This month we rolled out updates that make eligibility data more consistent across OneVerify and the API–especially for plan classification and reporting–right in time for year-end and benefit resets. We’re also expanding Workflow Management and sharing key payer shifts from our billing team to help you stay ahead.

Highlights

New Workflow Management Module!

The new workflow management module is available for free trial in December and January. View, assign, and work all of your checks within one platform. Reduce the need for several sheets, sources, or tabs to manage client's eligibility.

• Checks made through both the API and directly in OneVerify will show here. No need to export & compare excel files
• Create groups and assign policies by team or individual
• Reassign tasks and track progress in real time
• Customize filters and export reports to monitor performance

Fill out this form and say you heard about Nirvana on the blog to gain access today!

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Magellan Insights from our Billing Experts

Magellan has updated its behavioral health criteria, and several major payers are moving away from using Magellan’s as their behavioral health carveout. Many are bringing behavioral health administration in-house, while others are shifting to new behavioral health administrators.

• For providers, this creates an immediate contracting decision: they need to identify and credential with the new payer or behavioral health administrator in order to keep seeing their current patients.
• For patients, these transitions can disrupt continuity of care. If their provider isn’t in network with the new administrator, patients may face gaps in access and could be forced to either switch plans or find a new in-network provider to continue treatment.

Improvements

Insights from newly expanded Plan Type Feature:

• Over the last few months, we’ve expanded plan-type detection beyond Medicare/Medicaid to also capture commercial, dual, marketplace, and government plans. That broader coverage is already revealing how your populations really break down. Here’s what we’re seeing so far:
  • ~60% of plans are commercial
  • ~25% are Medicare/Medicaid managed by commercial payers (e.g., Medicare Advantage, Managed Medicaid)
  • 7% are Marketplace plans — especially important for confirming network eligibility
• These early insights show the impact of richer plan classification: smarter eligibility decisions, more denials avoided, and a clearer view of who you’re actually serving.

And Remember…

Annual Benefit Resets are here!
As we finish out the year, and you turn your focus to January verifications and reauthorizations, remember Nirvana is here to help, contact your CSM to ensure you are set up for success. Read more about how we can help on the blog.

Nirvana x CLEAR Partnership
Lowering barriers to intake, streamlining secure, easy, & effective eligibility checks. Read more about how Nirvana is partnering with CLEAR to revolutionize patient check in! Read more on the blog.

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