4,000 Insurance Plans

We turned complex insurance exceptions into real-time answers for doctors’ offices: does this patient’s plan permit coverage for the services they need?

General guidancePayer policies and narrative exceptions

Structured dataState · County · Address · Medical specialty

Real-time coverage insightCan this patient’s plan cover the needed service?

From general payer rules to patient-specific coverage guidance at the point of care.

Client goal

Help doctors’ offices determine, in real time, whether a patient’s insurance allows coverage for the services they need.

What we reimagined together

Translate general payer exceptions into precise rules based on location, provider specialty, and the services being considered.

What we built

A process that converts unstructured payer guidance into structured exception data keyed to state, county, address, and medical specialty.

What changed

Across 4,000 reviewed plans, exceptions were identified in roughly 1,200. Doctors’ offices can now check relevant restrictions in real time when deciding whether a patient’s insurance permits coverage for needed services.

What’s on your wish list?

Some of our best work started with something a client wasn’t sure was possible. Tell us what you’d like to accomplish.

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