Guardian
Guardian is a payer organization. For an ASC, what matters isn't the logo. It's how Guardian pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Guardian analysis
Tell us where to send it. Our team will prepare an analysis of Guardian covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Guardian pays
See how Guardian reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
See where Guardian concentrates and how its presence shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Guardian and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Guardian's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Guardian up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Guardian
- Payer ID
- 64246 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Guardian through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Guardian members are verified before the date of service, through a clearinghouse using payer ID 64246or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Guardian directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Guardian the way it pays.
- What is Guardian's payer ID?
- Guardian's electronic payer ID is 64246. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Guardian through a clearinghouse.
- How do ASCs verify eligibility for Guardian members?
- Eligibility and benefits for Guardian members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 64246) or through the payer's provider portal.
- Does Guardian require prior authorization for ASC procedures?
- Prior-authorization requirements for Guardian are set per plan and per procedure. Confirm whether an authorization is required with Guardian directly before the date of service.
- What type of payer is Guardian?
- Guardian is a payer organization.
- How does Guardian compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Guardian pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Guardian paying my ASC below market?
- Put your own Guardian contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.