Free, no form in the way
Useful whether or not you ever hire us
Denial code guides, an RCM glossary, a cost calculator and state-by-state certified payroll rules. None of it is gated behind an email address, because a resource you have to trade your contact details for is an advert.
Medicare revalidation lookup
Type an NPI and read that provider’s Medicare revalidation due date, from the free CMS dataset. Miss the date and CMS can hold your reimbursement or deactivate billing privileges. No email required.
233,499 providers
AR aging analyzer
Drop in the aged AR export from your practice-management system and see what share is past 90 days, which payers hold it, and what to work first. The file stays in your browser; nothing is uploaded.
nothing uploaded
Opening a US practice
Effective dates, retrospective billing, the $750 application fee most physicians do not owe, NPI types and the discontinued CMS-855R. Every rule cited to the regulation, not to another vendor’s blog.
6 guides, cited
Prompt pay laws by state
How many days each state gives an insurer to pay a clean claim, with a link to the statute on every row. Includes the two states most published summaries get wrong.
50 states, cited
Medicaid by state
Whether a state runs managed care or fee for service, which plans a provider actually bills, and the enrollment quirk that costs the most time. Cited to the state agency.
50 states, cited
Denial code guides
77 CARC codes, each with the standard description, why it actually happens, the order to work it in, and the change that stops it recurring. Written for somebody with a denial open right now.
77 codes
Remark code lookup and line decoder
Paste the line as the payer sent it — CO-16 M51 N382 — and read who is liable, what is missing and the next move. Every X12 reason and remark code with the official text; the reading is ours.
1,216 remark codes
Timely filing limits and calculator
The deadline each payer publishes for receiving a claim, quoted from the payer’s own document — and, where a payer publishes none, that fact instead of a guess. Pick a payer, enter the date of service, get the date.
Every row cited
Modifier lookup
What each CPT and HCPCS modifier asserts and how it goes wrong — 25 against 57, 59 against the X modifiers, GA, GY and GZ — searchable by code or by what you are trying to say.
In plain words
Place of service codes
All 53 CMS codes with the official descriptions, the ones that change the rate marked, and why 11 against 22 is a denial rather than a typo.
Complete CMS set
Cost calculator
What a seat costs against hiring the same role locally, with employer payroll tax, health cover and the desk added in. Public salary midpoints, editable to your city. Nothing stored against you.
No email required
RCM glossary
Days in AR, clean claim rate, CARC and RARC, NCCI edits, LCD and NCD, CAQH, PECOS, prevailing wage, WH-347. Defined without circular definitions.
28 terms
Certified payroll by state
What each state requires on top of the federal Davis-Bacon rule, drawn from the states’ own public filing data — including what they accept and what they bounce.
6 states
Every denial guide
- CO-197 — Prior authorization absent
- CO-16 — Claim lacks information or has a submission error
- CO-29 — Time limit for filing has expired
- CO-50 — Not deemed medically necessary
- CO-45 — Charge exceeds the fee schedule
- CO-97 — Included in the payment for another service
- CO-18 — Exact duplicate claim or service
- CO-22 — May be covered by another payer
- CO-27 — Expenses incurred after coverage terminated
- CO-151 — Information does not support this many services
- CO-109 — Not covered by this payer or contractor
- CO-B7 — Provider not certified or eligible on this date
- CO-4 — Procedure code inconsistent with the modifier
- CO-11 — Diagnosis inconsistent with the procedure
- CO-96 — Non-covered charges
- CO-119 — Benefit maximum reached
- CO-140 — Patient identification number and name do not match
- CO-170 — Payment denied for this provider type
- CO-234 — Procedure not paid separately
- CO-252 — Additional documentation required
- CO-198 — Prior authorization exceeded
- CO-288 — Referral absent
