Covering the majority of insured Americans
The real-time medical coverage policy network that tells you
(or your AI) exactly what's covered, what's not, and why.
The real-time medical coverage policy network
that tells you exactly what's covered, what's not, and why.
Who we are
Healthcare runs on payer medical coverage policies.
They show which codes and documentation each payer requires for a medical claim to be accepted.
But these policies are scattered, constantly updated, and nearly impossible to interpret at scale.
ICD, CPT, HCPCS code extraction
API response time
Policy updates
Who we are
Healthcare runs on payer medical coverage policies.
They show which codes and documentation each payer requires for a medical claim to be accepted.
But these policies are scattered, constantly updated, and nearly impossible to interpret at scale.
ICD, CPT, HCPCS code extraction
API response time
Policy updates
Who we are
Healthcare runs on payer medical coverage policies.
They show which codes and documentation each payer requires for a medical claim to be accepted.
But these policies are scattered, constantly updated, and nearly impossible to interpret at scale.
ICD, CPT, HCPCS code extraction
API response time
Policy updates
Services
Services
Services
From claim scrubbing, prior authorization case generation, appeal letter writing, payer competitive analysis and medical device field sales coverage, Penelope delivers the context you need to work.
01
02
03
04
Extracted codes from active policies, categorized by context.
Contextual code coverage.
Check if specific CPT, HCPCS, or ICD codes are covered, excluded, or experimental for any payer and plan.
Medical necessity criteria. Extracted with AND / OR logic.
Real-time coverage
Policies change constantly. We monitors updates as they happen, so your decisions reflect current requirements.
Of new policies, added to our network every working day.
Deploy
We handle installation, testing, and launch so your systems work perfectly from day one.
Clinically significant differences (avg.) between any two payer policies.
Payer variance.
Understand coverage variations across payers for competitive intelligence, market access planning, and strategic positioning of services or devices.
01
02
03
04
Extracted codes from active policies, categorized by context.
Contextual code coverage.
Check if specific CPT, HCPCS, or ICD codes are covered, excluded, or experimental for any payer and plan.
Medical necessity criteria. Extracted with AND / OR logic.
Real-time coverage
Policies change constantly. We monitors updates as they happen, so your decisions reflect current requirements.
Of new policies, added to our network every working day.
Deploy
We handle installation, testing, and launch so your systems work perfectly from day one.
Clinically significant differences (avg.) between any two payer policies.
Payer variance.
Understand coverage variations across payers for competitive intelligence, market access planning, and strategic positioning of services or devices.
01
02
03
04
Extracted codes from active policies, categorized by context.
Contextual code coverage.
Check if specific CPT, HCPCS, or ICD codes are covered, excluded, or experimental for any payer and plan.
Medical necessity criteria. Extracted with AND / OR logic.
Real-time coverage
Policies change constantly. We monitors updates as they happen, so your decisions reflect current requirements.
Of new policies, added to our network every working day.
Deploy
We handle installation, testing, and launch so your systems work perfectly from day one.
Clinically significant differences (avg.) between any two payer policies.
Payer variance.
Understand coverage variations across payers for competitive intelligence, market access planning, and strategic positioning of services or devices.
How we work
How we work
How we work
Real-time policy data to ensure compliance with changing payer policies.
01
Connect
Integrate our API into your workflow or access policy intelligence through our own interface.
01
Assessment
Integrate our API into your workflow or access policy intelligence through our own interface.
01
Connect
Integrate our API into your workflow or access policy intelligence through our own interface.
02
Query
Query code coverage, compare payer policies, and generate policy-backed appeal letters and prior auth requests.
02
Query
Query code coverage, compare payer policies, and generate policy-backed appeal letters and prior auth requests.
02
Query
Query code coverage, compare payer policies, and generate policy-backed appeal letters and prior auth requests.
03
Act
Prevent denials, accelerate appeals, analyze coverage, plan market access.
03
Act
Prevent denials, accelerate appeals, analyze coverage, plan market access.
03
Act
Prevent denials, accelerate appeals, analyze coverage, plan market access.
Why choose us
Why choose us
Why choose us
Everything we do is directly aligned with your goal:
increased clean claim rates, reduced A/R, more recovered revenue
Sell what's trendy
Unclear timelines
Hidden costs
Old information. Static retrieval. Opaque quality.
Data that matters
Built with you
Transparent process
Real results
Daily updates. Contextual code retrieval. Designed for you.
