Medical Policy Search demo
Ask which criteria apply to a service, plan and date; get the answer with the policy section and version. 1:14
What the demo shows
A search solution for plan reviewers that finds the criteria in force for a service and date.
A reviewer asks for a service, a plan type and a date; six agents find the edition of the medical policy in force on that date, check it against Medicare's own rule for Medicare Advantage members, and quote each criterion with its section and edition. Under the answer runs a strip of every edition: move along it and the criteria change in place as tracked changes, which is what appeals and provider disputes turn on. A physician reviewer decides.
Transcript
- Medical Policy Search gives health plan reviewers the criteria in force on any date.
- Policies change often, and four in five appeal Medicare Advantage denials are overturned.
- An appeals nurse asks, glucose monitor, Medicare Advantage HMO, August 18th.
- Agents quote that day's edition.
- The denial cited section 3.6.
- The next edition shows it inserted.
- Drag back to the date of service.
- Section 3.6 disappears, added two weeks later.
- For Medicare Advantage, it never applied.
- Medicare dropped that test in 2021.
- Forty other Medicare Advantage denials cited.
- All go back for review.
- The criteria that apply, in seconds, with the policy section and version that says so.
- Built on Botminds: agents, data, screens, and governance on one platform.
Transcribed from the film’s narration. Captions are on the player.