Payer Matching 🔍

Overview

Matching insurance cards to the responsible payer and identifying the necessary clearinghouse IDs for eligibility checks and claim submissions presents a complex challenge.

Insurance cards often lack explicit payer IDs, may feature only a payer's logo, present unclear payer names, or exhibit various issues that complicate accurate matching.

Note: Payer Match is a paid feature only available to our Enterprise customers.

We leverage our sophisticated matching algorithms, similar to those used in our eligibility check processes, to provide detailed and accurate payer information based on submitted card data.

Matches are generated during the scanning process and will be returned once the card scan is completed.

Payer matching works best when paired with backside scanning as many cards have important details only found on the backside of the card.

Payer Match

When enabled Payer Match is included in the standard Get Card payload. When a card scan is completed, the payer_match object will automatically include details for canonical, clearinghouse, and custom matches (if enabled). No separate request is required.

Canonical Match

We match card details against our internal database of payer names and identifiers. Upon finding a high-confidence match, we return the canonical payer name along with CardScan.ai's unique payer ID.

{
  "card_id": "42532e8b-6d38-44fb-b680-a8de47ca4717",
  "state": "completed",
  "payer_match": {
    "cardscan_payer_id": "pay_5de0cbfe",
    "cardscan_payer_name": "United Healthcare",
    "score": "0.985"
  }
}

Clearing House Matching

We also match card details with various clearinghouses, including Availity, Office Ally, Stedi, Change Healthcare and more. This feature is designed to help our customers maintain their workflows with existing vendors for processing eligibility checks and submitting claims, while significantly reducing errors.

{
  "card_id": "42532e8b-6d38-44fb-b680-a8de47ca4717",
  "state": "completed",
  "payer_match": {
    "cardscan_payer_id": "pay_5de0cbfe",
    "cardscan_payer_name": "UnitedHealthcare",
    "score": "0.99",
    "matches": [
      {
        "clearinghouse": "Availity",
        "payer_id": "87726",
        "transaction_type": "professional",
        "payer_name": "UnitedHealthcare",
        "cardscan_payer_id": "pay_5de0cbfe",
        "score": "0.99",
        "metadata": {
          "last_updated": "2025-03-06T19:19:48.352506+00:00",
          "source": "2025-03-05v01"
        }
      },
      {
        "clearinghouse": "Office Ally",
        "payer_id": "87726",
        "transaction_type": "institutional",
        "payer_name": "UnitedHealthcare (UHC)",
        "cardscan_payer_id": "pay_3c226c5a",
        "score": "0.982",
        "metadata": {
          "last_updated": "2025-03-06T19:19:48.352506+00:00",
          "source": "2025-03-05v01"
        }
      }
    ]
  }
}

We've moved payer matches into the matches key — per-payer key access is now deprecated.

Custom Matching

Recognizing the unique needs of our customers, we also offer the ability to match with a customer's specific payer list and return identifiers at scan time. This customization ensures that the payer information provided is directly relevant and tailored to the operational requirements of our customers.

{
  "payer_match": {
    "custom": [
      {
        "custom_payer_id": "UHC",
        "custom_payer_name": "United Healthcare",
        "custom_payer_name_alt": "Alternate name for UHC",
        "score": "0.958",
        "source": "custom_payer_list_20240130"
      }
    ]
  }
}

New: Configure Your Preferred Clearinghouse and Transaction Type

We now support the ability to configure your preferred clearinghouse and transaction type for payer matching and claim submissions.

While the ability to select your preferences directly will be available in a future update, you can contact our support team today to set up your desired clearinghouse and transaction type. This ensures smoother integration with your existing workflows and more accurate processing of eligibility checks and claims.

Access and Support

This feature is available exclusively to subscribers of our enterprise plans. For more information on accessing the Payer Match feature or for assistance in setting up and configuring custom payer matches, please contact our sales or support team.