Tools for revenue cycle questions
Payment, coverage, coding edits, payer rules, remittance and claim review, providers, and 340B policy — most of it also callable from the API. For payer-specific modules, see the workspace.
Payer Directory
3,400+ payers, and the rules for the ones that matter most
Find any payer by name, state, or type and get its EDI payer IDs and supported transactions. Medicare and the major national plans also carry filing deadlines, appeal levels, and prior auth rules.
Capabilities
- 3,400+ payers with EDI payer IDs
- Supported transactions per payer
- Filing deadlines for major payers
- Appeal levels and windows
- Prior auth rules for major payers
- Export the directory to CSV
Payer Intelligence
Ask a payer policy and get a cited answer
Upload payer policies, manuals, fee schedules, and contracts. We parse them into a folder tree and you can ask questions with answers cited to the source page and section.
Capabilities
- PDF policies parsed into a cited folder tree
- 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 a CPT, HCPCS, or DRG code — see the full breakdown with GPCI or wage-index adjustments. Compare facility and non-facility rates, and the date of service picks the right year's schedule.
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
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
Coverage Check
Does the diagnosis support the procedure?
Enter the procedures and diagnoses on a claim and see, line by line, whether Medicare coverage policy for your state supports them — with the LCD or NCD behind every verdict.
Capabilities
- Line-by-line coverage verdict
- Medicare LCDs and NCDs by state
- Covered diagnosis matching
- Multiple procedure lines per check
- Claim-level warnings
- Links to the policy on CMS
NPI Lookup
Find any provider in the national registry
Search the CMS NPPES registry by NPI number, name, organization, taxonomy, or location. See each provider's enumeration status, primary specialty, and practice and mailing addresses.
Capabilities
- Backed by the CMS NPPES registry
- Search by name, organization, or taxonomy
- Filter by city, state, or ZIP
- Individual and organization records
- Enumeration status and specialty
- Practice and mailing addresses