Machine-readable US payer medical coverage policy network

PENELOPE HEALTHbuyer room · privateManage buyer room

Machine-readable US payer medical coverage policy network: for every payer and plan, which CPT / HCPCS / ICD codes are covered, excluded or classified experimental, with medical-necessity criteria decomposed into executable AND/OR logic trees and the documentation required for a claim to be accepted, plus prior-authorization requirements and a dated change log of policy updates. Vendor-stated scale: >500,000 context-categorised extracted codes, >2 million medical-necessity criteria, ~99% code-extraction accuracy, dozens of new policies ingested every working day, covering the majority of insured Americans. Also derives a payer-variance layer quantifying clinically significant differences between any two payers' policies.