Core concepts

Payers

Manage the insurers you bill and the policy documents their rules come from.

A payer is an insurer you submit claims to. Payers are the anchor for rules: each payer owns the policy documents you upload, and the rules Revenue Guard extracts from those documents are what orders are validated against.

Payers in the API

For integrations, payers are read-only. Use them to resolve the IDs you pass in an order’s payer_ids (scope payer:read):

  • GET /public/v1/payer-categories — list payer categories.
  • GET /public/v1/payers — list payers with their id, name, and category. Supports search and pagination.
  • GET /public/v1/payers/{payerId} — verify a single payer ID.

The id returned here is exactly what you submit in payer_ids. See the API reference for details.

Payer Master in the dashboard

The Payer Master page manages payers for the active environment. From here you can create, edit, and organize payers, group them by category, and open a payer to see its documents, rules, and health.

Payer Master list
Payer Master list grouped by category

Each payer records details such as its category, legal name, EDI payer ID, effective date, owner, and contact information (provider-services phone, claims address, appeals URL). A per-payer stats view summarizes active rules, draft rules awaiting review, uploaded documents, and how many rules need attention.

Policy documents and rule extraction

Rules originate from payer policy documents. The upload and extraction flow is:

1

Upload a policy document

Upload a PDF or DOCX (up to 50 MB) to a payer. Uploads use a presigned URL, so the file goes directly to secure storage.

2

Revenue Guard parses the document

The document is parsed into a structured layout. You can open the parsed layout alongside the original in the built-in viewer.

3

Rules are extracted as drafts

Candidate rules are extracted into the Rules Engine as draft rules, each with a confidence score and a link back to the source excerpt.

4

You review and promote

Review the extracted drafts and promote the good ones to active rules. Low-confidence drafts are flagged as needing review.

Payer detail
Payer detail with uploaded policy documents and extracted rules

A document cannot be deleted while its payer still has active rules, and deleting a payer soft-deletes its documents. This protects the rules that orders are actively validated against.

Populating payers from a connected lab

If your organization is connected to a LiveHealth lab, you can import the lab’s insurance master into payers automatically instead of creating them by hand. See Crelio sync.