A customizable form you embed on your site or landing pages. A visitor enters insurance and contact details, submits, and VerifyTX returns a verified eligibility result to your admissions team with the person’s info. Your team has everything before they reach out, which is critical for behavioral health and mental health admissions.
Used by teams that take calls after hours, admit on weekends, and need fast answers when a patient is ready.
Add the form to your site. A visitor submits insurance and contact info. Your team receives a verified eligibility result and the person’s details right away inside VerifyTX. No manual lookups. No phone tag.
Every submission includes verified eligibility so admissions can move forward with confidence.
Instant results let staff call back while interest is high, which reduces drop offs.
Eligibility details arrive in the same layout for billing and utilization review.
Send leads to locations or programs, apply tags, and notify the correct staff.
“We are a third-party biller and VerifyTX is an excellent eligibility platform. Extremely accurate and easy to use. Their mobile app is intuitive and very helpful when checking eligibility away from your desk. Their customer service is the best around! Highly recommend VerifyTX!”
— Luke Allen, Director Of OperationsWebforms capture accurate data on the first touch, verify eligibility instantly, and route results to admissions with the contact information needed to follow up. Your team moves fast while the caller is engaged and ready to talk.
Match your brand and add the fields you need, including location or program selectors. Set required fields, add helper text, and use validation so submissions are clean. Place the form on any page and create versions for different sites or campaigns. The embed is plain HTML plus a script tag, so it works on any site or CMS with no developer project required.
VerifyTX web forms work out of the box: a simple HTML embed and script you drop on any page, and your site is capturing and verifying inquiries. Or keep the tools you already use. Submissions from JotForm, HubSpot, Typeform, Webflow, or any custom form builder can pipe straight into the VerifyTX insurance verification API and verify the same way: the inquiry comes in, eligibility runs, and your team gets a verified result.
Eligibility runs the moment a visitor clicks submit. Your team sees verified status with a reference number and timestamp, the matched payer and plan, and the service types you care about. Results land in VerifyTX on the client record so nothing gets lost. Explore the Insurance Verification API
Route by location, program, payer, or tag. Assign an owner and auto apply tags like web form or active patient. Admissions and billing receive notifications in app and by email, so the first call happens while interest is high. Unworked submissions remain visible in the activity feed.
HIPAA compliant with encryption in transit and at rest, role based access, and full audit logs. Emails and alerts avoid PHI. Forms are delivered over HTTPS and include consent language to keep intake aligned with policy. Because VerifyTX hosts the form, PHI is covered under your VerifyTX BAA from the moment it's submitted, with no extra compliance setup on your site.
First Name *
First Name
Last Name *
Last Name
Date of Birth *
mm/dd/yyyy
Phone *
Phone
Look up your insurance company
Type to search
Member ID *
Member ID
One thing to weigh: with VerifyTX web forms, HIPAA compliance is built in. Forms are delivered over HTTPS, data is encrypted, and PHI stays inside VerifyTX. With a third-party form, that responsibility sits with you: some builders offer HIPAA-enabled plans with a BAA, and others need compliant hosting and encryption you set up yourself. Either way, the 11 pm inquiry gets verified before your team is back at a desk.
Member details, insurance information, contact info, and optional fields like location or program. You choose which fields to show.
No. Results are visible to your staff inside VerifyTX. Clients only see your confirmation message.
Yes. You can create and manage multiple forms and route submissions by site, program, or tag.
Yes. Data is encrypted and access controlled. Staff receive in app and email notifications based on routing and tags.
Yes. Submissions from JotForm, HubSpot, Typeform, Webflow, or any custom form builder can connect to the VerifyTX API so verification runs automatically when someone submits. Keep in mind that HIPAA compliance for third-party forms is your responsibility; our integration guide covers what to check. VerifyTX web forms remain the fastest path since compliance is built in and setup is an HTML embed and script.
Join 30,000+ users using VerifyTX to qualify leads and respond faster
