Further reading & primary sources

Where to go for the authoritative version. This site cites these; you should be able to reach them directly.

Code sets and transaction standards

Source	What it is
ASC X12	The standards body. Transaction implementation guides.
X12 Claim Adjustment Reason Codes	The authoritative CARC list
X12 Remittance Advice Remark Codes	The authoritative RARC list
NUCC Provider Taxonomy	The taxonomy code set, updated twice yearly
CMS Place of Service Codes	The POS code set
CMS HCPCS	HCPCS Level II
CDC ICD-10-CM	Diagnosis codes, updated October 1
AMA CPT	CPT, licensed
ADA CDT	CDT, licensed
CMS NCCI Edits	Code-pair edits

CMS

Source	Use
CMS Internet-Only Manuals	The manual set. The chapters that matter most: Claims Processing Manual (Pub. 100-04) and Benefit Policy Manual (Pub. 100-02)
Medicare Physician Fee Schedule	Rates, RVUs, and the annual conversion factor
PECOS	Medicare enrollment
Medicare Revalidation Lookup	Check your revalidation date directly
Medicare Coverage Database	LCDs and NCDs
Medicare Appeals	The five-level process
Administrative Simplification	Transaction standards, operating rules, EFT
No Surprises Act	Balance billing and good faith estimates
Medicaid.gov Provider Enrollment	Screening requirements

Identifiers and credentialing

Source	Use
NPPES	Apply for and maintain NPIs
NPI Registry	Look up an NPI before creating a duplicate
CAQH ProView	Credentialing profiles
OIG LEIE	Exclusion screening, monthly
SAM.gov	Federal debarment screening
NPDB	Practitioner data bank

Compliance

Source	Use
HHS OCR HIPAA	Privacy, Security, and Breach Notification Rules
ONC Security Risk Assessment Tool	For the required risk analysis
HHS OIG Compliance Guidance	Compliance program elements
OIG Self-Disclosure	Voluntary disclosure protocols
OIG Fraud & Abuse Laws	AKS, Stark, FCA overview
CMS Physician Self-Referral	Stark
SAMHSA 42 CFR Part 2	SUD record confidentiality
eCFR	Current CFR text

Legal research

Source	Use
CourtListener	Free case law search and opinions
State legislature bill trackers	The primary source for pending legislation
State medical, dental, and other board sites	License verification, board rules, and position statements
State secretary of state business search	Entity status and good standing
Uniform Law Commission	Model acts, including the Revised Uniform Unclaimed Property Act

For CPOM specifically: major healthcare law firms publish state surveys and legislative alerts that are frequently the fastest route to a current picture. Holland & Knight, Epstein Becker Green, Nixon Peabody, Benesch, Ropes & Gray, DLA Piper, and Quarles all publish regularly on this area, and this wiki cites several of them. Treat them as pointers to primary sources rather than as the authority.

Tax and finance

Source	Use
IRS Applicable Federal Rates	Monthly AFRs for intercompany notes
IRS EIN application	Free, same-day
FASB Codification	ASC 810 consolidation
unclaimed.org (NAUPA)	State unclaimed property administrators

Payment and banking

Source	Use
Nacha	ACH rules
The Clearing House RTP	Real-time payments
FedNow	Federal Reserve instant payments
PCI Security Standards Council	PCI DSS
Visa and Mastercard rules	Dispute reason codes and monitoring thresholds, via your processor

Benchmarks and industry data

Source	Use
MGMA	Physician compensation and practice operations benchmarks
AAPC	Coding and billing certification and resources
AHIMA	Health information management
HFMA	Revenue cycle benchmarks and certification
ADA Health Policy Institute	Dental practice data
KFF	Health coverage and market data, including employer survey data on self-funding
AHA	Hospital and health system data

Compensation and productivity benchmark data is licensed. MGMA, SullivanCotter, and similar surveys require a subscription or purchase. If you need an FMV-defensible benchmark for a compensation arrangement, budget for the actual data rather than relying on secondary summaries.

Payer sources

Each payer publishes its own provider manual, medical policies, companion guides, and fee schedule terms. These are the authoritative source for anything payer-specific, and they outrank any third-party summary, including this one. See Payer enrollment and submission links for the index.

CPOM & Legal

Payers

Clearinghouses & Vendors

EDI & Code Sets

Banking & Payments

Glossary & Appendices

Further reading & primary sources

Code sets and transaction standards

CMS

Identifiers and credentialing

Compliance

Legal research

Tax and finance

Payment and banking

Benchmarks and industry data

Payer sources

​Code sets and transaction standards

​CMS

​Identifiers and credentialing

​Compliance

​Legal research

​Tax and finance

​Payment and banking

​Benchmarks and industry data

​Payer sources

Code sets and transaction standards

CMS

Identifiers and credentialing

Compliance

Legal research

Tax and finance

Payment and banking

Benchmarks and industry data

Payer sources