Know What Every Payer Will Approve — Before You Submit
A living intelligence network that maps payer behavior, tracks policy changes in real-time, and tells your team exactly what documentation each payer requires — eliminating preventable denials.
50+
Major payers tracked
72 hrs
Average policy update lag we catch
31%
Reduction in preventable denials
98%
Payer rule accuracy
Payer Rules Change 200+ Times Per Year —
Nobody Can Keep Up
200+
Payer policy updates per year
Medicare, Medicaid, and commercial payers update coverage policies, prior auth requirements, and bundling rules constantly. Your team can't monitor all of them.
72 hrs
Average lag before teams learn of a change
By the time your team discovers a new policy, you've already submitted dozens of non-compliant claims — creating a wave of preventable denials.
31%
Of denials are completely preventable
Nearly a third of all denials come from submitting claims that violated a payer rule your team didn't know had changed. Pure revenue leakage.
Everything Your Team Needs to Stay Ahead of Payers
Eight interconnected capabilities that give your RCM team complete payer intelligence — from real-time policy monitoring to pre-submission claim validation.
Real-Time Policy Monitoring
AI scans CMS, LCD databases, 50+ payer portals, and AMA guidelines daily. When a coverage policy changes, your team is alerted before the next submission.
Semantic Rule Search
Ask in plain English: "Does Aetna cover 29881 with diagnosis M23.211 without prior auth?" Get an instant, cited answer with the relevant policy section.
Denial Prevention Engine
Before every claim submission, NexaClaim checks it against current payer rules. If something will be denied, it's flagged for correction — not submission.
Payer Scorecards
See each payer's approval rate, average payment time, common denial reasons, and appeal success rate — ranked and trended over 24 months.
Geographic Coverage Maps
Visualize payer penetration and behavior by geography, specialty, and procedure. Know which payers are aggressive in your market before contracting.
Policy Change Alerts
Instant alerts when policies affecting your top CPT codes change. Get a plain-English summary of what changed, what it means for your claims, and what to do.
LCD/NCD Reference Library
Full-text search across all active Local and National Coverage Determinations, updated the day CMS publishes changes — with AI-generated summaries.
Denial Pattern Analytics
See which payer + CPT + diagnosis combinations are generating denials across the platform — anonymized data from thousands of practices.
From Policy Change to Protected Claim in Hours
NexaClaim's four-stage intelligence loop keeps your team ahead of payers — automatically.
Continuous Policy Scanning
AI monitors CMS, all major payer portals, LCD databases, and regulatory sources 24/7. Policy changes are detected within hours, not weeks.
Intelligent Alerting
When a rule change affects your top procedure codes or payer mix, your team receives an alert with a plain-English summary and recommended action.
Pre-Submission Validation
Every claim is checked against current payer rules before it touches the clearinghouse. Violations are flagged for correction, not rejection.
Continuous Learning
Denial patterns across the NexaClaim network improve everyone's rule database. The more practices use it, the smarter the system gets.
Real Results Across Every Specialty
See how healthcare organizations use NexaClaim's payer intelligence to prevent denials and protect revenue.
Challenge
UnitedHealthcare changed their MRI coverage policy; team didn't learn for 3 weeks; $340K in avoidable denials.
Result
Policy change alert received within 6 hours; submitted corrected documentation; $0 denials on the affected codes.
Challenge
Couldn't track which procedures required prior auth for each payer; team calling payers manually 30+ times/day.
Result
Instant prior auth requirement lookup; call volume reduced 94%; auth turnaround improved from 7 days to 1.2 days.
Challenge
New market expansion — didn't understand regional payer behavior patterns before contracting.
Result
Used payer scorecards to negotiate better contracts; avoided two aggressive payers; improved net collection rate by 4.2%.
By the numbers
Payer Intelligence That Moves the Needle
Major payers tracked daily
Policy change detection time
Reduction in preventable denials
Rule accuracy rate
Connected to Every Payer Intelligence Source
We actively monitor all major commercial payers, CMS programs, and regional plans — so nothing slips through the cracks.
CMS LCD/NCD Databases
Updated same-day
Commercial Payer Portals
50+ monitored daily
Regulatory Bulletins
AMA, CMS, state agencies
Frequently Asked Questions
Everything you need to know about NexaClaim's payer intelligence capabilities.
Stop Leaving Revenue on the Table
Join 50+ physician groups who have recovered millions in denied revenue with NexaClaim AI. Get started in 15 minutes with a free denial audit.
No credit card required. See results in under 24 hours.