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Coverage reports

Automated analysis combined with expert interpretation by experienced analysts to provide accurate coverage reports.

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Coverage Reports

Medical policy coverage summaries in real-time.

Review medical policies, coverage status, coding, and more via online Dashboard reports.
Coverage data from hundreds of insurance carriers compiled into a single report.
User-friendly features and design make finding relevant information simple.

Simplified Tracking

Easily monitor changes to medical policies from Commercial, Medicare, and Medicaid health plans.

Coverage Reports
Policy Status

Policy Status

Medical policies are categorized by the following statuses to show how they impact patients and providers.

Active policy is currently effective with routine reviews.
Draft policy is proposed and may be implemented based upon further comment or review.
Pending policy is approved with a future effective date.
Retired policy is no longer maintained or reviewed.
Policy attachments provide supporting information such as coding, payment, or criteria.
Coverage Status

Coverage Status

Dense medical policy coverage language translated into the following coverage statuses.

Positive coverage is described by medically necessary or covered indications.
Negative coverage is indicated by experimental, investigational, or non-covered indications.
Not mentioned is described by a product, procedure, or code(s) not described within a relevant policy.
No policy is listed when a product, procedure, or code(s) is not described in any medical policy.
Payer Name

Payer Name

Coverage reports are organized alphabetically by insurance carrier name.

Dashboard reports organized alphabetically by insurance carrier names.
Insurance carrier names are direct links to medical policy databases.
Parent organizations displayed when corporate medical policy applies to subsidiaries.
Payer Category

Payer Category

Insurance carriers are organized into categories size, membership type and product lines.

National category includes insurance carriers with products and membership enrollment in all states.
Regional category includes insurance carriers with products and membership enrollment in some states.
Local category includes insurance carriers with products and membership enrollment in only one state.
Other categories include Medicare MACs, Managed Medicaid, BCBS, TPAs, and more.
Payer Region

Payer Region

Quickly find insurance carriers, medical policies, and other information organized by state.

Insurance carriers with membership enrollment in all 50 states are indicated by National region.
State abbreviations are listed by insurance carrier for each state with membership enrollment.
Quickly and easily filter reports by region to display medical policy information by state.
Insured Lives

Insured Lives

Total medical enrollment for each insurance carrier is calculated by insured lives.

Insurance carriers range from large to small based upon the total medical membership enrollment.
Membership totals are calculated using various methodologies and are routinely updated.
Quickly and easily filter reports by insured lives to display medical policy information by enrollment total.
Policy Title

Policy Title

Directly access each insurance carrier’s current medical policy by clicking the policy title.

Insurance carriers organize coverage information by procedure and group similar topics into related policies.
Links to insurance carrier medical policies are maintained in real-time.
Coverage information can be found in various document types and may not always be a medical policy.
Policy Number

Policy Number

Unique document identification by insurance carrier to easily track medical policy versions.

Each medical policy typically has a unique document ID assigned by insurance carriers.
Policy numbers may change with each updated medical policy version.
Review Dates

Review Dates

Insurance carriers typically review medical policies annually, but updates can occur anytime without notice.

Any time a medical policy or supporting document is revised the most recent date of change is displayed.
Revisions to medical policies are not always implemented when posted and may have future effective dates.
Future reviews are displayed using numerous predictive algorithms to best anticipate upcoming reviews.
Coverage Statement

Coverage Statement

Medical policies provide detailed information on the products and procedures used to treat various conditions.

Searching medical policies for coverage information can be time-consuming and strenuous task.
Coverage language is pulled from each medical policy and summarized on each coverage report.
Experienced analysts provide reliable interpretation of coverage statements to determine the coverage status of each medical policy.

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