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Thrizer Canonical Insurer Recognition and Routing

Last Updated: 2026-04-06 Status: Canonical

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Purpose: Use this file when a question requires insurer-name recognition or insurer-level routing in Thrizer. This file is the source of truth for matching insurer inputs to canonical insurer records and aliases, assigning insurer_match_status (matched, no_match, or ambiguous_match), identifying whether the insurer has prior workflow presence in this dataset, and returning insurer-level routing fields such as thrizer_pay_available, eligibility_check_route, and program_type. Do not use this file for coverage determinations, eligibility outcomes, reimbursement outcomes, reimbursement estimates, or any plan-level decision.

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1. File Scope Rules

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Rule 1.1

This file is insurer-level only.

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Rule 1.2

This file does not determine plan coverage.

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Rule 1.3

This file does not determine eligibility outcomes.

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Rule 1.4

This file does not determine reimbursement outcomes.

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Rule 1.5

A listed insurer record means the insurer has previously appeared in Thrizer workflows.

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Rule 1.6

A listed insurer record does not guarantee coverage, eligibility, or reimbursement for a specific plan.

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2. Matching Rules

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Rule 2.1

Match insurer records using canonical insurer name and aliases.

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Rule 2.2

Name matching is case-insensitive.

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Rule 2.3

Alias matching is case-insensitive.

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Rule 2.4

If no canonical name or alias matches, set insurer_match_status = no_match.

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Rule 2.5

If insurer_match_status = no_match, respond that the insurer is outside prior Thrizer experience in this dataset and route to Thrizer team review.

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Rule 2.6

If one input matches more than one insurer record, set insurer_match_status = ambiguous_match.

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Rule 2.7

If insurer_match_status = ambiguous_match, do not select a single insurer record.

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Rule 2.8

If insurer_match_status = ambiguous_match, require disambiguation using region, program, or full insurer name when available.

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Rule 2.9

Do not infer insurer identity from parent-company relationships, network relationships, or brand-family relationships unless the exact canonical name or alias is present in this file.

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3. Routing Category Rules

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Rule 3.1

thrizer_pay_available is a record-level mapping only.

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Rule 3.2

thrizer_pay_available is not plan-level confirmation.

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Rule 3.3

eligibility_check_route is a routing category only.

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Rule 3.4

eligibility_check_route = likely_automatic does not guarantee a successful automatic check.

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Rule 3.5

eligibility_check_route = manual_review_likely does not define the review process.

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4. Government Program Rules

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Rule 4.1

Medicare is a government program record.

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Rule 4.2

Medicaid is a government program record.

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Rule 4.3

Medicare and Medicaid generally do not include out-of-network benefits.

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Rule 4.4

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Rule 4.4

For Medicare and Medicaid, reimbursement through Thrizer is generally not available unless a usable benefit check confirms out-of-network benefits. Constraint:

• Plan classification alone must not be used to determine usability
• A usable benefit check overrides this general limitation

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Rule 4.5

Medicare and Medicaid records do not override plan-specific or legal determinations outside this file.

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Rule 4.6 — Commercial Administration Edge Case (Medicare)

Some insurance plans may be administered by commercial insurers (e.g., UnitedHealthcare, Aetna, Cigna) while still being classified as Medicare-related plans. Constraints:

• These plans may appear similar to commercial plans in naming or administration.
• Classification as a government program (e.g., Medicare) remains authoritative in this file.
• This file does not determine whether such plans support out-of-network reimbursement.

Handling:

• Do not assume support for out-of-network reimbursement based on commercial administration alone.
• Do not override Medicare classification based on insurer branding or administrator.
• Plan usability must be determined via benefit verification.

If a benefit check is usable:

• Treat the plan as eligible for Thrizer workflows regardless of Medicare classification

If a benefit check is not usable:

• Do not proceed with Thrizer workflows

Routing Guidance:

• Treat these plans as:
  • program_type = government_program when identified as Medicare
• If plan classification is unclear:
  • require manual verification or support review

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5. Ambiguity Rules

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Rule 5.1

The alias Kaiser is ambiguous across multiple regional Kaiser Permanente records.

