

Four steps. Fully automated.

1

Patient insurance confirmed

Medsync reads patient insurance data from your pharmacy system and confirms the active plan and member ID before running any checks.

2

Real-time eligibility query sent

An eligibility transaction is submitted to the payer in real time using NCPDP or HL7 standards. Most payers respond in under 10 seconds.

3

Coverage data parsed and enriched

Medsync parses the raw payer response and enriches it with formulary lookup, tier determination, and cost-share calculation — presenting your team with readable, actionable data.

4

Results surfaced to dashboard and staff

Complete BV results appear in your Medsync dashboard alongside the PA status — a single view of everything needed to move the script forward.

91%
Reduction in coverage surprise at point of fill
< 15 sec
Average BV check response time
98.4%
Copay estimation accuracy vs. final claim

No more coverage surprises at the counter.

Medsync's BV check runs in parallel with PA from the first moment — so your team has everything before they fill.

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