Health Systems and IDNs
Policy changes affect your service lines
before your teams know about them.
Polify gives health systems and IDNs continuous visibility into payer coverage policy across every service line. Changes surface before they reach the denial queue, with alerts routed to the teams they actually affect.
The problem
The denial arrives weeks after the policy changed.
Coverage criteria for a procedure updates. Your team finds out when the claim comes back. By then, the prior auth was submitted against outdated requirements, the documentation is incomplete, and the appeal clock is running.
Prior authorization requirements vary by payer, line of business, and jurisdiction.
Tracking them manually is not a system. It is a liability. A single service line can touch dozens of payer policies across commercial, Medicare Advantage, and Medicaid managed care. Each carries different criteria, different documentation thresholds, and different review organizations.
Policy monitoring without clinical context produces noise.
An alert that a policy changed is not useful unless it tells you what changed, which procedures are affected, and what your documentation now needs to include. Your teams need signal, not volume.
EHR Integration
From diagnostic codes to procedure coverage in one step.
Most health systems document clinical encounters using SNOMED CT. Most payer coverage policies are written against CPT and HCPCS procedure codes. The gap between those two systems is where prior authorization errors and coverage denials are born.
Polify maps SNOMED clinical terms to the CPT and HCPCS codes that govern payer coverage, connecting your existing clinical documentation workflows directly to payer policy intelligence. If your EHR uses SNOMED, Polify integrates without requiring a workflow rebuild or a separate coding translation layer.
The result: your clinical teams document in the language they already use, and your revenue cycle teams see the coverage policy that applies to the resulting procedure code before the claim is submitted.
See code coverage analysisSNOMED 84114007
Heart failure
CPT 33274
Transcatheter pacing system implantation
SNOMED 44054006
Type 2 diabetes mellitus
CPT 95251
Ambulatory glucose monitoring
SNOMED 73211009
Diabetes mellitus
HCPCS E2101
Insulin infusion pump
SNOMED 57054005
Acute myocardial infarction
CPT 92928
Percutaneous coronary intervention
Each mapped procedure code links directly to payer coverage policy
What Polify surfaces for health systems
Policy intelligence built for the complexity of a health system.
Service line policy monitoring
Continuous monitoring across commercial, Medicare, and Medicaid policies for every service line in your system. Changes surface before they reach the denial queue.
Prior authorization requirement tracking
PA requirements by payer, line of business, and procedure, updated in real time as payers revise their criteria. No more manual lookups before submission.
SNOMED-to-procedure mapping
Polify maps SNOMED clinical terms to CPT and HCPCS procedure codes, connecting your diagnostic coding workflows directly to payer coverage policy. If your EHR or clinical documentation system uses SNOMED, Polify integrates without requiring a workflow rebuild.
Policy change alerts routed to the right teams
Alerts are not broadcast to everyone. They are routed to revenue cycle, managed care contracting, clinical documentation, or compliance based on the service line and payer affected.
Coverage criteria mapped to documentation requirements
When a policy requires specific clinical documentation, Polify surfaces exactly what is required so your clinical documentation team knows what to capture before the claim goes out.
Denial pattern analysis
Polify connects denial data to the policy versions in force at the time of submission. When a denial pattern emerges, you can see whether it is a documentation gap, a policy change, or a payer-specific interpretation issue.
Who uses it
Built for the teams that carry the policy burden.
Policy changes do not affect one team. They ripple across revenue cycle, managed care contracting, clinical documentation, and compliance simultaneously. Polify routes intelligence to the right team at the right time, so no one is working from stale information.
How a policy change flows through Polify
Policy change detected
Aetna updates coverage criteria for CPT 27447 (total knee arthroplasty). Conservative therapy requirement extended from 3 to 6 months.
Alert routed to affected teams
Revenue cycle and managed care contracting receive the alert. Clinical documentation receives the updated documentation checklist.
Prior auth templates updated
PA submission templates for Aetna knee procedures are flagged for update before the next submission cycle.
Start with your service line code set.
Bring your CPT or SNOMED code set and Polify maps the coverage policy landscape across your payer mix in minutes.