Question 1

How to use the payer lookup?

Accepted Answer

Type a payer or health plan name into the search bar — for example, “Cigna,” “Centene,” or “Blue Cross.” Use the state filter to see which payers operate in a given state. Open any result for the payer’s full profile: market share and CMS market presence, member demographics, coverage footprint, and related medical policies and prior authorization requirements.

Question 2

What is a payer in healthcare?

Accepted Answer

A payer is the organization that pays for healthcare services. These organizations include health insurance companies, health plans, and government programs like Medicare and Medicaid. Commercial payers such as UnitedHealthcare, Aetna, and Cigna set the medical policies, prior authorization rules, reimbursement rates, and timely filing limits that providers and billers work with every day.

Question 3

Who are the largest health insurance payers in the US?

Accepted Answer

The largest US payers by membership are UnitedHealth Group (UnitedHealthcare), Elevance Health (Anthem), CVS Health (Aetna), Cigna, Humana, Centene, and Kaiser Permanente. Each has a full profile on OpenPayer with market share, state footprint, and related medical policies.

Question 4

How do I find a payer's prior authorization requirements?

Accepted Answer

Open the payer's profile from any search result, or jump to the live policy feed filtered to that payer to see its latest medical policies and prior authorization updates. Each policy entry lists the covered codes, clinical criteria, and effective dates.