NOF1 Public API

Payer policy intelligence, through a single API.

Coverage policies, medical necessity criteria, drug coverage, and prior authorization requirements from 50+ payers across Commercial, Medicare Advantage, Medicaid, and ACA as structured JSON your systems can act on.

View API Documentation
REST · JSON4 lines of businessState-aware Medicaid
POST https://api.nofone.io/v1/prior-auth/check

Request

{
  "payer_id": "aetna",
  "lob": "commercial",
  "cpt_codes": ["63650", "95972"]
}

Response 200

{
  "results": [
    {
      "cpt_code": "63650",
      "prior_auth_required": true,
      "policies": [{
        "policy_name": "Spinal Cord Stimulation"
      }]
    },
    {
      "cpt_code": "95972",
      "prior_auth_required": false,
      "policies": []
    }
  ]
}

50K+

Payer policies

50+

Payers & UM vendors

4

Lines of business

REST

JSON over HTTPS

Data Sources

Every source behind a coverage decision

A single determination often depends on a payer policy, the UM vendor's own criteria, and a CMS rule at once. We ingest all three and reconcile them.

01 · Clinical

Payer clinical policies

Medical-necessity criteria and covered indications, per payer and line of business.

med_nec_tree

02 · Payment

Reimbursement policies

Coding, modifier and payment rules.

03 · Pharmacy

Formularies & Part D

Tiers, step therapy and Part D coverage criteria, with brand and generic synonyms resolved.

drug_coverage[]

04 · Authorization

Prior-auth lists

Code-level PA requirements, tracked per payer and per line of business.

05 · Delegated

UM vendor policies

EviCore, Cohere, Carelon and peers.

06 · Federal

CMS policies

NCDs, LCDs and the Medicare Claims Processing Manuals.

Parsed daily into one structured schema

Reconciled across sources, dated, and linked back to the original document.

GET /v1/policies
Capabilities

What the API gives you

The same payer intelligence behind the NOF1 platform, built for software to consume.

Payer directory & matching

List the payers and UM vendors NOF1 covers on each line of business, and resolve messy payer names from your eligibility or claims data to a single NOF1 payer ID.

Policy search

Search clinical and pharmacy policies by free text, CPT/HCPCS code, payer, drug, or CMS LCD, ranked by relevance.

Medical necessity criteria

Get each policy's covered and excluded services, with coverage conditions as a structured AND/OR logic tree your software can evaluate.

Drug coverage

Per-drug requirements from payer policies: step therapy, preferred alternatives, specialty and dosage limits, NDC codes, and FDA label IDs.

Prior authorization

Check whether a payer requires prior auth for up to 10 CPT codes at once, with the policies that cover each code.

State-aware Medicaid

Medicaid policies and prior-auth answers carry the states they apply in, scoped to each payer's actual footprint.

Lines of Business

Four lines of business, one interface

Pass a line of business on each request, or search all four at once. The same payer ID works across all of them.

Employer-sponsored and other commercial health plans.

lob=commercial

Private Medicare Advantage plans offered by commercial payers.

lob=medicare

Managed Medicaid plans, with state-level policy coverage and state-specific prior-auth answers.

lob=medicaid

Individual marketplace (exchange) plans.

lob=aca
Built For

Put payer rules where the work happens

Built for health tech platforms, provider organizations, and revenue-cycle teams that want payer policy inside their own products and workflows.

Prior authorization automation

Know before submission whether a procedure needs prior auth for the patient's payer and plan type.

Clinical decision support

Surface a payer's medical necessity criteria at the point of care, not after a denial.

Pharmacy & drug workflows

Show step therapy, preferred alternatives, and dosage limits for a drug under a payer's policy.

Policy-aware analytics

Compare how payers cover the same procedure or drug across lines of business.

How It Works

From access to integration

No SDK to install. Any HTTP client works.

  1. 1

    Get API access

    NOF1 enables the API for your organization.

  2. 2

    Create a key

    Generate API keys yourself in the NOF1 APIs panel.

  3. 3

    Call the API

    Send a Bearer token to any /v1 endpoint over HTTPS.

  4. 4

    Filter & query

    Narrow by line of business, payer, code, drug, or state.

  5. 5

    Integrate

    Use structured JSON directly in your product or workflow.

Developer Experience

Five endpoints. Everything you need.

A small, predictable surface with every parameter and response field documented.

Endpoints

https://api.nofone.io
  • GET/v1/payers

    List payers

    The NOF1 payer directory, filterable by line of business.

  • POST/v1/payers/match

    Match payer names

    Resolve up to 25 payer names from your own data to NOF1 payers.

  • GET/v1/policies

    Search policies

    Search by text, CPT/HCPCS code, payer, drug, LCD, or state.

  • GET/v1/policies/{policy_id}

    Get a policy

    Coding, medical-necessity criteria trees, and drug coverage.

  • POST/v1/prior-auth/check

    Check prior authorization

    Prior-auth requirements for up to 10 CPT codes per call.

Simple key auth

Organization-scoped API keys you create, revoke, and rotate yourself.

Structured JSON

Consistent response envelopes, typed fields, and machine-readable error codes.

One payer ID

The same payer ID works on every endpoint and every line of business.

Filtering & search

Relevance-ranked text search plus code, payer, drug, LCD, and state filters.

Clear rate limits

Per-key limits reported on every response through standard headers.

Usage dashboard

Requests, errors, and latency by endpoint and key in the APIs panel.

Everything you need to integrate

Authentication, lines of business, Medicaid states, every parameter and response field.

View API Documentation