Is Your Hub Underperforming in Reverification Season? Discover How CareMetx Leads the Way

The annual reverification season demands flawless execution, but many well-known hub providers repeatedly fall short. This leads to missed documentation, frustrated providers, and delays that compromise patients’ timely access to therapies. These issues expose hub providers that simply aren’t equipped to manage reverifications at the level manufacturers need, leaving clients disappointed when it matters most. 

Before choosing a partner for your annual reverification, it's essential to focus on the criteria that drive success. As industry leaders with a proven track record of completing over 450,000 reverifications each year—all ahead of schedule—CareMetx consistently delivers fast, accurate, and seamless reverification seasons.  

Behind CareMetx’s Success: Seamless Coordination of People, Processes, and Systems 

The annual reverification season presents a major challenge: processing a high volume of benefit verifications (BVs) in a short timeframe. Each BV is complex, involving millions of transactions across payers, providers, and patient services.  

At CareMetx, our goal is to complete all reverifications by the end of January. Our strategic planning starts long before reverification season to ensure flawless execution. Hub operations leaders focus on preparing our systems, processes, and workforce to exceed the expectations of manufacturers and providers. This preparation includes: 

• Building a cross-functional team to develop strategy 

• Defining project scope, including expected BV volume and provider needs 

• Ensuring data accuracy by pre-processing patient data 

• Testing system capacity to handle anticipated BV volume 

• Applying insights from past seasons to refine processes and improve performance 

This methodical approach enables us to deliver a fast, accurate reverification season every year. 

Automation: Returning Comprehensive BVs 

CareMetx leads the industry by leveraging advanced automation to process the vast majority of benefit verifications (BVs), relying on our Hub representatives only for manual calls when automation alone isn’t sufficient. Unlike many other hubs, which are still developing their automation capabilities, CareMetx delivers one of the most comprehensive and precise automated BV solutions available. Using a proprietary database and AI/machine learning, we return complete, product-specific benefit verifications that empower providers with the critical information they need—an area where other hubs may fall short.  

Our automated BVs are highly detailed and tailored to the specific drug in question, checking critical criteria that can impact drug costs, such as:  

• Cost share: Out-of-pocket costs, including deductibles, copays, and coinsurance 

• Restriction requirements: Conditions, limitations, or rules required for coverage 

• Predetermination: Pre-estimates of patient costs based on benefits and policy terms 

• Step therapy: Requirements to try alternative therapies before accessing the prescribed drug 

• Prior authorization: Requirements for payer approval before use of the medication 

• Drug acquisition: Whether the drug is buy-and-bill or requires direction to a specialty pharmacy 

Unlike hub providers still developing their automation capabilities, CareMetx has refined its automated BV solution over a decade, incorporating provider feedback to continuously enhance accuracy and relevance. This experience and commitment to improvement allow us to consistently deliver the precise information providers need. 

Staffing and Training: Recruiting from Key Markets and Training Efficiently 

While CareMetx leads the industry in automation, we understand that sometimes automation alone isn’t enough. If our automated processes return incomplete results, having the best team ready to step in is crucial to ensuring seamless service and accuracy. That’s why finding and onboarding top talent is essential for a successful reverification season.  

Each year, CareMetx scales rapidly, hiring over 1,000 representatives through our innovative micro-hub model. Recognizing that the best call center talent is spread across key markets nationwide, our recruiting team targets these areas to find highly qualified seasonal workers. We prioritize candidates with insurance and benefits experience, or those who can quickly master the essentials, ensuring they’re ready for intensive training in a short timeframe. 

Once we’ve assembled a well-qualified team, our training program ensures staff are prepared to handle manual reverifications in the event they are required. Since the most challenging aspect of this role is engaging with payers and providers, we start by familiarizing our team members with each drug and each manufacturer’s program, before moving swiftly into live practice calls. 

Reflecting on their experience with the 2024 reverification season, one CareMetx client shared, “I only heard about the wonderful collaboration amongst teams, the ability to remain flexible throughout the process, and extreme focus on accuracy and speed. Thank you for your service to [our] patients.” 

Improving Throughput: How Streamlined Tools Boost Manual Call Performance 

While CareMetx automates the majority of benefit verifications, the comprehensive nature of our BV results means that certain information can only be obtained manually. 

Our team’s high throughput enables us to efficiently manage the large volume of BVs during reverification season, ensuring both speed and accuracy—while keeping costs lower for manufacturers. In 2024, CareMetx achieved an average throughput of 14 BVs per person per day- and we’re actively working to increase this number. Alongside advanced planning, staffing, and training strategies, we’re implementing new tools to further improve efficiency. 

For example, CareMetx has adopted streamlined interfaces for our CRM system, making it easier for representatives to quickly enter data during calls and close out cases within minutes. Additionally, we are developing an automated tool to minimize on-hold time with payers, which can significantly impact productivity during reverification season. These enhancements continuously improve our efficiency, helping us exceed our current throughput targets. 

CareMetx is the clear leader in annual reverification, setting the standard that other hubs are still working to match. With speed, accuracy, and dedication to continuous improvement, we consistently deliver a seamless reverification experience. As one client described it, working with CareMetx in 2024 was their “Best AR season ever.” Another shared, “I appreciate the engagement that you all bring on a daily basis… Getting out of AR and moving into steady state in January does not happen without the teamwork between [client] and CareMetx.” 

Our focus on tech-enabled processes, top-tier talent, and innovative productivity tools allows us to redefine what’s possible in the annual reverification season. 

Were you frustrated with your last reverification season? Are you confident your next one will go smoothly? Reach out after your upcoming season to share your challenges—and discover how CareMetx can be the solution you need.