How we source and verify payor data.

ABA Insight tracks authorization rules, documentation requirements, and CPT modifier policies across 192 commercial, Medicaid, and government payors. This page describes how we source that data and how to read the confidence tier on every record.

Every field in the database carries a tier — Verified, Likely Current, or Needs Review — and links to the source document the value was extracted from. The tier determines the posture you should take toward the record before acting on it.

"The source link on every record is the verification path. Trust the tier — verify the source before claims."

Records are sourced from the documents a credentialed coder would consult: payor provider manuals, state Medicaid handbooks, and federal program documents. The source URL is stored on every record so anyone can verify the value against the original document.

We do not use secondhand aggregators. We do not buy lists. Every payor in the database is sourced to a document the payor or government agency itself published.

Every field carries one of three tiers, and the tier dictates how to use it:

Our verification process has four steps. We work through the dataset in priority order — top commercial payors first, then top-volume state Medicaid programs, then the rest.

1. 01
   Source identification.

   We locate the relevant payor policy document, provider manual, or state Medicaid handbook for each payor and extract candidate values for the fields we track. The source URL is stored alongside the value.

2. 02
   Confidence-tier tagging.

   Records default to "Needs Review" until a spot-check confirms the values match the source. They move to "Likely Current" after that check, and to "Verified" once confirmed against a current primary source.

3. 03
   Rolling verification, priority-ordered.

   Top commercial payors (Aetna, Anthem, Cigna, UHC, Humana) are reviewed first, followed by the top-volume state Medicaid programs. Each verified record's lastVerified date reflects the actual confirmation date.

4. 04
   User-reported corrections.

   Every payor record has a "Report an error" button. Corrections are reviewed and used to update both the value and the confidence tier on the affected record.

Freshness runs on two layers. Detection is daily: monitoring agents check every registered payor policy source every day, and a verified material change is published to the policy log — and alerted to subscribers — the same day it's confirmed. Review is scheduled: on top of detection, a human editorial pass re-reads each payor's full record on the tiered cadence below, catching what automated diffing can't.

ABA Insight is a reference tool, not a substitute for direct payor communication. Payor-level policies may differ from plan-level variations (e.g., employer-sponsored plans with custom benefit designs), and policies can change between scheduled review cycles. Always verify authorization requirements directly with the payor before submitting a request for a new patient or a renewal.

We do not provide legal or billing compliance advice. The confidence tier on each record tells you how recently it was verified — use it to calibrate how much double-checking is warranted for a given claim.

If you spot a record that conflicts with your own verification, email data@abainsight.ai. User-reported corrections are our highest-signal channel.