Eligibility fails in the channel you did not check, and a 271 that comes back thin is a different failure from a portal you never opened. Black Book, 8 June 2026 ranks Inovalon for eligibility, benefits, and real-time payer-rule interpretation, and Experian Health for coverage discovery and retroactive eligibility. Those are category ranks. They do not say what a 271 returns, and they do not price a batch re-check.
Weights match the other matrices: channel coverage 20, autonomy and touch rate 15, evidence per action 15, outcomes with a denominator 15, integration and time to first claim 10, pricing unit 10, buyer segment 10, agent security 5. CARC 26, 27, and 31 are the outcome row, and every vendor's rate on that row is not published.
Channel, then the denial you can still prove
Score 270/271, portal, and phone per payer. Portal-only Medicaid, an MCO, and workers' comp are the gap a clearinghouse eligibility ping tends to skip. What a 271 actually returns, the payer-count method, the evidence a later eligibility denial can use, and the price at batch re-check volume are the topic columns. Billing companies, DME, ABA, home health, and Medicare Advantage or secondary coverage are the segments. Where a source does not cut the data that way, the cell says not published.
| Vendor | Tier | Channel coverage | Autonomy and touch rate | Evidence per action | Integration and time to first claim | Pricing unit | Outcomes with a denominator | Buyer segment | Agent security | 270/271 vs portal vs phone | Portal-only Medicaid, MCO, workers' comp | What a 271 returns | Payer-count method | Evidence a later eligibility denial can use | Price at batch re-check volume | CARC 26/27/31 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Inovalon | Platform | Black Book, 8 June 2026: category leader for eligibility, benefits, and real-time payer-rule interpretation, and for the full provider cloud RCM suite. | not published | not published | not published | not published | not published | not published | not published | not published | The category is eligibility, benefits, and real-time payer-rule interpretation. A 270/271 versus portal versus phone split is not published. | not published | not published | not published | not published | not published |
| Experian Health | Platform | Black Book, 8 June 2026: category leader for coverage discovery and retroactive eligibility. KLAS RCM Suites 2026, via HIT Consultant, 22 July 2026: insurance discovery and eligibility 7.8. | not published | not published | not published | not published | KLAS RCM Suites 2026, via HIT Consultant, 22 July 2026 grade B+. Patient access and insurance discovery are above average. Denials and contract management are less mature. KLAS public card, October 2025–October 2026: overall 87.2. | not published | not published | not published | not published | not published | not published | not published | not published | not published |
| Availity | Platform | not published | not published | not published | not published | not published | KLAS RCM Suites 2026, via HIT Consultant, 22 July 2026: eligibility 8.4, on a small sample, grade A-. Remittance posting 8.8 and clinical authorizations 8.5 are separate scores. | not published | not published | not published | Eligibility 8.4 is not a channel split. 270/271 versus portal versus phone is not published. | not published | not published | not published | not published | not published |
| Waystar | Platform | not published | not published | not published | not published | Lisa H., 11 June 2026, says smaller billers will find the price high. The unit is not published. | Capterra Waystar profile, updated 29 September 2026: eligibility verification 4.2 from 41 reviews. Overall 4.4 from 214 reviews, 90% positive, 4% neutral, 7% negative. | not published | not published | not published | not published | not published | not published | not published | not published | not published |
| pVerify | Platform | not published | not published | not published | not published | Capterra pVerify, updated 29 September 2026: listed start price $50, usage-based, per month. Value for money 4.0 from 37 reviews. | Capterra: 4.3 from 41 reviews, sentiment 80% positive and 17% neutral, star split 21 / 12 / 7 / 0 / 1. The insurance-eligibility feature score is 3.5 from 2 reviews, so that feature score is not a market result. | Capterra does not publish a billing-company, DME, ABA, home-health, or Medicare Advantage cut. | not published | not published | Brittainy W., 24 June 2024, on batch checks and pulling general, telehealth, and mental-health benefits separately, including during the Change Healthcare outage. The same review says behavioral-health nuances are missing and there is no CPT-level coverage search. | not published | not published | not published | not published | The $50 start price is usage-based per month. A batch re-check price is not published past that list price. |
| FinThrive | Platform | not published | not published | not published | not published | not published | KLAS RCM Suites 2026, via HIT Consultant, 22 July 2026: insurance discovery 7.6, grade B. Customers waited years for claims status and denial prevention. An eligibility-denial rate is not published. | not published | not published | not published | not published | not published | not published | not published | not published | not published |
| AdvancedMD | System of record | not published | not published | not published | not published | not published | Reviewers also cite auto-posting, a claim scrubber, and denial tracking. Those are examples, not a denominator. | not published | not published | not published | Capterra reviews, not a profile score: eligibility in seconds at scheduling is a positive reviewer example. Channel coverage beyond that example is not published. | not published | not published | not published | not published | not published |
| Substrate | Autonomous agent | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published |
| Adonis | Autonomous agent | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published |
| Infinitus | Autonomous agent | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published | not published |
Elizabeth V., 5 March 2024, on pVerify: information does not load, or the site is down. That is one review, not a rate. The telehealth matrix stays at Best AI Eligibility Verification for Telehealth Companies (2026) and is not rebuilt here.
When to pick someone else
Pick Inovalon when the category you need is eligibility and real-time payer rules, and pick Experian when the category is coverage discovery, including retroactive eligibility. Pick pVerify when a published list price and a 41-review profile are enough to start a batch-check conversation, and do not treat two feature reviews as the market. Pick someone else when the payer is portal-only and the row does not say portal. Substrate, Adonis, and Infinitus are not published.
Seven questions to ask in the demo
- For this Medicaid MCO, is the check a 270, a portal, or a phone call?
- What fields does the 271 actually return, and which ones are missing?
- How do you count a payer?
- What evidence is kept so a later CARC 26, 27, or 31 denial can use it?
- What does batch re-check cost at your volume, not at one transaction?
- Do you separate Medicare Advantage and secondary coverage, or flatten them?
- What is the touch rate, and what is the denominator?
RFP checklist
- Channel per payer, including portal-only Medicaid, MCO, and workers' comp.
- A sample 271, with the missing fields marked.
- Payer-count method.
- Evidence retained for a later eligibility denial.
- Price at batch re-check volume.
- Segment: billing company, DME, ABA, home health, Medicare Advantage, secondary.
- CARC 26/27/31 outcome with a denominator, or not published.
Capterra's Waystar eligibility line is 4.2 from 41 reviews, inside a 4.4 profile from 214. Claims scrubbing on that same profile is 3.8 from 25 reviews. A strong eligibility review is not a scrubbing result.