For RCM and healthcare teams

Put payer policies to work in your workflow.

Give your team repeatable, source-cited answers inside the systems they already use.

Consistent answersThe same facts and policy edition give the same result.
Sources your team can checkSee the policy passage behind each matching result.
Control over policy versionsKeep an edition and compare what changes.

Try it with Medicare election periods

Choose a sample call, change a detail, and check the cited answer.

Also try a payer-policy exampleBCBSMA TMS documentation checkCommercial policy snapshot · demonstration

Fictional client details · CMS guidance, Section 30

POST /decide

The current client details as an API request. Change the details or choose an example to update it.

Run this request locallySetup and commands

First run node serve.js in that folder. Leave it running, then paste this request into a second terminal opened in the same folder.

Uses the call details above. Returns matching election periods and CMS citations. Commands are for macOS, Linux, or WSL.

Loading the pearl…

Periods that do not apply

What we understood from your answers

Decision receipt

Paste this into the client file. It records the answers, the result, and the rules edition used for this answer.

application/json

The local API’s response format, using this browser’s result and evaluation time.

– to evaluate

Based on the details entered and the selected rules edition. Decision support for a licensed agent, not a determination.

Where this could fit your team’s work

The example above checks Medicare election periods. These are applications we can explore with your policies and workflow.

Prior authorization

Check submitted facts against payer requirements and show reviewers the supporting policy criteria.

Denial review

Identify the policy criteria behind a result so your team can review the evidence and decide the next step.

Policy updates

Compare how two editions answer the same case before introducing a new version into your workflow.

No per-call feesRun this downloaded pearl as often as you need.

No network waitEvaluation runs locally, even offline.

Client details stay localNo client details need to be sent to LogicPearl.

Take the rules with you.

The election periods covered here, in one downloadable pearl. Use it offline, or bring the same cited answers into your team’s workflow.

Bring us a payer policy your team checks every day.

Let’s review how it could become a pearl for your workflow. Start with the policy, the questions your team asks, and where the answers need to go.

Discuss your policy

Glossary

MA / MA-PD: Medicare Advantage plan, without / with drug coverage.
PDP: Stand-alone Part D prescription drug plan.
AEP: Annual Election Period, October 15 to December 7.
MA OEP: Medicare Advantage Open Enrollment Period, January to March, for people already in an MA plan.
ICEP / IEP: The first window to enroll when someone becomes eligible for Medicare.
SEP: Special Election Period: a window opened by a life event such as a move, a plan closing, or losing other coverage.
LIS / Extra Help: The Part D low-income subsidy.
Dual eligible: Has both Medicare and Medicaid.
D-SNP, C-SNP, I-SNP: Special needs plans for dual eligibles, chronic conditions, and institutional residents. FIDE, HIDE and AIP are D-SNPs integrated with a Medicaid plan.
GEP: The Part B General Enrollment Period, January to March.
PACE: Program of All-inclusive Care for the Elderly.