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At Penelope, we believe that there is translation gap between providers (doctors, physician practices, hospitals) and payers (insurance companies). The revenue cycle is fundamentally an exercise in converting patient notes into payer reimbursement. Denials, where they occur, are increasingly caused by payers ‘speaking a different language’ from one another. The codes and modifiers one payer accepts, may arbitrarily differ from another, even for the same procedue. Our mission is to translate what billers say into what payers want. Our first tool, to do this, is to use payer policies to their fullest extent.

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Overview

The Penelope API provides programmatic access to our proprietary knowledge graph containing:
  • Medical coverage policies from major US payers (UnitedHealthcare, Cigna, Aetna, Humana, Anthem) and CMS Medicare (NCDs, LCDs)
  • Insurance plans across commercial, individual exhange markets, Medicare, Medicare Advantage and Medicaid.
  • Medical codes including CPT procedure codes, HCPCS codes, and ICD-10-CM diagnosis codes
  • Relationships between policies and codes (coverage, exclusions, references)

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What You Can Do

  • Verify coverage: Check if a specific CPT code is covered by an insurance plan
  • Research policies: Search policies by medical codes or keywords
  • Compare plans: Find which plans cover specific procedures or diagnoses

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Quick Start

Ready to make your first API call? Follow our Getting Started guide to:
  1. Authenticate with your API key
  2. List available insurance plans
  3. Query policies by medical codes
  4. Search policies by keywords
  5. Download policy documents