Hayes RCM’s AI-powered platform verifies patient insurance benefits 24 hours a day — nights, weekends, and holidays — so your team can focus on patient care, not paperwork.
Hayes RCM has built an AI-powered insurance benefits verification system specifically for home health and hospice providers. Submit a patient’s information by email and receive a structured benefits summary in seconds — any time of day, any day of the week. No more waiting for business hours. No more Monday morning backlogs from weekend referrals. Note: Traditional Medicare (Fee-for-Service) is not supported by this platform.
Hayes RCM’s AI Benefits Verification platform
Hayes RCM’s AI Benefits Verification platform automates the most time-consuming part of patient intake — insurance verification. Built on real-world home health and hospice billing expertise, the system understands the nuances of post-acute benefits: HMO network checks, prior authorization requirements, home health benefit activation, and managed care organization benefit structures.
Providers submit a simple plain text email with four data points — patient name, date of birth, member ID, and insurance carrier — and the AI queries the payer’s eligibility system in real time via a real-time 270/271 EDI API integration. A structured benefits summary is returned by email within seconds, filtered specifically for the agency’s service line and contract network status.
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 Processing
Nights, weekends, and holidays — verification requests are processed the moment they arrive, not when your office opens.
Built For Post-Acute, Not Generic Eligibility
The system understands home health and hospice benefit structures, HMO network requirements, prior auth flags, and managed care nuances that generic eligibility platforms miss.
Results In Seconds, Not Hours
A real-time eligibility API integration returns live payer data immediately. No batch windows, no waiting.
Human Backup For Exceptions
Unsupported payers and edge cases are routed to the Hayes RCM Intake Team for review. Traditional Medicare (Fee-for-Service) is not supported by this platform due to HEITS Attestation requirements. The AI handles the volume; people handle the nuance.
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
Use these feature descriptions for feature cards, bullet lists, or any section highlighting what the platform does:
24/7 automated processing
Verification requests submitted at any hour are processed immediately. 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.
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.
Email follow-up Q&A
Providers can reply to any benefits summary with clarifying questions. The AI responds in plain language — 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. Email communications containing patient data are 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 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.
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. Month-to-month — no annual contracts required. No setup fees. Current Hayes RCM billing clients receive AI benefits verification at no additional charge as part of their existing engagement.
Basic
$199
/month
- Up to 75 verifications
- $3.00 per verification over limit
Standard
$449
/month
- Up to 250 verifications
- $3.00 per verification over limit
Professional
$799
/month
- Up to 600 verifications
- $3.00 per verification over limit
Enterprise
Custom Pricing
- 600+ verifications
- Volume-based — contact us
What’s Included
Basic — $199/month
- Up to 75 verifications per month
- 24/7 automated AI processing
- AI-generated benefits summaries
- Email follow-up Q&A
- 1 approved sender email address1 approved sender email address
- HIPAA-compliant processing
Standard — $449/month
- Up to 250 verifications per month
- Everything in Basic
- Up to 3 approved sender email addresses
- Priority processing queue
- Monthly usage report
Professional — $799/month
- Up to 600 verifications per month
- Everything in Standard
- Up to 5 approved sender email addresses
- Dedicated account support
- Quarterly review call
Enterprise — Custom pricing
- 600+ verifications per month — volume-based pricing
- Everything in Professional
- Unlimited approved sender email addresses
- 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 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.
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. Email communications containing patient data are automatically deleted within 24 hours of processing.
PDF and image support is coming soon. The current platform accepts plain text email submissions only. Plain text submissions follow the format: Patient / DOB / Member ID / Insurance.
Yes. The AI Benefits Verification 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, handled. What will your team do with the extra time? Your next referral deserves an answer in seconds, not hours.