Meet the founders
Sohum spent residency frustrated by admin chaos causing patient harm. Mattijs scaled optimization systems for millions globally. Together, we're helping to fix healthcare infrastructure.
Meet the founders
Sohum spent residency frustrated by admin chaos causing patient harm. Mattijs scaled optimization systems for millions globally. Together, we're helping to fix healthcare infrastructure.
Meet the founders
Sohum spent residency frustrated by admin chaos causing patient harm. Mattijs scaled optimization systems for millions globally. Together, we're helping to fix healthcare infrastructure.
FAQ
Still have questions? Book a call and we'll talk things through.
How quickly can we integrate Penelope's policy network?
You can use our web-app straight after signing up. Our API is designed for straightforward integration into existing workflows. Most organizations are querying policies within days, not weeks. We provide documentation, testing environments, and technical support throughout the process.
How do you ensure policy accuracy?
We use intelligent extraction methods that understand policy context, not just keyword matches. We understand how codes are referenced, whether they're approved, excluded or experimental.
But how do I actually use policies?
Great question! After you use our API or web-app to find policies (e.g. by payer, plan CPT code, ICD code or a 'fuzzy' text search), you can use our policies for a few pretty important things. - Checking code coverage - Checking medical necessity criteria - Auto-generating prior auth requests and appeal letters
Why don't I just Google the policies?
You definitely can! In fact, that's what most of our clients were doing before they used Penelope. But once you do this, you'll probably start facing some challenges. - There are a lot of payers, like, a lot (trust us, we know). - Their policies aren't always the easiest to find (we've scoured enough arcane web portals for a lifetime). - They can randomly update on a Wednesday, and completely change code coverage. - And then, once you find them, you're faced with a 50-page quasi-legal text, with some of the most important info being hidden away in footnotes and appendices. You can't integrate the info into your current workflows - be it to create dynamically updating coding rules, or to automatically generate appeal letters. So yes, you can Google things. But maybe give Penelope a try when you're ready to turbocharge your workflows.
How much does it cost?
Pricing depends on your needs, claims volume and scope. After our free assessment, we'll provide a clear proposal with transparent pricing and no hidden fees.
Keeping your data safe
How do you secure our information?
We take a privacy-first approach. All data is processed within isolated execution environments and stored using AES-256 encryption at rest. For data in motion, we use TLS-encrypted connections to ensure that your information is never exposed during transit.
How do you manage data access?
We enforce a strict Role-Based Access Control (RBAC) model. This means that every authenticated use is limited to the specific data and operations authorized for their role. We use project and resource scoping to ensure that users never see data from projects they aren't explicitly assigned to.
What infrastructure do you use?
Our platform is built on enterprise-grade infrastructure that maintains SOC 2 Type 2 and HIPAA-aligned security standards.
How do you handle AI governance?
We don't treat AI as a 'black box'. We implement a rigorous AI governance framework that includes systematic model validation against strict internal benchmarks, with a human-in-the-loop. A key part of our governance strategy is a focus on explainability and auditability. AI-generated outputs are traceable to their underlying source data.
Is my data used for model training?
No. We do not use customer data- including prompts, uploads, or outputs- to train our underlying models, unless we have explicit, written consent.
FAQ
Still have questions? Book a call and we'll talk things through.
How quickly can we integrate Penelope's policy network?
You can use our web-app straight after signing up. Our API is designed for straightforward integration into existing workflows. Most organizations are querying policies within days, not weeks. We provide documentation, testing environments, and technical support throughout the process.
How do you ensure policy accuracy?
We use intelligent extraction methods that understand policy context, not just keyword matches. We understand how codes are referenced, whether they're approved, excluded or experimental.
But how do I actually use policies?
Great question! After you use our API or web-app to find policies (e.g. by payer, plan CPT code, ICD code or a 'fuzzy' text search), you can use our policies for a few pretty important things. - Checking code coverage - Checking medical necessity criteria - Auto-generating prior auth requests and appeal letters
Why don't I just Google the policies?
You definitely can! In fact, that's what most of our clients were doing before they used Penelope. But once you do this, you'll probably start facing some challenges. - There are a lot of payers, like, a lot (trust us, we know). - Their policies aren't always the easiest to find (we've scoured enough arcane web portals for a lifetime). - They can randomly update on a Wednesday, and completely change code coverage. - And then, once you find them, you're faced with a 50-page quasi-legal text, with some of the most important info being hidden away in footnotes and appendices. You can't integrate the info into your current workflows - be it to create dynamically updating coding rules, or to automatically generate appeal letters. So yes, you can Google things. But maybe give Penelope a try when you're ready to turbocharge your workflows.
