Tools for revenue cycle questions
Explore reimbursement, facility context, payer policy, denial, coding, and rule-change workflows with signed-in tools and API examples. For payer-specific modules, see the workspace.
Knowledge Network
Search 3,400+ payer rules in one place
Searchable directory of payer rules, filing deadlines, appeal processes, GPCI values, MAC jurisdictions, and facility type requirements. Browse by payer, state, or rule category.
Capabilities
- Filing deadlines per payer
- Appeal levels and processes
- Prior auth requirements
- GPCI values by area
- MAC jurisdiction lookup
- Rule change subscriptions
Payer Intelligence
Ask a payer policy and get a cited answer
Upload payer policies, manuals, fee schedules, and contracts into a structured document library. Parsed documents can be queried in the workspace, with answers cited to the source page and section.
Capabilities
- PDF policies parsed into cited sections
- Answers cite the source page and section
- Question packages for edits, appeals, and clinical review
- Payer and facility associations
- Tags, notes, and document-type filters
- Any file type accepted in the intake UI
Payment Calculator
RVU × GPCI × CF = expected payment
Enter a CCN and CPT code — see the full MPFS breakdown with GPCI adjustments. Compare facility vs non-facility rates, toggle between years, and run bulk calculations.
Capabilities
- Facility vs non-facility rates
- GPCI-adjusted calculations
- Medicare and Medi-Cal payers
- Inpatient MS-DRG and Medi-Cal APR-DRG
- Provider lookup by CCN or hospital name
- Data source cited per result
340B Policy Radar
Manufacturer restrictions with primary sources
Resolve contract-pharmacy access status for a covered entity and NDC, browse approved manufacturer policies, track versioned changes, and list rebate-model / MFP drugs — every fact cited to a source URL.
Capabilities
- Resolve by 340B ID + NDC
- Approved manufacturer registry
- Versioned change feed
- OPAIS entity + contract pharmacies
- Rebate-model / MFP drugs
- Fail-closed unknown (never invent allowed)
Implant Module
Map implant devices to coding context
Search implantable devices by manufacturer catalog number and optional vendor. Review device metadata, predicted HCPCS, revenue-code context, audit flags, and trust signals.
Capabilities
- Manufacturer catalog lookup
- GUDID-backed device details
- HCPCS prediction review
- Revenue-code context
- Manual review flags
- Raw JSON for QA
NCCI
Check coding edits before submission
Validate procedure pairs, inspect professional and hospital PTP edits, and review MUE limits for practitioner, hospital outpatient, and DME workflows.
Capabilities
- PTP pair validation
- Practitioner and hospital edit lookup
- MUE limits by setting
- Date-of-service context
- Professional/facility claim type
- Proxy quota surfaced
Remit Explorer
Upload an 835. See where the money went.
Parse 835 remittance files in your browser — files never leave your machine. See what every CARC, RARC, and group code means, how your payers use them differently, and what to work first. Try it with the built-in demo data.
Capabilities
- CARC + RARC + group code interpretation
- Adjustments ranked by dollars
- Recommended action per combination
- Payer scorecards, with per-claim-form drill-down
- PLB takeback and reconciliation view
- Underpayment check against Medicare rates
Claim Scrubber
Catch denials before you submit the claim
Drop an 837P or 837I and scrub it in your browser — files never leave your machine. Structure, provider and subscriber IDs, diagnosis pointers, and NCCI coding edits, each finding cited to the public standard behind it. The pre-submission companion to Remit Explorer. Try it with the built-in demo data.
Capabilities
- 837P and 837I parsed in your browser
- Structure and envelope edits
- NPI check-digit and Medicare MBI format
- Diagnosis pointer validation
- NCCI PTP, MUE, and add-on code checks
- Toggle rules and export the findings
Billing Rules Network
The open reference for billing codes
Open catalog of Type of Bill codes, Place of Service codes, modifiers, NCCI edits, and revenue codes — searchable and cross-referenced with real-world usage patterns.
Capabilities
- TOB code lookup
- POS code reference
- Modifier requirements
- NCCI edit checker
- Revenue code catalog
- Cross-referenced relationships
CCN Resolver
Paste a CCN. See everything about that facility.
Enter any Medicare provider number and see the complete billing context — from geographic location through payment system to the codes and rates that apply there.
Capabilities
- Full L1-L6 breakdown
- GPCI values for location
- Payment system identification
- Billing form determination
- Available care settings
- Deep resolution with CPT + payer
Rule Change Feed
Know before your claims get denied
Track payer rule changes, CMS fee schedule updates, new NCCI edits, and coding changes. Subscribe via webhook, RSS, or email — get notified before changes take effect.
Capabilities
- CMS fee schedule updates
- Payer policy changes
- NCCI edit changes (quarterly)
- New/deleted CPT codes
- Timely filing changes
- Severity-rated alerts
NPI Lookup
Find any provider. Get their billing context.
Search the NPPES National Provider Identifier registry by NPI number, name, organization, taxonomy, or location — enriched with RCIntel's billing knowledge layer. NPI → CCN → L1-L6 knowledge in one lookup.
Capabilities
- Powered by CMS NPPES API v2.1
- Search by NPI, name, org, taxonomy
- RCIntel enrichment: GPCI, MAC, payment system
- NPI → CCN facility linkage
- Full L1-L6 resolution with CPT
- Bulk provider lookup via API
ProFee Coder
Professional coding reference with API access
RVU lookup from CMS MPFS with GPCI adjustments, NCCI edit checker for up to 50 code pairs, LCD/NCD policy lookup, modifier crosswalks, and Medicare fee schedules — all with year toggling.
Capabilities
- RVU lookup with GPCI adjustment
- Year toggle (2024-2026)
- NCCI edits + MUE data (50 codes)
- LCD/NCD lookup with covered ICD-10s
- Modifier crosswalk + payment impact
- MPFS, DMEPOS, CLAB fee schedules
Facility Coder
Facility coding and payment reference
DRG lookup with weights, length of stay, and payment calculator per facility. APC lookup with OPPS payment by CBSA. Status indicators, DRG grouper logic, and revenue code validation.
Capabilities
- DRG codes, weights, LOS, payment calc
- APC codes, weights, OPPS payment by CBSA
- Status indicator reference
- DRG grouper: Dx + Px → DRG
- Revenue code + TOB validation
- Wage index adjustments per facility
Code Crosswalk
Map between CPT, HCPCS, and ICD-10. Instantly.
Enter a CPT code — see related HCPCS codes, commonly paired ICD-10 diagnoses, LCD-required pairings, and plain-English lay terms. Works in both directions. Bulk mode available.
Capabilities
- CPT → HCPCS (drug + admin pairing)
- CPT → ICD-10 (common + LCD-required)
- ICD-10 → CPT (reverse lookup)
- Lay term lookup for any code
- Frequency data for code pairs
- Bulk crosswalk via API