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How Epic, Humana are automating insurance verification
Are we finally doing away with physical insurance cards and manual entry?
Humana and Epic have activated a digital insurance verification workflow that removes the need for physical insurance cards, marking a meaningful shift toward automated insurance coverage confirmation. According to a Nov. 18 press release, the capability now supports more than 800,000 Humana Medicare Advantage members across 120 health systems, with the potential to reach millions more.
Early data suggests meaningful gains. In time studies performed at Texas Health Resources, the move from physical cards and manual entry to automated data exchange cut registration time by about 50%.
"We found it was about 90 seconds per patient interaction," said Ryan Bohochik, vice president of value-based care at Epic.
Ninety seconds doesn't seem like much, but when the number is multiplied across applicable patient encounters, it adds up.
The case for interoperability at the front desk
Health systems have long cited insurance-card capture as a source of administrative waste.
Manual data entry is slow, inconsistent and error-prone. It's a recurrent pain point that Bohochik reported he has heard from health systems for years.
"One of the things that came up consistently was… every time we take care of someone, we have to go validate their insurance… and there are all these steps we have to go through," he said.
Those inefficiencies carry a cost.
"About 8% of the time someone gets registered with insurance information that the health system doesn't actually end up billing," Bohochik said.
Fixing those errors on the backend consumes staff time, and missing them can lead to denials.
Industry analyses estimate that each denied claim costs over $25 to rework. And, according to HFMA Pulse survey data, missing or incorrect patient information at the point of registration is one of the most common reasons for initial claim denials.
Although Epic's Coverage Finder and Digital Insurance Card Exchange tools are predicted to reduce denials, Bohochik noted that it is still too early to determine whether this result shows up in practice.
"We just haven't been live long enough to have meaningful comparisons," he said.
Still, both organizations hope that automating this first touchpoint will help establish true provider-payer interoperability and open the way to better care.
How the digital verification process works
The new workflow uses demographic information -- including names and addresses -- to identify a member in the EHR. Epic then queries participating payers. When a match is found, the payer returns the subscriber ID, coverage ID and digital insurance card directly into the EHR without the need for manual card entry. The workflow adapts the CARIN ID Card standard to a real-world provider operation.
"It's leveraging an industry standard on the topic at scale," said Chris Walker, Humana's associate vice president of interoperability.
To prevent mismatches, the system reverts to human review when the confidence threshold is not met.
"If we don't have a confident match, that's when the human comes back into it," said Bohochik.
Impact at scale
While Humana was the first payer to implement the exchange, Bohochik reports that seven additional national insurers have since begun participating in digital insurance card exchange and coverage verification with Epic. That momentum signals rapid adoption across the Epic network.
The vision for widespread interoperability is one both Humana and Epic share.
"We're working toward hundreds of Epic healthcare systems that now have this live. That's really what the vision of interoperability is — impact at scale," said Walker.
He added that adoption is continuing to rise steadily.
"That number is quite literally growing on a weekly basis as more systems continue to opt into this feature," he said.
Ease of implementation is the primary factor helping drive that growth.
"The effort for a health system to adopt this is basically turning it on," said Bohochik.
Epic expects to make the feature "on by default" across its systems next year.
What's next for Humana and Epic
Bohochik reports that Humana and Epic are focusing on several collaborations, notably modernizing prior authorization ahead of new CMS requirements taking effect in 2027. The goal is to move prior authorization away from fragmented fax-and-portal exchanges toward a streamlined, API-based process.
"There's a lot of time and energy in the industry going into modernizing the prior auth process," said Bohochik. "We are asking: How do we take these implementation guides and not just make sure the software supports it, but make a real-world impact?"
Modernizing prior authorization may be the next objective on Humana and Epic's collaborative agenda, but for now, both organizations view digital insurance verification as a promising starting point for scaled, repeatable payer-provider collaboration.
"This is an example… of finding something that can be a significant benefit and making it available not only to our own companies but the industry as a whole," said Bohochik.
Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.