How much does it cost?
Pricing depends on your needs, claims volume and scope. After our free assessment, we'll provide a clear proposal with transparent pricing and no hidden fees.
Keeping your data safe
How do you secure our information?
We take a privacy-first approach. All data is processed within isolated execution environments and stored using AES-256 encryption at rest. For data in motion, we use TLS-encrypted connections to ensure that your information is never exposed during transit.
How do you manage data access?
We enforce a strict Role-Based Access Control (RBAC) model. This means that every authenticated use is limited to the specific data and operations authorized for their role. We use project and resource scoping to ensure that users never see data from projects they aren't explicitly assigned to.
What infrastructure do you use?
Our platform is built on enterprise-grade infrastructure that maintains SOC 2 Type 2 and HIPAA-aligned security standards.
How do you handle AI governance?
We don't treat AI as a 'black box'. We implement a rigorous AI governance framework that includes systematic model validation against strict internal benchmarks, with a human-in-the-loop. A key part of our governance strategy is a focus on explainability and auditability. AI-generated outputs are traceable to their underlying source data.
Is my data used for model training?
No. We do not use customer data- including prompts, uploads, or outputs- to train our underlying models, unless we have explicit, written consent.
FAQ
Still have questions? Book a call and we'll talk things through.
How quickly can we integrate Penelope's policy network?
You can use our web-app straight after signing up. Our API is designed for straightforward integration into existing workflows. Most organizations are querying policies within days, not weeks. We provide documentation, testing environments, and technical support throughout the process.
How do you ensure policy accuracy?
We use intelligent extraction methods that understand policy context, not just keyword matches. We understand how codes are referenced, whether they're approved, excluded or experimental.
But how do I actually use policies?
Great question! After you use our API or web-app to find policies (e.g. by payer, plan CPT code, ICD code or a 'fuzzy' text search), you can use our policies for a few pretty important things. - Checking code coverage - Checking medical necessity criteria - Auto-generating prior auth requests and appeal letters
Why don't I just Google the policies?
You definitely can! In fact, that's what most of our clients were doing before they used Penelope. But once you do this, you'll probably start facing some challenges. - There are a lot of payers, like, a lot (trust us, we know). - Their policies aren't always the easiest to find (we've scoured enough arcane web portals for a lifetime). - They can randomly update on a Wednesday, and completely change code coverage. - And then, once you find them, you're faced with a 50-page quasi-legal text, with some of the most important info being hidden away in footnotes and appendices. You can't integrate the info into your current workflows - be it to create dynamically updating coding rules, or to automatically generate appeal letters. So yes, you can Google things. But maybe give Penelope a try when you're ready to turbocharge your workflows.
How much does it cost?
Pricing depends on your needs, claims volume and scope. After our free assessment, we'll provide a clear proposal with transparent pricing and no hidden fees.
Keeping your data safe
How do you secure our information?
We take a privacy-first approach. All data is processed within isolated execution environments and stored using AES-256 encryption at rest. For data in motion, we use TLS-encrypted connections to ensure that your information is never exposed during transit.
How do you manage data access?
We enforce a strict Role-Based Access Control (RBAC) model. This means that every authenticated use is limited to the specific data and operations authorized for their role. We use project and resource scoping to ensure that users never see data from projects they aren't explicitly assigned to.
What infrastructure do you use?
Our platform is built on enterprise-grade infrastructure that maintains SOC 2 Type 2 and HIPAA-aligned security standards.
How do you handle AI governance?
We don't treat AI as a 'black box'. We implement a rigorous AI governance framework that includes systematic model validation against strict internal benchmarks, with a human-in-the-loop. A key part of our governance strategy is a focus on explainability and auditability. AI-generated outputs are traceable to their underlying source data.
Is my data used for model training?
No. We do not use customer data- including prompts, uploads, or outputs- to train our underlying models, unless we have explicit, written consent.
Covering the majority of insured Americans
Book a call. We'll show you how Penelope fits your workflow and audit your existing AI setup at no cost.
Book a call. We'll show you how Penelope fits your workflow and audit your existing AI setup at no cost.
Covering the majority of insured Americans
Book a call. We'll show you how Penelope fits your workflow and audit your existing AI setup at no cost.
payer policy intelligence, at your fingertips
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