Prior-authorization decision support for interventional pain
Rubrica pulls the correct payor policy, surfaces the criteria that must be met, and tells you whether the case will clear — before a single form is submitted.
For any state, payor, and CPT, Rubrica pulls the governing policy — LCDs for Medicare (auto-routed by MAC), CPBs and medical policies for commercial plans — and renders the required criteria as a plain checklist.
Enter what's documented — MRI date, conservative-care weeks, prior diagnostic blocks, ICD-10. Rubrica marks which criteria are met, missing, or not documented — with the failing one flagged in rubric red.
Every decision carries the policy number, effective date, last-reviewed date, and link to the source document. Never a black-box answer. Every output is printable as a clinic-ready PDF.
Unlike generic prior-authorization platforms, Rubrica's policy database is maintained specifically for pain procedures — epidurals, facet joint work, RFA, SCS, SI fusion, vertebral augmentation, intradiscal, peripheral nerve stim — and handles the Medicare MAC jurisdictional variation that determines whether an ESI clears in Pennsylvania but not Texas.
Answer as many fields as you can. More context sharpens the decision.
Run your first policy check.
For any procedure, see each payor's disposition in your state side-by-side. Useful for choosing which payor to submit first, for patient counseling, and for identifying plans where a gap analysis is worth running.
Pick a state and search for a procedure.
About
Rubrica is named for the Latin rubrica terra — "red earth" — the ochre pigment medieval scribes used to mark the rules, rubrics, and procedural headings in manuscripts and early legal texts. A rubric was literally the instruction written in red. Centuries later, the word came to mean any set of criteria by which a case is evaluated and graded.
That is exactly what this tool does. Payor policy is a rubric. Rubrica renders it.
For interventional pain physicians and their staff, Rubrica is the prior-authorization decision-support platform that replaces hours of policy-PDF hunting with a single, sourced answer — because unlike horizontal PA tools, Rubrica is built by pain physicians, maintains its policy database specifically for pain procedures, and handles the Medicare MAC jurisdictional variation that determines whether an ESI clears in Pennsylvania but not Texas.
No hedging. If the policy requires an MRI within twelve months, say so in those words.
Physician-native vocabulary. "Medial branch block" — not "specialized injection." Respect the reader's training.
No "leveraging," no "synergize," no "best-in-class." Plain language that a practice manager and a board member can both parse.
Rubrica surfaces the requirement. Never "Rubrica guarantees approval." The tool is decision-support; the physician is accountable.
Rubrica was built by Ehsan Abdeshahian, MD, an interventional pain physician, to solve the policy-PDF problem that still burns hours of clinic time for every practice in the country.
Trademark clearance is in progress. The name Rubrica has not yet completed USPTO search in Class 9 (software) or Class 42 (SaaS).
FAQ
No. Rubrica is decision-support — it reads the payor's published policy and tells you whether the criteria are likely met. The actual coverage determination is made by the payor after the submission. Always verify current policy and benefits before performing procedures.
Three sources: (1) Medicare LCDs and NCDs, routed by MAC jurisdiction, (2) commercial payor clinical policies (Aetna CPB, Cigna medical coverage, UHC medical policy, CareFirst, etc.), (3) the Clearway Master Payer Guidelines coverage matrix. Every rule in the database carries its source title, policy number, effective date, and last-reviewed date.
Manually, whenever a payor publishes a revision. The Library view flags any rule older than 12 months as "Review needed" and any first-pass stub — sourced from the coverage matrix alone without full policy text — as "Verify with payor."
Flag it. Every rule is a single JSON record sourced, versioned, and auditable. Corrections propagate to the whole system on the next deploy.
No. Rubrica runs entirely in your browser. No PHI is sent to any server. An audit log of decision queries (state, payor, CPT, likelihood — no identifiers) is kept in your browser's local storage, capped at the last 500 entries.
Medicare Advantage plans (UHC MA, Humana MA, Devoted, Wellcare) generally follow the traditional Medicare LCDs, but plan-specific variations exist. When you pick a Medicare Advantage payor, Rubrica shows the MA plan rule if one is on file; otherwise it falls back to the LCD.
105 interventional-pain CPT codes are in the current build — epidurals (ILESI, TFESI), facet/MBB, RFA, SI injection and fusion, SCS, PNS, vertebral augmentation, sympathetic, peripheral joint and nerve, regenerative, trigger point, botulinum toxin, interspinous device (Vertiflex, MinuteMan), decompression (MILD), intradiscal (Intracept, ViaDisc), intrathecal pumps, and the relevant HCPCS drug codes. More can be added at any time.
Yes — Phase B. Per-clinic accounts with role-based access (clinician, billing, admin), contracted-rate overlays, and team audit log. Phase D adds iOS and Android.