Knowledge Network
The directory of healthcare billing rules, payer policies, facility data, and coding references. Sign in to search it through the API playground.
Payer Rules
3,400+ payers
Filing deadlines, appeal levels, prior auth requirements, and policy details for 3,400+ payers.
Medicare
12-month filing, 5 appeal levels, 120-day redetermination
UnitedHealthcare
90-day filing (commercial), 180-day appeal window
Aetna
180-day filing, independent review available
Blue Cross Blue Shield
Varies by plan — 60–365 day filing windows
Facility Directory
200K+ facilities
CCN-resolved facility data. Location, type, payment system, billing form, and care setting for every Medicare-enrolled provider.
CCN 170001
Kansas • Short-term Hospital • MPFS • CMS-1500
CCN 050454
California • Short-term Hospital • OPPS • UB-04
CCN 335412
New York • SNF • SNF PPS • UB-04
CCN 457300
Texas • Home Health • HH PPS • UB-04
Billing Rules
10K+ rules
TOB codes, POS codes, modifiers, revenue codes, NCCI edits, and billing form requirements — all cross-referenced.
TOB 0131
Hospital Outpatient • Outpatient services at hospital
POS 22
On-campus outpatient hospital • Facility rate
Modifier 25
Significant, separately identifiable E/M • Allows separate payment
NCCI 99213/36415
Modifier indicator 1 • Can unbundle with modifier
Payment Data
89 MAC localities
GPCI values, RVU tables, conversion factors, and fee schedule data by geography and facility type.
Manhattan, NY
Work GPCI 1.058 • PE GPCI 1.281 • MP GPCI 1.385
Rest of Kansas
Work GPCI 1.000 • PE GPCI 0.886 • MP GPCI 0.411
San Francisco, CA
Work GPCI 1.068 • PE GPCI 1.544 • MP GPCI 0.628
Rest of Texas
Work GPCI 1.000 • PE GPCI 0.869 • MP GPCI 0.895
Denial Codes
350+ CARC/RARC codes
CARC and RARC code directory with plain-English explanations, root cause categories, and recommended resolution strategies.
CARC 197
Precertification/authorization absent • Request retro auth
CARC 50
Non-covered service • Validate medical necessity
CARC 29
Time limit for filing expired • Check exceptions
CARC 16
Missing/incomplete information • Identify missing fields
Rule Change Feed
Daily updates
Real-time feed of payer rule changes, CMS fee schedule updates, NCCI edit changes, and coding updates.
CMS Fee Schedule
Annual MPFS update • Conversion factor changes
NCCI Edits
Quarterly edit pair updates • New bundling rules
Payer Policies
Filing deadline changes • Prior auth updates
Coding Updates
New CPT codes • Revised descriptions • Deleted codes
Developer access for the network
The Knowledge Network supports public tools and programmatic access. Product and engineering teams can use the developer path when this knowledge needs to live inside existing systems.
# Look up payer rules for a facility curl "https://api-dev.rcintell.com/v1/knowledge/layers/170001/l4?payer=Medicare" \ -H "X-API-Key: kp_test_..." # Check an NCCI edit pair curl "https://api-dev.rcintell.com/v1/ncci/validate?column1=99213&column2=36415" \ -H "X-API-Key: kp_test_..."