Market intelligence
Billing rules, payer resources, and official updates
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Public reference material organized by topic. Each entry links to the publisher, so you read the original, not a summary.
Annual update to Medicare physician payment rates, conversion factor, telehealth policies, and quality program changes effective January 1, 2027.
Quarterly procedure-to-procedure and medically unlikely edits used by Medicare and most commercial payers to deny unbundled claims.
Place of service codes, modifiers 93 and 95, and originating site rules for Medicare telehealth claims.
New, revised, and deleted diagnosis codes effective October 1, 2026, with the official guidelines for coding and reporting.
Claims status, prior authorization, and the commercial reimbursement policy library.
MAC resources for Jurisdiction H (Texas, Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma): enrollment contacts, LCDs, and the Novitasphere portal.
MAC for Florida, Puerto Rico, and the U.S. Virgin Islands. Fee schedule lookups, LCD search, and provider enrollment status.
Step-by-step enrollment, revalidation, and reassignment of benefits for individual and group practices, including required documents.
Rules for out-of-network billing disputes, open negotiation timelines, and the federal IDR portal.
How providers obtain a National Provider Identifier, update practice location and taxonomy, and what fields are published in the public file.
Shared credentialing application used by most commercial payers. Attestation cadence and common rejection reasons.
Where to find the HIPAA-adopted 005010X222A1 implementation guide and CMS companion guides for electronic professional claims.