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
A directory of 3,400+ payers with EDI payer IDs and supported transactions, plus filing deadlines, appeal levels, and prior auth rules for Medicare and the major national plans.
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
Any Medicare CCN
Location, facility type, payment system, billing form, and type of bill resolved from any Medicare CCN.
CCN 170001
Kansas • Short-term Hospital • IPPS / OPPS • UB-04
CCN 050454
California • Short-term Hospital • IPPS / OPPS • UB-04
CCN 335412
New York • SNF • SNF PPS • UB-04
CCN 457300
Texas • Home Health • HH PPS • UB-04
Billing Rules
3M+ NCCI edits (2026)
Type of bill, place of service, modifiers, NCCI edits, and billing form requirements — cross-referenced to the facility.
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
CY 2026 CMS fee schedules
GPCI values, RVUs, conversion factors, and the physician, outpatient, lab, and DME fee schedules by geography and facility type.
Rest of New York
Work GPCI 1.000 • PE GPCI 0.948 • MP GPCI 0.575
Rest of Kansas
Work GPCI 1.000 • PE GPCI 0.877 • MP GPCI 0.375
Rest of California
Work GPCI 1.030 • PE GPCI 1.072 • MP GPCI 0.619
Rest of Texas
Work GPCI 1.000 • PE GPCI 0.935 • MP GPCI 0.583
Denial Codes
X12 CARC / RARC code sets
CARC and RARC codes with plain-English explanations, root cause categories, and recommended next steps.
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
Versioned dataset snapshots
Versioned changes to CMS fee schedules, NCCI edits, coverage policies, and payer rules — so you can see what moved and when.
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://sandbox.rcintell.com/v1/knowledge/layers/170001/l4?payer=Medicare" \ -H "X-API-Key: kp_test_..." # Check an NCCI edit pair curl "https://sandbox.rcintell.com/v1/ncci/validate?column1=99213&column2=36415" \ -H "X-API-Key: kp_test_..."