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Rule 5.2

If input is Kaiser without region, set insurer_match_status = ambiguous_match.

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Rule 5.3

The alias BCBS may refer to a general BCBS record or a more specific BCBS record.

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Rule 5.4

If state, employer program, or program detail is present for BCBS, prefer the most specific matching BCBS record.

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Rule 5.5

The term Medcost is ambiguous because it appears in more than one record.

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Rule 5.6

If input matches Medcost without additional distinguishing detail, set insurer_match_status = ambiguous_match.

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6. Record Schema

Each insurer record must use the following fields:

• canonical_name
• aliases
• prior_workflow_seen
• thrizer_pay_available
• eligibility_check_route
• program_type

Allowed values:

• prior_workflow_seen: yes
• thrizer_pay_available: yes or no
• eligibility_check_route: likely_automatic, manual_review_likely, not_applicable
• program_type: commercial_or_other, government_program

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7. Insurer Records

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Record

• canonical_name: Adventist Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Aetna
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: All Savers
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Allegiance
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Allied Benefit Systems
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Ambetter
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: AmeriBen Solutions
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: AmeriHealth
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Anthem Blue Cross Blue Shield
• aliases: [Anthem, Anthem BCBS]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Atrium Health (Medcost)
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: BCBS of Massachusetts
• aliases: [Blue Cross Blue Shield of Massachusetts, BCBS MA, BCBS of MA]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Beacon Health Options
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Blue Cross Blue Shield (General)
• aliases: [BCBS]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Blue Cross Blue Shield Federal Employee Program (FEP)
• aliases: [BCBS FEP, FEP Blue, Federal Employee Program]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Blue Shield of CA
• aliases: [Blue Shield of California, Blue Shield CA]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: California Physicians Health Program (CAPHP)
• aliases: [CAPHP]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Capital District Physicians Health Plan (CDPHP)
• aliases: [CDPHP]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Carelon
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Carolina Behavioral Health Alliance
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: ChampVA
• aliases: [CHAMPVA]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Cigna
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: ComPsych
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Connecticare
• aliases: [ConnectiCare]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Custom Design Benefits
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Deseret Healthcare (DMBA)
• aliases: [DMBA]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Emblem Health (GHI)
• aliases: [EmblemHealth, GHI]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Excellus Blue Cross Blue Shield of New York
• aliases: [Excellus BCBS, Excellus]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: First Choice Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: First Health Network
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: FoxEverett
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Fringe Benefit Group
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: GEHA
• aliases: [Government Employees Health Association]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Geisinger Health Plan
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: GUARDIAN LIFE
• aliases: [Guardian, Guardian Life]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Harvard Pilgrim Health Care
• aliases: [Harvard Pilgrim]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Health Alliance
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Health Choice
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Health Net
• aliases: [HealthNet]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Health New England
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Health Plans Inc
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: HealthEZ
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Healthfirst
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Healthlink PPO
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: HealthPartners
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: HealthScope
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: HMA
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Hometown Health Plan Nevada
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Humana
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Illinois Blue Cross Blue Shield
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

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Record

• canonical_name: Imagine Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Independent Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Insight Benefit Administrators
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: John Hopkins USFHP
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Johns Hopkins Employer Health Programs (EHP)
• aliases: [Johns Hopkins EHP, EHP]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Kaiser Permanente (Colorado)
• aliases: [Kaiser, Kaiser Colorado, KP Colorado]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

