Hayes RCM’s AI-powered platform verifies patient insurance benefits in real time, 24 hours a day — paired with hands-on prior authorization management from our Intake Team, all under one subscription.
Hayes RCM has built an AI-powered platform for home health and hospice providers that automates benefits verification in real time, any time of day. Prior authorization requests are handled by our Intake Team and billed under the same combined monthly allotment — one subscription instead of piecing together separate tools. Note: Traditional Medicare (Fee-for-Service) is not supported by this platform.
Hayes RCM’s AI Benefits Verification platform
Hayes RCM’s platform combines AI-automated benefits verification with hands-on prior authorization management — one subscription covering both, instead of separate tools or vendors. Built on real-world home health and hospice billing expertise, it understands the nuances of post-acute benefits: HMO network checks, prior authorization requirements, home health benefit activation, and managed care organization benefit structures.
Benefits verification requests are processed by the AI in real time, with a structured response typically returned within seconds. Prior authorization requests are reviewed and managed directly by our Intake Team, with status tracked under the same monthly allotment.
We’ve been here before
We Know What It Feels Like When Billing Lets You Down
Hayes Billing isn’t just about collecting payments; it’s about igniting growth. We go beyond traditional billing, unlocking hidden revenue streams and empowering healthcare providers to achieve financial freedom. We’re here to help your practice surge, not just stay afloat.
Claims Management
Ensure accurate and timely submission of claims to insurance companies for services rendered
A/R Management
Track and post payments received from insurance companies and patients.
Credentialing and Enrollment
Assist healthcare providers with the credentialing and enrollment process with insurance companies.
Reporting and Analytics
Reporting provides healthcare providers with insights into their billing performance, identifies improvement areas, and tracks key metrics.
Why Choose Us
Benefits Verification That Never Sleeps
24/7 Automated Verification
Nights, weekends, and holidays — benefits verification is processed by AI the moment a request arrives, not when your office opens.
One Combined Package, Not Two Systems
Benefits verification and prior authorization management are billed together under one monthly allotment — no separate tools, no separate pricing, even though verification is AI-automated and authorization is handled directly by our team.
Built For Post-Acute, Not Generic Eligibility
The system understands home health and hospice benefit structures, HMO network requirements, and managed care nuances that generic eligibility platforms miss — and our team applies that same expertise to every prior authorization request.
AI-Powered Verification In Seconds
Real-time processing returns live payer data for benefits verification immediately. No batch windows, no waiting.
Human Backup For Exceptions
Unsupported payers and edge cases are routed to our Intake Team for review. Traditional Medicare (Fee-for-Service) is not supported by this platform due to HEITS Attestation requirements. Our team also handles every prior authorization request directly, start to finish.
Standalone Or Bundled
Available as a standalone subscription for any qualifying agency — or included free for current Hayes RCM billing clients.
HIPAA-Compliant By Design
All patient data is processed within a HIPAA-compliant infrastructure. PHI is automatically deleted within 24 hours of processing.
Features
Features and Capabilities
24/7 automated benefits verification
Requests submitted at any hour are processed immediately by AI — nights, weekends, and holidays included.
AI-generated benefits summaries
Structured output covering deductible, co-insurance, network status, prior authorization requirements, and home health benefit status — filtered for the agency’s service line and contract.
Prior authorization management
Our Intake Team handles authorization requests directly, tracked under the same monthly allotment as your benefits verifications — one subscription, one team, for both.
HMO out-of-network advisory
If a patient carries an HMO plan and the agency is out of network, the system automatically returns a decline advisory based on payer-reported network status.
Follow-up Questions Answered
Ask a follow-up question about any benefits verification result and get a plain-language answer — no hold queues, no callback windows.
Traditional Medicare — not supported (HEITS)
Traditional Medicare (Fee-for-Service) is not supported by this platform due to HEITS Attestation requirements. Subscribers are responsible for verifying Traditional Medicare eligibility independently.
HIPAA-compliant infrastructure
All PHI is processed within a HIPAA-compliant environment and automatically deleted within 24 hours of processing.
Intake team escalation
Unsupported payers, complex cases, and patient acceptance questions route to the Hayes RCM Intake Team.
Step by step
Here’s How It Works
Three clear steps. No guesswork. No lock-in pressure.
Submit the request
Email patient name, date of birth, member ID, and insurance carrier to the designated Hayes RCM benefits verification inbox in plain text. That is all the system needs. No login. No portal. No PDF attachment required.
AI extracts and validates
The system identifies the sender against the agency’s approved account, extracts the four data points from the email, and validates the request before querying the payer.
Real-time payer query
The platform queries the payer’s eligibility system in real time via a HIPAA-compliant 270/271 EDI API integration. Live payer data — not cached or batch results.
Structured benefits summary returned
A structured benefits summary is emailed back to the requesting provider. Fields include deductible status, co-insurance, network status, prior authorization requirements, home health benefit activation, and any payer-specific flags relevant to the agency’s service line and contract.
