Turn payer requirements into billing rules your team can use.
Converus reads payer policies, LCDs/NCDs, mandates, and your contracts, and turns them into structured rules your systems and agents can run, with the source behind every one.
Payer requirements becomerules your systems can run.
Source · Payer medical policy 0341
Coverage rules
Covered, not covered, limited, excluded, or PA required by payer, test, CPT, indication, diagnosis, and state.
Prior auth rules
Whether PA is required, what evidence is needed, which form or portal to use, and what exceptions apply.
Documentation rules
Required diagnoses, clinical criteria, medical-necessity evidence, attestations, therapy history, prior labs.
Billing rules
Payer-specific logic for claims, coding, documentation, routing, submission, and reimbursement.
Rate rules
Contracted rates, CPT-level rates, state variations, and payer-specific reimbursement terms.
Appeal rules
Policy-backed arguments, missing evidence, denial root causes, and appeal language tied to the source.
Update billing rules beforestale logic creates denials.
Most teams find out a rule is stale only after claims start denying. Converus tracks the sources behind your rules and maps every change back to the rules, tests, and workflows it touches, before it reaches a claim.
Know which rules changed
Payer requirements, mandates, LCDs/NCDs, and contract terms move constantly. Converus flags every rule, test, and workflow a source change touches.
Review the evidence
Every update links back to the policy section, contract term, or bulletin that triggered it, so your team approves from the source.
Push approved logic into work
Updated rules flow into billing systems, work queues, agents, and internal tools.
Even the rules that are never cleanly published get structured into the same rule layer: authorization windows, filing limits, portal quirks, rep-confirmed rules from payer calls.
More than a place to search policies.The layer that runs them.
- Search it, ask it anythingfind any policy in plain language and get a cited answer in seconds
- Source stays connectedevery rule traces to the policy, contract, or mandate it came from
- Rules update when sources changeConverus surfaces which rules are affected and what needs to change
- Your team controls the logicreimbursement, billing, and market access review and approve before anything reaches claims, agents, or systems
- Systems and agents use the same rulesAPI, MCP, and integrations expose the exact same approved logic
- Knowledge becomes infrastructureno more tribal memory and spreadsheets
Turn payer policy into logicyour systems can execute.
A 30-minute walkthrough with your codes, your payers, and the policies behind last quarter's denials.