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Record

• canonical_name: Kaiser Permanente (Georgia)
• aliases: [Kaiser, Kaiser Georgia, KP Georgia]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Kaiser Permanente (Hawaii)
• aliases: [Kaiser, Kaiser Hawaii, KP Hawaii]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Kaiser Permanente (Mid-Atlantic)
• aliases: [Kaiser, Kaiser Mid-Atlantic, KP Mid-Atlantic]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Kaiser Permanente (Northern California)
• aliases: [Kaiser, Kaiser NorCal, KP Northern California, KP NorCal]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Kaiser Permanente (Northwest)
• aliases: [Kaiser, Kaiser Northwest, KP Northwest]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Kaiser Permanente (Southern California)
• aliases: [Kaiser, Kaiser SoCal, KP Southern California, KP SoCal]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Kaiser Permanente (Washington)
• aliases: [Kaiser, Kaiser Washington, KP Washington]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Loomis Health Company
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Lucent Heath
• aliases: [Lucent Health]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Luminare Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: MagnaCare
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Managed Care Services LLC
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Mass General Brigham
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: McClaren Health Advantage
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Medcost
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Medica
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Medical Mutual
• aliases: [Medical Mutual of Ohio]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Meritain Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Midlands Choice
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Moda Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Molina Healthcare
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: MVP Healthcare
• aliases: [MVP Health Care, MVP]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Network Health Insurance
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: New Jersey Horizon Blue Cross Blue Shield
• aliases: [Horizon BCBS, Horizon Blue Cross Blue Shield, Horizon BCBSNJ]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Nippon Life Benefits
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Northwell Direct
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: NYSHIP (Carelon)
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Optum Behavioral Health
• aliases: [Optum]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Oscar Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Oxford Health (United)
• aliases: [Oxford, Oxford Health Plans]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Pacific Source
• aliases: [PacificSource]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Performance Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Personify Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Planned Administrators (Non Preferred Blue Providers)
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Premera Blue Cross
• aliases: [Premera]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Presbyterian Health Plan
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Priority Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Providence Health Plan
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Quest Behavioral Health
• aliases: [Quest]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Regence Blue Cross Blue Shield
• aliases: [Regence, Regence BCBS]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Samba Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Sana Benefits
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Select Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Sentara Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: SMBA
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: SUNSHINE HEALTH
• aliases: [Sunshine Health]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Surest
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Tribado
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: TRICARE East (Humana)
• aliases: [TRICARE East, Tricare East]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: TriCare West
• aliases: [TRICARE West, Tricare West]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Trusteed Plans Service Corporation
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Trustmark
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Tufts
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: UMR (United Healthcare)
• aliases: [UMR, UnitedHealthcare UMR]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: UniCare
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: United Healthcare
• aliases: [UnitedHealthcare, United HealthCare, United Health Care, UHC]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: United Healthcare Student Resources
• aliases: [UnitedHealthcare Student Resources, UHCSR, UHC Student Resources]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Univera Healthcare
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: University of Utah Health Plan
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: UPMC Health Plans
• aliases: [UPMC]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Vault Admin Services
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Vitori Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: WebTPA
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: WellFleet Health
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

Record

• canonical_name: Wellmark BCBS
• aliases: [Wellmark, Wellmark Blue Cross Blue Shield]
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: likely_automatic
• program_type: commercial_or_other

​

Record

• canonical_name: Wellpoint
• aliases: [WellPoint]
• prior_workflow_seen: yes
• thrizer_pay_available: yes
• eligibility_check_route: manual_review_likely
• program_type: commercial_or_other

​

8. Government Program Records

​

Record

• canonical_name: Medicaid
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: not_applicable
• program_type: government_program

​

Record

• canonical_name: Medicare
• aliases: []
• prior_workflow_seen: yes
• thrizer_pay_available: no
• eligibility_check_route: not_applicable
• program_type: government_program

​

9. Unresolved Dataset Dependencies

​

Dependency 9.1

The file does not define normalization for punctuation, abbreviations, or spacing beyond explicit aliases.

​

Dependency 9.2

The file does not define plan-level exceptions.

​

Dependency 9.3

The file does not define how manual review is performed.

​

Dependency 9.4

The file does not define how automatic checks are performed.

​

Dependency 9.5

The file contains unresolved alias ambiguity for Kaiser, BCBS, and Medcost.