Coverage Intelligence

Healthcare teams ship cleared products with real clinical evidence, then stall on one question: where does this actually get paid? The answer is scattered across codes, fee schedules, coverage rules, state Medicaid programs, payer policies and the value-based programs where the biggest dollars move.

Most teams guess, or pay a consultant for a memo that is stale the day it is written. The coverage record shifts weekly. Between two of our own dated extracts, 22 coverage policies were revised.

Coverage graph

Codes, coverage posture, the state Medicaid map and published rates, in one query.

Code and revenue discovery

The billable paths for a product, the AI code pathway, and where denial risk sits. One billing choice can swing revenue threefold for the same scan.

Follow-the-money strategy

Which quality measures a product moves, which bundles it fits, and the return-on-investment case a payer will read.

Always-current monitoring

Alerts when a code, a rate or a rule shifts. Monitoring, not a memo, is the product.

Denial and appeal intelligence

Wrongly denied claims, and the published basis to overturn them.

The source record itself: the CMS coverage record, national and local coverage determinations, coverage articles and the published comment history; state Medicaid policy; commercial payer published rate files; Medicare physician and lab fee schedules; NCCI procedure-to-procedure edits; hospital price transparency filings.

Every source is preserved with its vintage, so an answer holds up a year later when someone asks which version applied on the date of service. CMS rebuilds its coverage database in place with no changelog, and nothing requires a payer to keep last month’s rate file available. We keep it.

Business development leads and chief executives in digital health; medical device and diagnostics companies; investors doing diligence on a reimbursement story; market-access advisors who want the map under their own name.

• No denial rates it cannot source. A published rate never becomes a paid amount by implication.
• No payment probabilities. The record says what a payer published, not what it will do on a claim.
• No claim that a payer covers a code. Coverage posture is reported with its citation and its date, and absence of evidence is reported as absence. The refusal classes are published by the lab.