Follow-up questions answered
Reply to the benefits summary email with any clarifying question — ‘Does this plan cover wound care?’ ‘Is a co-pay required at the start of care?’ — and the AI responds with a plain-language explanation. No hold queues. No callback windows.
Submit Your Request
Send us the patient and request details — simple, no portal login required. Your Hayes RCM Intake Team can walk you through the best method for your workflow.
We Process It
Benefits verification requests are processed by AI in real time. Prior authorization requests are handled directly by our Intake Team. Both are tracked under the same monthly allotment.
Get Your Answer
Benefits verification results typically return within seconds, covering deductible status, co-insurance, network status, prior authorization requirements, and home health benefit activation. Prior authorization updates come from your dedicated Intake Team contact.
Ask Follow-Up Questions
Have a question about a benefits verification result? Ask and get a plain-language answer — no hold queues, no callback windows.
PROCUREMENT & BILLING READY
Billing System
Our AI-powered Revenue Cycle Management solution integrates with a growing network of commercial and Medicare Advantage payers to help streamline claims processing and improve reimbursement efficiency.
Currently Supported Payers :
Pricing
Present pricing as a four-tier subscription model. Each tier’s allotment covers benefits verifications and prior authorization requests combined — one number, not two separate limits. Month-to-month, no annual contracts, no setup fees. Current Hayes RCM billing clients receive this at no additional charge as part of their existing engagement.
Basic
$199
/month
- Up to 75 verifications and authorization requests combined
- $3.00 per request over limit
Standard
$449
/month
- Up to 250 verifications and authorization requests combined
- $3.00 per request over limit
Professional
$799
/month
- Up to 600 verifications and authorization requests combined
- $3.00 per request over limit
Enterprise
Custom Pricing
- 600+ combined requests per month
- Volume-based — contact us
What’s Included
Basic — $199/month
- Up to 75 verifications and authorization requests combined per month
- 24/7 automated AI benefits verification
- AI-generated benefits summaries, plus prior authorization status updates from our Intake Team
- Follow-up Q&A on results
- HIPAA-complaint processing
Standard — $449/month
- Up to 250 verifications and authorization requests combined per month
- Everything in Basic
- Priority processing queue
- Monthly usage report
Professional — $799/month
- Up to 600 verifications and authorization requests combined per month
- Everything in Standard
- Dedicated account support
- Quarterly review call
Enterprise — Custom pricing
- 600+ combined requests per month — volume-based pricing
- Everything in Professional
- White-label branding option
- SLA guarantee
- Custom contract terms
Billing note: Subscriptions auto-renew monthly on the anniversary date of enrollment. No annual commitment required. Overages are billed at $3.00 per verification above the monthly tier limit.
We’ve been here before
We Know What It Feels Like When Billing Lets You Down
Hayes Billing isn’t just about collecting payments; it’s about igniting growth. We go beyond traditional billing, unlocking hidden revenue streams and empowering healthcare providers to achieve financial freedom. We’re here to help your practice surge, not just stay afloat.
Claims Management
Ensure accurate and timely submission of claims to insurance companies for services rendered
A/R Management
Track and post payments received from insurance companies and patients.
Credentialing and Enrollment
Assist healthcare providers with the credentialing and enrollment process with insurance companies.
Reporting and Analytics
Reporting provides healthcare providers with insights into their billing performance, identifies improvement areas, and tracks key metrics.
QUESTiON & ANSWER
Frequently Asked Questions
No. The platform returns benefits and authorization information only. All decisions regarding whether to admit or accept a patient are the sole responsibility of your agency based on your own clinical, administrative, and contractual criteria. For acceptance guidance, our Intake Team is available at support@hayesrcm.com.
The system will return an advisory to decline, based on the network status and plan type reported by the payer at the time of verification. We recommend independently confirming network status when any question exists, as payer data can change.
Yes. Each tier’s monthly allotment covers both combined — there’s no separate cap for authorizations.
Traditional Medicare (Fee-for-Service) is not supported by this platform due to HEITS Attestation requirements. Subscribers are responsible for verifying Traditional Medicare benefits independently.
Yes. All PHI is processed within a HIPAA-compliant infrastructure covered by a Business Associate Agreement and automatically deleted within 24 hours of processing.
Yes. The platform is available as a standalone subscription to any qualifying home health or hospice agency, regardless of who manages their billing.
Month-to-month. No annual contracts, no setup fees. Your subscription renews on the anniversary date of your enrollment each month.
Contact Hayes RCM at info@hayesrcm.com or call (713) 244-8397 to set up your account. Once your subscriber agreement and BAA are executed and your account is configured, you will receive instructions to complete a test verification before going live.
Ready to stop doing this manually?
Benefits verification and prior authorization, handled under one subscription. What will your team do with the extra time? Your next referral deserves a fast answer — not hours or days juggling two separate processes.
