The Orchestration Layer
Find the coverage. Know who pays. Carry both to the claim.
Four products, connected so what one step learns, the next already knows. Who funds the plan is identified once and carried into the eligibility answer, the authorization and the claim.
The Orchestration Layer drawn as one band above your clearinghouse, eligibility vendor and billing system, returning active coverage, funding type and claim detail.
The five steps
The Orchestration Layer connects eligibility, discovery, prior authorization and claim status into one transaction. Run as separate tasks in separate queues, what registration learns about who funds the plan is lost by the time the authorization is submitted or the denial is appealed. The Orchestration Layer carries that answer forward.
Funding type is identified at Classify, the second step, and known at every step after it, which is what sends an authorization down the right payer pathway the first time and returns a claim status that says more than pending.
Eligibility says whether coverage is active. Reimbursement intelligence says who pays and what the claim needs.
Rules first. AI only where the rules run out. A confidence score on every answer.
Verify
Confirm or locate active coverage
Classify
Self-Funded, Fully Insured or Unknown
Route
Send it down the right payer pathway
Authorize or Appeal
Under the rules of whoever funds the plan
Recover and Report
Bill the plan that pays, report the results
The story in two minutes
One patient record, from no card to a claim paid under the right rules
Why coverage goes unfound, how Integrex Health finds it, and why knowing who pays decides where every request goes. Silent film with captions; the full text is below it.
Read the transcript
Someone goes to the emergency room. Call her M. Alvarez.
She has Blue Cross coverage. But no insurance card.
The hospital runs insurance discovery with her name and date of birth. Without a member ID, her Blue plan is not found.
So the account becomes self-pay. The bill goes to her instead of her health plan, and balances like that often end up as bad debt.
She had coverage all along. It just was not found.
Why not? Standard discovery is built around the insurer’s member ID. Without it, most insurers never have to look.
And Blue Cross is not one company. It is dozens of independent plans, and each one knows only its own members.
The coverage is there. The question is asked the wrong way.
Integrex Health starts with what the hospital has: her name and her date of birth.
Its insurance discovery finds her active Blue plan. No member ID required.
But the coverage response does not say who pays her claims. And that answer decides which rules apply.
If her employer self-funds the plan, Blue Cross only administers it. Her employer pays the claims, and federal ERISA rules govern.
If Blue Cross pays the claims, the plan is fully insured, and situs, the state where the policy was issued, decides which state’s laws apply. Not always where she lives.
Same Blue Cross coverage, different rules: where the prior authorization goes, how long the payer has to pay, where an appeal is filed.
Same coverage. Different rules. Integrex Health identifies funding type and situs before the first request goes out.
Put together, Integrex Health is a layer on top of what a hospital or billing team already runs: find the coverage, identify who pays and which rules apply, route each authorization, claim and appeal correctly, and track it until it is paid.
Works with the systems you already run.
M. Alvarez’s account comes back whole: coverage found, rules known, claim paid by the right party under the right deadlines.
No calls to the payer. No time on hold.
Integrex Health. Reimbursement intelligence for healthcare.
Bring us your hardest accounts. Schedule a conversation
All Payer Insurance Discovery
Where Verify begins
Send a name and a date of birth. Active coverage comes back across every payer with funding type attached, and everything after starts here.
Enhanced Eligibility Verification
Verify, for accounts that already show a payer
Eligibility requests you already send go out with the correct payer ID and come back with funding type identified.
Prior Authorization
Where Route and Authorize decide the pathway
Funding type, identified at Classify, decides where the authorization goes before it is submitted.
Claim Status and Resolution
Where Recover and Report happens
Claim status requests come back with the allowed amount, the patient responsibility and the payer's denial description, so the claim is worked without a call.
How it fits what you already run
If you have a clearinghouse, a discovery vendor, or both, none of that changes. The Orchestration Layer sits alongside what you run. Send us the accounts your current process could not resolve and we work only those.
Send us the coverage results you already have and we return them with funding type and policy detail attached. Your workflow, your vendors, your integrations and your work queues stay where they are. What arrives is more information in the file you already read.
Who we serve: clearinghouses and technology partnersSend us what your current process could not resolve.
The results return with funding type attached, in the file you already read. Nothing you run changes.
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