Payor Policy Check
Every payer has their own rules — and they change them without telling you. The Payor Policy Check agent validates every claim against the specific payer's coverage policies, medical necessity requirements, and LCD/NCD guidelines. It catches the denials that coding rules alone can't predict, so you fix issues before submission, not after.
How It Works
Four steps from setup to results — no IT project required.
Load payer policies
The agent maintains a continuously updated database of coverage policies, medical necessity rules, and LCD/NCD guidelines for all major payers.
Validate against specific payer
Each claim is checked against the specific payer's rules — not generic coding rules, but the payer's actual published coverage policies.
Flag policy violations
If a procedure isn't covered under the payer's policy, requires documentation that's missing, or needs a modifier the payer requires, the agent flags it with a clear explanation.
Suggest corrections
Where possible, the agent suggests the specific fix — add a modifier, attach documentation, or re-code the procedure to align with the payer's policy.
What It Does
Every capability included, out of the box.
Common Use Cases
Works With Your Stack
Frequently Asked Questions
Real questions from practices evaluating this agent.
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