Browse standards
Every knowledge collection, grouped for fast discovery. Open a collection to read its standards.
Claim Types
Professional Claims
CMS-1500 field accuracy, rendering provider rules, and clean professional submissions.
3 standardsFacility Claims
UB-04 / 837I structure, revenue codes, and institutional billing standards.
3 standardsASC Billing
Ambulatory surgery center place-of-service, device, and reimbursement guidance.
3 standardsLaboratory
Lab panels, NCD/LCD coverage, and molecular pathology billing rules.
3 standardsRadiology
Technical/professional splits, modifiers, and imaging medical necessity.
3 standardsBehavioral Health
Authorization, time-based coding, and payer nuance for BH services.
3 standardsPayers
Medicare
Medicare Claims Processing Manual guidance, NCCI edits, and MAC policy.
3 standardsManaged Medicaid
Plan-specific enrollment, encounter data, and wrap payment standards.
3 standardsCommercial Insurance
Commercial payer manuals, prior auth, and network-specific requirements.
3 standardsMarketplace Plans
ACA marketplace grace periods, cost sharing, and eligibility standards.
3 standardsAmbetter
Ambetter portal workflows, authorization, and claim resolution paths.
3 standardsOperations
Provider Enrollment
PECOS, CAQH, and enrollment playbooks that keep providers billable.
3 standardsCredentialing
Primary source verification, re-credentialing, and delegation standards.
3 standardsRevenue Integrity
Charge capture, CDM maintenance, and audit frameworks.
3 standardsAppeals
Compliant appeal construction, timelines, and escalation pathways.
3 standardsMedical Necessity
NCD/LCD, documentation support, and coverage determination logic.
3 standardsAuthorization
Prior auth workflows, retro authorization, and denial prevention.
3 standardsCharge Capture
Front-to-back charge reconciliation and missing charge recovery.
3 standardsDenial Prevention
Edit design, root-cause analysis, and upstream process controls.
3 standardsCoding
CPT/HCPCS selection, modifiers, NCCI, and diagnosis linkage.
3 standardsRegistration
Eligibility, COB, and demographic accuracy at the front end.
3 standardsPatient Access
Scheduling, financial clearance, and access-driven denial prevention.
3 standardsRevenue Cycle Leadership
KPIs, governance, and operational excellence frameworks.
3 standards