Payer Policy Intelligence

Stop losing revenue to policy changes you didn't see coming

Claims Clarity monitors payer policy updates across Medicare, Medicaid, and major commercial insurers — alerting your team to changes before they become costly denials.

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⚡ Recent Policy Alerts
NGS Medicare — LCD Update
Botulinum Toxin L39832 — new diagnosis criteria & dose limits effective Feb 22
HIGH
BCBS Illinois — Reimbursement Policy
Updated reimbursement policy for outpatient infusion services
MODERATE
CMS — NCCI Edit Update
Q2 NCCI edit updates affecting bundled procedure codes
ROUTINE
The Problem

Payer policies change constantly. Missing one is expensive.

Healthcare organizations are required to stay current across dozens of payer sources — but manually monitoring every update is time-consuming, inconsistent, and prone to costly gaps.

01
📋
Policies change without warning
CMS, MACs, and commercial payers update LCDs, reimbursement policies, and coverage guidelines constantly — often with little notice.
02
⏱️
Manual monitoring doesn't scale
Keeping up with 40+ payer sources across Medicare, Medicaid, and commercial plans is a full-time burden most teams simply can't sustain.
03
💸
Missed changes become denials
By the time a policy change surfaces through denials, weeks of claims may already be affected — costing time, staff hours, and recovered revenue.
How It Works

Proactive monitoring. Plain language alerts. Actionable guidance.

Claims Clarity delivers a done-for-you policy intelligence service so your team can focus on revenue — not research.

1
Continuous source monitoring
We monitor CMS, MAC contractors, state Medicaid, and major commercial payers for policy updates across your specific payer mix.
2
Expert interpretation
Every change is reviewed by a revenue integrity specialist who translates complex policy language into clear, actionable summaries.
3
Timely alerts with impact assessment
You receive alerts flagging what changed, which service lines are affected, the impact level, and recommended next steps — before denials occur.
4
Ongoing coverage
As your payer mix evolves, so does your monitoring profile. Claims Clarity grows with your organization.
📡 Active Monitoring Dashboard
CMS / Medicare
Monitoring
NGS (MAC — Illinois)
Change detected
Illinois Medicaid (HFS)
Monitoring
BCBS Illinois
Change detected
Aetna
Monitoring
UnitedHealthcare
Monitoring
Cigna
Monitoring
Humana
Monitoring
Why Claims Clarity

Built by a revenue integrity expert. Not a software company.

🏥
12+ Years in Healthcare Revenue Integrity Medical coding, auditing, and revenue integrity analytics including Epic-based systems at major health systems.
📊
Deep Payer Policy Expertise Hands-on experience monitoring Medicare, Medicaid, and commercial payer policy changes and assessing their financial impact.
⚙️
Epic Revenue Cycle Knowledge Extensive experience with Epic workflows and how policy changes translate into real-world billing and coding decisions.
🎯
Illinois Market Specialist Deep familiarity with Illinois-specific payer landscape including HFS Medicaid, NGS MAC, and regional commercial plans.
"
Most organizations find out a payer policy changed the hard way — through a wave of unexpected denials. Claims Clarity exists to make sure that never happens to your team.
— Claims Clarity Founder
Get Started

Ready to stay ahead of payer policy changes?

Schedule a free consultation to discuss your payer mix, current monitoring gaps, and how Claims Clarity can protect your revenue.

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