About OpenPayer
Coverage policy intelligence,
in one place
OpenPayer centralizes payer medical policies, prior authorization rules, reimbursement benchmarks, and billing-code intelligence into a searchable platform built for provider organizations.
What we do
Turn fragmented payer documents into answers you can act on
Provider teams still spend hours hunting coverage rules across payer portals. OpenPayer puts those policies, codes, and facilities in one system so you can ask a question, open the source page, and move on.
Ask in plain language
Research the source pages
Look up the day-to-day details
Get notified when policies change
Research library
A map of the US payer landscape
Every hub page is a starting point. Open a payer, a state, a code family, or a facility type and keep drilling into the related policies and reimbursement context.
Health insurance payers
State markets
Billing codes
Hospitals & facilities
Service lines
Provider taxonomy codes
Research tools
Lookups for the work you already do
Free lookup pages for billers, coders, and revenue-cycle teams. Each result opens a full detail page. The tools just get you there faster. View all tools.
Billing Code Lookup
Healthcare Provider & Facility Lookup
Health Insurance Payer Lookup
Provider Taxonomy Code Lookup
CPT Modifier Lookup
Prior Authorization Lookup
Timely Filing Lookup
Coverage Criteria Lookup
Payer Contact Directory
Stay current
See policy changes as they land
Payer rules move constantly. OpenPayer watches publications for you, then lets you filter, save, and subscribe to the slice that affects your organization.
Live policy feed
Policy monitoring
Watchlists
Signed-in teams can also keep chat history and, on Trek Health deployments, organize findings into collections and reports for internal sharing.
How it works
From payer PDF to an answer you can cite
Four steps take you from ingestion to action. The loop is the same whether you start from search, a tool, or a hub page.
- 01
Ingest payer documentation
OpenPayer continuously pulls medical policies, prior authorization rules, and coverage criteria from payer publications into the live policy feed.
- 02
Structure them into pages
Unstructured PDFs and portals become searchable pages for payers, codes, facilities, and individual policies, all with effective dates attached.
- 03
Ask, look up, or browse
Start from natural-language search, a research tool, or a hub like payers and billing codes.
- 04
Watch what matters
Save the payers, states, specialties, or policy numbers you follow in a watchlist, or get email alerts through policy monitoring.
Data sources
Built on sources you can verify
Every page on OpenPayer traces back to an authoritative source, from payer-published policy documents to federal datasets and the standard industry code registries. The data sources page lists them all with links to the originals.
Payer policy libraries
Medical policies, prior authorization rules, and provider bulletins payers publish themselves.
CMS datasets
HCPCS and ICD-10 code sets, enrollment and marketplace data, and provider certification files.
NAIC market share reports
Premiums and market position for every payer group, nationwide and by state.
NUCC taxonomy registry
The provider specialty code set payers and CMS use for credentialing and claims routing.
AMA CPT code set
Procedure codes and modifiers maintained by the American Medical Association.
U.S. Census Bureau
State-level coverage demographics from the American Community Survey.
Built for provider operations
Billers & coders
Confirm CPT, HCPCS, modifiers, and diagnosis context before a claim goes out.
Revenue cycle
Trace denials back to coverage criteria, timely-filing rules, and related payer policies.
Utilization management
Check medical necessity and prior authorization requirements by payer, drug, or procedure.
Managed care & contracting
Research payer footprints, facility mix, and policy behavior before a negotiation.
Powered by Trek Health
The same intelligence behind payer performance
OpenPayer is powered by Trek Health’s payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data. OpenPayer uses that foundation for personalized search, dynamically generated policy pages, and tailored policy monitoring. The same intelligence powers reimbursement benchmarking, contract evaluation, and payer negotiations on Trek.
FAQ
Common questions
Straight answers about what OpenPayer covers, who it is for, and how to start.
Ready to look something up?
Ask a coverage question, open a billing code, or browse the latest payer policy updates. No account required.