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
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 REST API for payer coverage policies, medical necessity criteria, drug coverage, and prior authorization requirements across Commercial, Medicare Advantage, Medicaid, and ACA.
Endpoints
Request
POST /v1/prior-auth/check
payer_id: "aetna"
lob: "commercial"
cpt_codes: ["63650"]
Response
{
"cpt_code": "63650",
"prior_auth_required": true,
"policy_name": "Spinal Cord Stimulation"
}
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