Coverage rules, prior auth requirements, cost-sharing data, and bill intelligence — delivered as a simple REST API.
Is a procedure covered for a given carrier? What's the policy status?
Required, conditional, or not required — with the specific criteria.
Deductible, copay, and coinsurance rules per procedure per carrier.
How often is a procedure covered? Age and interval restrictions.
Medical necessity triggers and clinical criteria required for approval.
Detect duplicates, unbundling, screening reclassification, and benchmark overcharges.
All plans also include /v1/coverage/procedures and /v1/coverage/carriers. Full docs →
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