New at Nirvana: July 2025

This month we made core enhancements across both OneVerify and our API. These improvements are all focused on enabling your teams to file more accurately, bill with more confidence, and stay ahead of eligibility complexity.

Highlights & Improvements

1. Carveout & TPA Enhancements

We’ve made it easier than ever to understand where and how to file claims:

• Expanded carveout identification: Twenty additional carveouts identified including Surest, Centivo, Quartz health & Priority Health.
• Smart filing logic: Our system now distinguishes between types of third party administrators:
  
  • Whether the detected entity accepts and adjudicates claims (“PAYER”)
  • Whether the detected entity handles plan administration functions (e.g., managing networks, reviewing utilization, processing member enrollment changes) but does not accept claims ("UTILIZATION_MANAGER")

Why it matters: This improvement in the API reduces back-and-forth across RCM teams and ensures claims are submitted to the right place, the first time.

2. New Plan Type Identification

We’ve improved how we categorize health plans:

• Available today: Dual and Marketplace plan types. Reach out to your Nirvana to find out how.
• Previously supported: Medicaid, Managed Medicaid, Medicare, and Medicare Advantage
• Coming in November: Support for Commercial plan types

Why it matters: More granular plan types help your team tailor workflows and distinguish variations in network eligibility and reimbursement within a broader insurance carrier–reducing claim rejections caused by coverage misunderstandings.

And Remember…

Telehealth Coverage Detection

Available now in both OneVerify and the API: Check if a patient's plan includes telehealth coverage – no guessing required.

QMB Patient Detection

Proactively identify patients with Qualified Medicare Beneficiary (QMB) status: Available in API responses and OneVerify

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