- PR-204 — Not covered under the patient’s current plan
- OA-23 — Prior payer’s adjudication
- CO-185 — Rendering provider not eligible
- CO-8 — Procedure inconsistent with provider type
- CO-236 — Procedure/modifier combination not compatible
- CO-231 — Mutually exclusive procedures
- CO-107 — Related or qualifying claim not identified
- PR-31 — Patient cannot be identified as our insured
- CO-286 — Appeal time limits not met
- PR-1 — Deductible amount
- CO-5 — Procedure inconsistent with place of service
- CO-9 — Diagnosis inconsistent with patient age
- CO-10 — Diagnosis inconsistent with patient gender
- CO-15 — Authorization number missing or invalid
- CO-24 — Charges covered under a capitation agreement
- CO-32 — Patient is not an eligible dependent
- CO-33 — Insured has no dependent coverage
- CO-35 — Lifetime benefit maximum reached
- CO-39 — Services denied at the time authorization was requested
- CO-136 — Failure to follow the prior payer’s coverage rules
- CO-150 — Information does not support this level of service
- CO-167 — Diagnosis is not covered
- CO-177 — Patient has not met eligibility requirements
- CO-181 — Procedure code invalid on the date of service
- CO-182 — Procedure modifier invalid on the date of service
- CO-183 — Referring provider not eligible to refer
- CO-184 — Ordering provider not eligible to order or prescribe
- CO-226 — Requested information from the provider not supplied
- CO-227 — Requested information from the patient not supplied
- CO-242 — Services not provided by network providers
- CO-251 — Attachment or documentation incomplete or deficient
- CO-253 — Sequestration reduction in federal payment
- CO-256 — Service not payable under the managed care contract
- CO-272 — Coverage or program guidelines not met
- CO-B10 — Allowed amount reduced — a component of the procedure was already paid
- CO-273 — Coverage or program guidelines exceeded
- N130 — Consult plan benefit documents for restrictions
- N382 — Missing, incomplete or invalid patient identifier
- MA130 — Claim unprocessable — no appeal rights
- N29 — Missing documentation, orders, notes or report
- N30 — Patient ineligible for this service
- N34 — Incorrect claim form or format for this service
- N54 — Claim inconsistent with the authorized services
- N115 — Decision based on a Local Coverage Determination
- N122 — Add-on code cannot be billed by itself
- N362 — Units of service exceed the payer’s maximum
- N381 — Adjusted per the contract — read the contract
- N522 — Duplicate of a crossover claim
- MA30 — Missing, incomplete or invalid type of bill
- N830 — Processed under surprise-billing rules — the patient cannot be balance billed
- M115 — Denied — not a contract supplier for this item
- MA27 — Missing, incomplete or invalid Medicare number or name
- M51 — Missing, incomplete or invalid procedure code
- N4 — Missing or invalid primary payer explanation of benefits
- N290 — Missing, incomplete or invalid rendering provider identifier
Every specialty
- Pain Management
- Anesthesia
- Orthopedics
- Ambulatory Surgery Centers
- Behavioral Health
- Cardiology
- Gastroenterology
- Dermatology
- Urology
- Podiatry
- Physical Therapy
- Radiology
- Ophthalmology
- Otolaryngology
- Neurology
- Obstetrics & Gynecology
- Urgent Care
- Primary Care
- Nephrology
- Rheumatology
- Oncology
- Wound Care
- Sleep Medicine
- Chiropractic
- Pediatrics
- Clinical Laboratory and Pathology
- DME and Orthotic Supplies
- Allergy and Clinical Immunology
- Hospitalist Medicine
- Plastic and Reconstructive Surgery
- FQHC Community Health Centers
- Rural Health Clinics
- Geriatric Medicine
- Infectious Disease
- Pulmonology and Critical Care
- Endocrinology and Diabetes
- Vascular Surgery
- Occupational Medicine
- Home Health and Hospice
- Substance Use Treatment
- Cardiothoracic Surgery
- General Surgery
- Emergency Medicine Groups
- Integrative and Functional Medicine
- Internal Medicine
- Family Practice
- Dental Cross-Coding
If this is work somebody on your team is doing at four in the afternoon, it can be a seat.
Next step
One seat. One month. Cancel any time.
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com