Regulatory Monitoring
Know when payer rules change.Before your claims get denied.
Your compliance team is excellent. But even the best teams can't manually track policy changes across every payer, every week. Rules change silently — coverage criteria, prior auth requirements, coding updates — and the first sign is usually a denied claim. We automate the monitoring so your team knows about changes before they cause problems, not after.
Real-time
policy tracking
Aetna, Cigna, CMS, UHC + more
Same-day
proactive alerts
Know before the denial
Zero
surprise denials from rule changes
Pre-submission validation updated automatically
We map your regulatory exposure
We identify which payers you bill, which services are most affected by policy changes, and where your team currently has blind spots. Every organization has different risk areas.
We automate the monitoring
Not a generic compliance feed — targeted tracking of the specific payer policies that affect YOUR services. Changes detected, analyzed for impact, and routed to the right people on your team. AI analyzes policy documents and summarizes what changed in plain language. Tracking when policies update uses monitoring automation. AI interprets; rules alert.
Your team stays ahead of changes
Same people, better visibility. Your compliance and billing teams act on changes proactively instead of discovering them through denials.
"We already track payer changes."
It probably does. We don't duplicate what works. We find the gaps — the manual steps your current process doesn't catch — and automate those. Every organization's gaps are different. That's why we start with an assessment, not a demo.
Problems We've Solved
Common Regulatory Monitoring bottlenecks we automate
Every operation is different. We work with you to identify the ones that cost you the most.
With an engineer — not a salesperson. No commitment.
Real Results
How proactive monitoring eliminates surprise denials
Healthcare organizations billing multiple payers face a constant problem: rules change without warning. A diagnostic lab network was experiencing recurring denial spikes — not because their billing team made mistakes, but because payer policies changed between when the test was ordered and when the claim was submitted. The team was excellent at working denials, but they were always reacting instead of preventing.
We built proactive monitoring across their top payers — Aetna, Cigna, CMS, and UnitedHealthcare — tracking coverage criteria, prior auth requirements, and coding rules in real time. When a policy changes, the billing team gets an alert with a specific impact analysis: which tests are affected, how many pending orders match, and what action to take. Pre-submission validation rules update automatically.
The team didn't change. What changed was when they found out about policy updates. Instead of learning from denial reports weeks later, they now know the same day a policy changes. Denial spikes from policy changes went to near-zero. The same team that was spending hours on rework now spends minutes on prevention.
See more resultsSame-day
policy change alerts
~0
surprise denials from rule changes
4
major payers monitored
Hours
of rework eliminated weekly
How We Work
What a typical engagement looks like
No two engagements are the same — because no two organizations have the same payer mix or regulatory exposure. But this is the general shape.
Assess
We map your payer mix, service lines, and current compliance workflow. We identify where policy changes have caused denials in the past and where your team has blind spots. We tell you exactly what we'd monitor and what impact to expect.
Free workflow exploration + $1,999 deep roadmap
Build
We build monitoring for your specific payers and services. Policy tracking, impact analysis, alert routing, and pre-submission validation integration — all customized to your test menu and billing workflow.
$25K–$75K depending on scope
Run
We maintain the monitoring infrastructure, add new payers as your mix changes, and refine impact analysis as we learn your workflow. When regulations change, we update tracking rules. Your team focuses on compliance strategy — we handle the surveillance.
$2K–$5K/month · 30-day cancel anytime
Expand
Most organizations start with their top 3–5 payers. Once that's running, we add secondary payers, state-specific regulations, and automated billing rule updates. Same approach, expanding coverage.
Scoped per project
$50K Savings Guarantee
If we can't identify $50K in annual savings during the Roadmap phase, we refund the $1,999. You keep the analysis either way.
We Work With Your Stack
We don't replace your systems. We connect them.
We've built integrations with these systems — but if yours isn't listed, we'll figure it out. That's the job.
Common Questions
Before you book
Let's find your regulatory blind spots.
Schedule a workflow exploration call with an engineer — not a salesperson. We'll map your payer exposure, identify where policy changes are costing you money, and tell you exactly what we'd monitor. Free, no obligation.
Book Free AssessmentOr call us: 1-877-326-1761