From clinical policy to contract terms to market data — NOF1 gives payers, providers, and investors the intelligence they need to move with confidence.
The most comprehensive database of clinical, reimbursement, and prior auth policies across 40+ payers — with AI that understands what the policies actually mean.
Payers
Actemra® (Tocilizumab) Intravenous Infusion
United Healthcare · Prior Authorization · CPT 96413
Medical Necessity Criteria
0/5 verifiedAs a payer, upload your provider contracts and get structured extraction of FFS rates, MLR thresholds, VBC terms, and quality gates — then compare across your provider book to see where terms are inconsistent or off-market.
Contract Document
Base reimbursement at 118% of Medicare for Schedule A services...
MLR threshold of 85% for all commercial lines...
Quality bonus requires HEDIS ≥ 87th percentile annually...
Risk corridor triggers at ±3% variance from target MCR...
Risk adjustment follows HCC v28 as published by CMS...
Extracted Terms
FFS Rate
118% Medicare
MLR Threshold
85% Commercial
Quality Threshold
87th pct HEDIS
Risk Corridor
±3% variance
Risk Adjustment
HCC v28 basis
✓ 3 negotiation opportunities
Est. value: +$3.33M annually
Live equity data, Medicare Stars ratings, ACO performance, drug pipelines, and SEC filings — all in a single keyboard-driven terminal designed for the healthcare industry.
UNH
UnitedHealth
CVS
CVS Health
ELV
Elevance
HUM
Humana
HCA
HCA Healthcare
LLY
Eli Lilly
2026 MA final rate notice: +5.06% benchmark increase
UNH Q1: medical cost ratio expected at 85.2–85.8%
CMS finalizes prior auth rule for MA plans — Jan 2026
Humana explores strategic alternatives amid pressure
A single REST API covering clinical policies, prior auth status, formulary data by NDC, payer enrollment, and ACO performance — all queryable in milliseconds.
Endpoints
Request
GET /v1/formulary/lookup
ndc: "00069-0152-11"
payer_id: "AETNA"
Response
{
"drug_name": "Eliquis 5mg",
"tier": 3,
"prior_auth": false,
"step_therapy": true,
"copay": "$45"
}
Join leading payer and provider organizations using NOF1 to make faster, smarter healthcare decisions.
We're always building. Subscribe for updates, and be the first to know. No spam, we promise!