Healthcare · Insurance & Billing
Coverage Guidelines (by payer)
A reference that spells out what each insurance plan will and won't pay for, and under what conditions.
What it usually contains
- Covered and non-covered services or procedures by plan
- Medical necessity criteria and required documentation
- Prior authorization and referral requirements
- Frequency and quantity limits, age or diagnosis restrictions
- Notes on appeals, denial reasons, and policy effective dates
What the assistant uses it for
Use it to check whether a specific payer covers a planned service, what proof of medical necessity is needed, and whether prior authorization or a referral must be obtained before billing.
How it is versioned
A document of this type has exactly one current version at a time. Upload a revision and it becomes the version that counts — the one before it is kept and dated, but is no longer what your assistant answers from. Nothing is ever deleted, so you can always show what this document said on a given date.
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