About Rubrica · The Clinical Policy Library
The library built because looking up the same policy twice is malpractice on time.
Rubrica is the largest sourced policy library for interventional spine, pain management, ortho spine, and orthopedics — 13,900+ payor coverage rules across 155 carriers, every record carrying its policy number, last-reviewed date, and verbatim source citations. We exist because every interventional pain practice in the country is losing hours of clinic time to payor policy PDFs, and the existing tools didn't solve that.
The decision engine doesn't black-box anything. Every coverage answer ships with the policy of record, the last-reviewed date, a denial-risk score with its top three drivers, and (where we have it) the verbatim policy text. That transparency is the point: when you submit a prior auth and it gets denied anyway, you have the exact criterion that was missed — not a vendor saying "the algorithm said so."
Why Rubrica exists
A short version of the founding story.
In 2024, a single radiofrequency ablation on a long-standing patient was denied after we submitted what we thought was a clean prior auth. The criterion we missed was a 2-percentage-point change in the relief threshold from the diagnostic block, buried on page 14 of a 31-page PDF that the payor had quietly updated four months earlier. Our prior-auth coordinator had no way to know. The patient waited another six weeks.
That denial was the proximate cause of Rubrica, but the underlying problem was bigger. Every interventional pain practice in the country is doing the same work — re-reading the same payor policies, hand-copying the same criteria into a denial-prevention template, tracking the same revisions across the same fragmented portals — independently, in parallel, badly. It was an obvious place for one good piece of software to do the work once, properly, and let every practice pull from the same authoritative library.
Rubrica is that library. A 20-agent weekly swarm monitors every Medicare MAC, every major commercial payor, every BCBS regional plan, and every 50-state Medicaid program for revisions. The decision engine turns the resulting rules into criterion-level answers with sourced citations and denial-risk scores. The first version was live in late 2025; the policy library passed 13,000 rules in May 2026.
Who builds Rubrica
The team is small on purpose.
Built by practicing physicians
Rubrica is built by practicing interventional pain physicians — clinicians who write the prior auths they're now automating. The thesis: if a tool is going to make decisions about patient access to procedures, it should be built by people who actually order those procedures, and it should show its work down to the verbatim source quote — not hide behind "the algorithm said so."
The team continues to practice clinically. Rubrica is the platform we wish had existed five years ago, and it's maintained by the people who use it every day.
What we're working on
A short, honest list. We don't ship roadmap fiction.
- → Source-quote depth. Today ~5% of records carry verbatim policy excerpts. We're working toward 100% on the top 30 payors by mid-2026 — the single highest-ROI quality lift in the product.
- → EHR integrations. athenahealth Marketplace + Availity CDS Hooks listings are in progress; the goal is "click a CPT in your EHR, see the Rubrica answer in a side-pane, no copy-paste."
- → Per-CPT × per-payor coverage tables. ~14,000 indexable pages live as of May 2026 so practitioners can find the exact "is this CPT covered at this payor" answer from a Google search, then sign in for full criteria.
- → Outcomes data. We'd like to publish real denial-rate-reduction numbers from pilot practices, with consent. Honest data, including the cases where we didn't help.
- → Auditable point-in-time history. Postgres source-of-truth shipped May 2026; every policy revision is now snapshotted with a timestamp so we can show "what did the policy say on the day you submitted."
Contact
For policy issues you've found in the library, use the in-app report flow — it's the fastest path to a triaged fix.
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