What Changed in This Payer Policy?
What changed between two versions of a payer's published criteria, criterion by criterion, with stricter thresholds first.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Earlier version of the criteria, keeping its numbering
- All of the following: 1. Diagnosis of rheumatoid arthritis 2. Step through 2 prior drugs 3. Prescribed by a rheumatologist 4. Age 18 years or older
- Newer version of the criteria, keeping its numbering
- All of the following: 1. Diagnosis of rheumatoid arthritis 2. Step through 3 prior drugs 3. Prescribed by or in consultation with a rheumatologist 4. Age 18 years or older 5. Negative TB test within 12 months
Result: 3 changes: 1 tightened, 1 added, 1 reworded; 2 unchanged.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Earlier version of the criteria, keeping its numbering
- Earlier version effective date (YYYY-MM-DD)
- Newer version of the criteria, keeping its numbering
- Newer version effective date (YYYY-MM-DD)
How this is calculated
Citation
Compares the wording of two versions of a payer's published criteria. A Medicare Advantage plan's internal coverage criteria must be publicly accessible (42 CFR 422.101(b)(6)(ii)); the payer's policy decides each request. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.