Payer policy intelligence for health system infusion networks. Organized, human-verified, and delivered to your team before the denial happens.
Every payer sets its own rules and updates them on its own schedule, buried in a different document. Miss it, and the cost shows up as a denial, a delayed patient, wasted resources, or staff hours chasing an answer that should have taken seconds. At health-system scale, that risk is multiplied across every infusion site and every payer your system contracts with.
Each payer publishes decisions across multiple portals, documents, and policy hubs — on its own schedule, in its own format, with no central place to find them.
Payers update their policies frequently, often with 30 days notice or less. Most teams find out when a claim is denied — not before treatment begins.
Your authorization team, clinical staff, billing department, and physicians are all navigating the same fragmented landscape for the same patient, separately.
A denial, a mid-treatment change, a delayed patient. Across every infusion site and every payer contract, the financial and clinical stakes are real and compounding.
One health system's infusion clinics cut denials tied to authorization and site-of-care gaps by 68% after centralizing their workflows — recovering $3.8M a year in previously denied claims.
Scoped to your payer mix and patient population. Human-reviewed before it reaches your team — not a raw automated output. Every change confirmed before it is delivered or published.
When a payer updates a policy, your team is notified. No one has to go looking. Delivered via your preferred channel, scoped to what matters for your patient population.
On-demand access to verified payer policy information whenever your team needs an answer — mid-call, mid-claim, or before scheduling.
Coverage spans major commercial insurers, Medicare Advantage plans, and Medicaid programs — scoped to what matters for your patient population, with new payers added continuously.
Request access to see full payer coverage →PayerNexus is live today. We want your team using it and giving us feedback as we continue building. In exchange, we ask only for your perspective.
Product and AI strategy leadership across US Oncology, IntraFusion, McKesson, and JPMorgan Chase. Archana spent years watching infusion teams lose hours every week to a problem that should have been solved a long time ago — and built PayerNexus to solve it.
Read more about the team →Reviewed and approved individually. Free 30-day pilot available for health systems. Product details shared on approval.