Product methodology
PayerPolicy Watch
Source contract, normalization path, entity-graph join, refresh posture, and publication limits for this Branmoor product.
Status
Pending. This product is pending. The methodology page is published first so the source contract and join path are visible before Branmoor represents the product as live.
Distribution Scope
Nationwide; TN/BCBS-TN and TennCare feed; Nashville payer impact
Product Question
Diff feed for payer medical/reimbursement policy changes.
Primary Sources
- Commercial payer medical policy portals — Aetna, Anthem/Elevance, Cigna, UnitedHealthcare, Humana, BCBS plans — policy documents, PA requirements, fee schedule notes
- State Medicaid program publications — Coverage policy, fee schedule, and bulletin changes by state
- CMS National Coverage Determinations + LCDs — Medicare coverage policy baseline
- Payer provider manuals — Administrative requirements, claims edit rules
Entity-Graph Join
`payer_id`, `policy_id`, CPT/HCPCS, `npi`, `ccn`, service-line taxonomy.
Publication Rule
Branmoor does not treat raw public records as the product. A surface is publishable only when the source record is dated, normalized, source-linked, and joined to the relevant Branmoor entity identifiers with enough confidence to state the limits of the result.
Current Methodology Note
Every captured document is diffed against the prior version and stored. Operational translations are templated and reviewed; the source link and effective date are always present.
Limits
Coverage follows the underlying source. Missing state portals, gated APIs, PDF-only filings, suppressed fields, lagged agency refreshes, and entity-name ambiguity can all limit product completeness. Pending products are not marketed as live until those limits are documented on the product surface.