Insurance & payers

What payer data is for

Payer configuration gives the assistant factual clinic context such as which organizations the clinic works with or which prices/policies are explicitly configured.

Keep the data operational and current. A payer name alone does not prove that a particular patient, referral or treatment is covered.

Questions that may be answered from configured data

• “Do you work with Payer X?” when the relationship is explicitly configured.
• A payer-specific price when the clinic has entered a clear price for that exact context.
• A documented clinic policy about what patients should bring to an appointment.

Questions that usually need verification or handoff

• “Will my insurance cover this?”
• “Does this referral definitely work?”
• “Will I get reimbursed?”
• Any question where eligibility depends on the patient, policy, authorization or current payer decision.