Where OpenPayer’s
data comes from

Medical policies, prior authorization requirements, clinical criteria, and provider bulletins come directly from each payer’s published policy library. OpenPayer ingests these publications daily and turns them into structured, searchable pages that keep the payer, policy number, and effective dates visible. The payer directory below lists every payer whose publications feed the platform.

Payer profiles combine regulator filings and federal datasets: NAIC market share reports supply premium and market position figures, and CMS enrollment and marketplace data supply plan participation. Subsidiary and state presence details come from the same filings.

Code pages are grounded in the standard industry code sets: CPT from the American Medical Association, HCPCS Level II and its quarterly updates from CMS, ICD-10-CM and ICD-10-PCS from CMS, and the MS-DRG definitions used in Medicare inpatient payment.

Facility profiles are built from CMS provider enrollment and certification data and Medicare cost report filings, which supply ownership, bed counts, financials, and payer mix. NPI network figures come from the NPPES registry.

Taxonomy pages follow the NUCC Health Care Provider Taxonomy code set, the registry payers and CMS use for credentialing and claims routing, paired with NPI registration counts from NPPES.

State pages draw on Census Bureau coverage estimates, NAIC state-level market share reports, and CMS datasets to describe payer concentration and coverage demographics in each state.