For every role in your practice
Clinical OperationsInfusion NursesPharmacistsRevenue CyclePhysicians and PrescribersPractice AdministratorsRevenue Cycle
Policy document landscape
Every document type. Every payer.
One place.
Payers publish coverage decisions across dozens of document types. We bring them together so your team stops hunting and starts knowing.
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Coverage Decisions
Payers publish policy decisions across dozens of document types — each structured differently, updated on different schedules, and housed in different portals.
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Authorization Requirements
Approval requirements vary by drug, payer, plan, and patient. The criteria change frequently and differ significantly across lines of business.
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Site Restrictions
Where and how a treatment can be administered is governed by payer policy. These rules directly affect scheduling, reimbursement, and patient access.
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Coverage Rules
The rules governing what is covered — and under what conditions — shift frequently. Most teams discover changes only after a denial.
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Patient-Level Rules
Coverage for the same treatment can differ based on the patient’s clinical history and diagnosis. Policies can produce different outcomes for different patients.
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Benefit Determination
Whether a drug falls under the medical benefit or pharmacy benefit determines how it is billed, who administers it, and what the patient’s cost sharing looks like.
The problem we solve
The information exists.
Finding it is the problem.
01
Policies are scattered
Each payer publishes coverage decisions across multiple portals, PDFs, and policy hubs.
02
They change without warning
Payers update their policies frequently — often with 30 days notice or less. Most teams find out when a claim is denied, not before.
03
Each role needs different information
Different members of the same team need different pieces of the same policy. Finding the right answer for the right role means navigating the same fragmented landscape, over and over.
04
The cost of a wrong answer is high
A missed policy detail at the wrong moment means a denied claim, a delayed treatment, or an out-of-pocket cost no one planned for. The financial and clinical stakes are real.
Coverage
National and regional payers.
Commercial, Medicare, Medicaid.
Coverage spans major commercial insurers, Medicare Advantage plans, and Medicaid programs — with new payers added continuously.
Built by someone who knows the problem
PayerNexus was built by Archana Modi — former Senior Product Strategy Leader at McKesson and VP of Product Strategy at JP Morgan Chase. She has spent years watching infusion teams lose hours every week to a problem that should have been solved a long time ago.
Read more about the team →Request access
Access is reviewed and approved individually.
Product details are shared with approved teams.
We review every request personally. Product details shared on approval.