Coverage risk, caught before submission.
Verity reads payer policies and returns the answer, the source, and the missing requirements through an operator UI, API, and agent-safe tools before a prior-auth request or claim gets stuck.
Why coverage work breaks down.
Your team checks coverage from payer portals, PDFs, CMS sources, policy updates, and billing rules that were never built to be used at the point of work.
The failure usually appears later: a missing document, an authorization assumption, a stale policy, or denial risk that could have been flagged earlier.
Verity checks those rules before submission and returns the answer, the source, and the gaps your team needs to fix.
The coverage-risk layer for healthcare ops and agents.
Policy-backed answers
Check payer, plan, procedure, diagnosis, modifier, and site of service against policy evidence, dates, confidence, and known gaps.
Denial-risk 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 your top codes and highest-friction payers.
Bring the codes, payer mix, and workflows that cause rework. Verity returns PHI-free coverage requirements, missing-documentation signals, policy sources, recent changes, and API examples where evidence is available.
Denial-risk check: 27447, Medicare Advantage, TX
Requirement summary, documentation checklist, and source policy returned.
Validate J0585 with diagnosis context and site of service
Coverage status, denial-risk signals, known gaps, and review notes returned.
What changed for policies tied to my watched codes this month?
2 policy updates found with affected HCPCS codes, effective dates, and sources.
GET /v1/agent/tools
{
"tools": [
{
"id": "validate_claim",
"scope": "agent:tool:validate_claim",
"approval_required": false
},
{
"id": "acknowledge_policy_change",
"scope": "agent:tool:acknowledge_policy_change",
"approval_required": true
}
]
}
POST /v1/agent/tools/validate_claim
X-Verity-Agent: claims-triage-agent
{
"procedure_codes": ["E0601"],
"diagnosis_codes": ["G47.33"],
"state": "TX",
"site_of_service": "home",
"response_format": "concise"
}
{
"coverage_status": "conditional",
"prior_auth_required": true,
"denial_risk": "medium",
"confidence": "medium",
"requires_manual_review": false,
"result_window": {
"policy_sources": { "shown": 2, "has_more": false }
}
}Built as infrastructure for RCM workflows, vendors, and agents.
Verity returns coverage requirements, prior-auth rules, documentation criteria, denial risk, policy sources, confidence, effective dates, and last-verified dates as stable JSON. Claim scrubbers, specialty workflows, and healthcare agents can call the same policy layer before they take action.
Agents use scoped keys, machine-readable tool schemas, no-PHI validation, and an invocation ledger. Operators use the dashboard to review evidence, resolve gaps, and approve write actions.
Machine-readable payer policy for denial prevention.
Verity handles policy ingestion, normalization, validation, versioning, and evidence so your team can build pre-submission checks without rebuilding the payer-policy pipeline.
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.
The shift: lookup to prevention.
Instead of digging through portals after something fails, your team sees the policy, the missing documentation, the affected codes, and the denial risk 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.
Try a rule-level coverage question, or bring the payer/source, code, state, and workflow your team keeps checking by hand.