Question 1

What is a payer coding guideline?

Accepted Answer

A payer coding guideline (also called a Document of Understanding or DOU) is a set of rules from a health insurance payer that defines how medical coders should capture and validate diagnosis codes for risk adjustment. Common payers include Humana, Molina, Aetna, and UnitedHealthcare.

Question 2

How does AI-powered guideline search work?

Accepted Answer

When you upload a payer PDF, HCC Buddy uses semantic embeddings (vector search) to index every section. Unlike keyword search, this understands coding context — searching 'diabetes documentation requirements' finds relevant passages even if those exact words aren't used.

Question 3

How is my data protected?

Accepted Answer

HCC Buddy uses a HIPAA-conscious design. Uploaded guidelines are scanned for PHI (Protected Health Information) before processing — documents containing PHI are automatically rejected. Your guidelines are stored encrypted and accessible only to your account. HCC Buddy does not store or transmit any patient-identifiable data.

Question 4

What file formats are supported?

Accepted Answer

Currently, PDF files up to 10MB are supported. This covers the vast majority of payer guideline documents, which are typically distributed as PDFs.

Question 5

Can I search across multiple payers at once?

Accepted Answer

Yes. The search bar queries across all of your uploaded guidelines simultaneously. Results show the source document and relevance score for each match.

Question 6

What is a Document of Understanding (DOU)?

Accepted Answer

A Document of Understanding (DOU) is a formal agreement between a health plan and its contracted coding vendors. It specifies coding rules, acceptable documentation formats, quality standards, and compliance requirements that coders must follow during retrospective chart review.

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