DataQorp is OpAgent's proprietary policy intelligence engine — 3,455 prior authorization workflows, 50 payor families, and 6 policy layers. Built for orthopedic surgery and interventional pain management. Updated continuously.
DataQorp maps the exact clinical criteria, documentation requirements, and medical necessity thresholds that determine approval at each payor. Source documents tracked. Effective dates tracked. Always verify with the payor before submission.
Office of Inspector General guidance governing documentation integrity, coding accuracy, and medical necessity language. Helps ensure every note meets OIG documentation standards regardless of payor.
Local Coverage Determinations from Medicare Administrative Contractors. Includes SI joint fusion, spinal cord stimulation, epidural injections, and 80+ orthopedic and interventional pain procedures with full indications, limitations, and documentation thresholds.
Payor-specific prior authorization criteria mapped to procedure and workflow. UnitedHealthcare, Cigna, Aetna, Anthem state plans, BCBS plans, Regence, Premera, Molina, Centene, and 40+ others — each with required documentation, imaging criteria, conservative care thresholds.
National Coverage Determinations from CMS — the federal baseline that all Medicare payors follow. Includes implantable neurostimulators, lumbar artificial disc, vertebral augmentation, and other nationally adjudicated procedures.
Medicare Administrative Contractor billing and coding articles that supplement LCDs. Modifier guidance, ICD-10 code specificity requirements, and billing documentation standards that affect claim processing.
Procedure-specific clinical criteria from NASS, ISASS, ISIS, and ASIPP guidelines that payors reference in their medical policies. Aligning your documentation with society guidelines means your records speak the same language as the coverage criteria.
DataQorp indexes publicly published payor medical policies and federal Medicare guidance. Source documents and effective dates tracked per entry. Always verify policy currency with the payor before submission.
Each bubble represents a payor family in the DataQorp engine. Size reflects workflow depth. Hover to explore coverage. Every bubble is a live data source powering Admin Qo-Pilot authorizations in real time.
| # | Payor Family | PA Workflows | Coverage Depth | Type |
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DataQorp maps the exact clinical criteria, documentation requirements, and medical necessity thresholds published by each payor — procedure by procedure. This is what OpAgent's agents reference to ensure submissions match payor expectations on the first try.
Admin Qo-Pilot runs on DataQorp intelligence. Every major payor. Every orthopedic and interventional pain procedure. Built for your practice.
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