Where CLV Intelligence gets its data

Local and National Coverage Determinations — the coverage criteria and medical-necessity requirements that drive most Medicare coverage decisions and denials.

Internet-Only Manual transmittals and Change Requests that operationalize Medicare policy for claims processing.

The LCD and Billing & Coding Article pages of Noridian, CGS, First Coast, NGS, Novitas, Palmetto GBA, and WPS — monitored by jurisdiction.

Proposed and final rules — Physician Fee Schedule, OPPS, IPPS, ESRD — read for the provisions that change coverage or payment.

The OIG Work Plan and guidance, which signal the billing and coding areas under federal audit focus.

Drug and biological approvals with billing implications — new products that drive new HCPCS/J-codes and coverage questions.

Authoritative, free code definitions from the National Library of Medicine, powering the code lookup tool and linked to CMS and CDC source documentation.

National Correct Coding Initiative edits and the Physician Fee Schedule / OPPS pricing files that change correct coding and payment.