Coverage risk, caught before submission.
Verity reads payer policies and returns the answer, the source, and the missing requirements before a prior-auth request or claim gets stuck.
Why coverage work breaks down.
Your team makes coverage decisions from payer portals, PDFs, CMS sources, policy updates, and billing rules that were never built to be used at the point of decision.
The failure usually appears later: a missing document, an authorization assumption, a stale policy, or a preventable denial.
Verity checks those rules before submission and returns the answer, the source, and the gaps your team needs to fix.
One policy source for humans and software.
Coverage decisions
Check payer, plan, state, procedure, diagnosis, modifier, and site of service against policy evidence, dates, confidence, and known gaps.
Pre-submission validation
Check code and policy combinations before claim submission. Flag prior-auth requirements, documentation criteria, denial risk, and manual-review cases without PHI.
Policy Monitoring
Watch codes, payers, specialties, and policy documents. Get what changed, which codes are affected, the source link, and the effective date.
Start with a Coverage Risk Audit.
Send top codes, payers, states, and denial pain points. We return a PHI-free map of prior-auth requirements, missing documentation, policy sources, recent changes, and API examples.
DME/sleep: E0601, Medicare Advantage, TX, dx G47.33
Prior auth likely required. Documentation checklist and source policy returned.
Validate E0470 with diagnosis code G47.33 and adult age category
Medium denial risk. Missing adherence and sleep-study documentation criteria.
What changed for CPAP/BiPAP policies this month?
2 policy updates found with affected HCPCS codes, effective dates, and sources.
POST /v1/coverage/validate
{
"payer": "Example Health Plan",
"line_of_business": "Medicare Advantage",
"state": "TX",
"procedure_codes": ["E0601"],
"diagnosis_codes": ["G47.33"],
"site_of_service": "home",
"policy_context": {
"age_category": "adult"
}
}
{
"coverage_status": "likely_covered",
"prior_auth_required": true,
"denial_risk": "medium",
"documentation_requirements": [
"sleep study",
"face-to-face evaluation",
"adherence documentation"
],
"confidence": "moderate",
"last_verified_at": "2026-05-07",
"requires_manual_review": false
}Built for RCM workflows and vendors.
Verity returns coverage requirements, prior-auth rules, documentation criteria, denial risk, policy sources, confidence, effective dates, and last-verified dates as stable JSON. The UI, feeds, webhooks, and API all use the same policy data.
Coverage policy data your software can use.
Verity handles policy ingestion, normalization, validation, versioning, and evidence so your team does not have to build the payer-policy pipeline from scratch.
Structured policy objects
Payers, plans, policies, code relationships, documentation requirements, effective dates, citations, and confidence.
Policy-change stream
Watch codes, payer documents, and specialties. See what changed, which codes are affected, and when the change takes effect.
Bulk feeds and webhooks
Use JSON, CSV, and webhooks in billing tools, RCM products, analytics, and audit work.
What actually changes.
Instead of digging through portals after something fails, your team sees the policy, the missing documentation, and the affected codes before submission.
The answer is not a guess. It comes with the policy source, dates, confidence, and a JSON response your team can inspect or use in software.
Frequently Asked Questions
Find the coverage risk hiding in your top codes.
Send top CPT/HCPCS codes, payers, states, and prior-auth or denial pain points. We'll map the coverage rules, missing documents, policy sources, recent changes, and API examples.