Reimbursement intelligence
Medicare Policy Monitoring before it costs you a claim
CLV Intelligence is Medicare policy monitoring software that tracks every CMS and Medicare Administrative Contractor (MAC) policy change — coverage, coding, and payment — and surfaces the ones that affect your claims, every business day.
- 1,150+
- Policy alerts tracked
- 33
- Clinical specialties
- 7
- MAC contractors
- 15+
- Source families
Medicare policy is set in two layers — national policy from CMS and regional policy from the seven Medicare Administrative Contractors — and both change constantly: coverage determinations, fee schedules, transmittals, and coding edits. Watching all of it by hand is impossible, and the contractor layer is exactly where most denials begin. CLV Intelligence is Medicare policy monitoring built for that reality: it tracks CMS and every MAC every business day, scores each change by impact, and tells the people who bill what changed and what to do about it.
Coverage
What CLV monitors across CMS
CMS national policy
Transmittals, Change Requests, and National Coverage Determinations that set Medicare policy nationwide.
MAC regional policy
Local Coverage Determinations and Billing & Coding Articles from all seven MACs, by jurisdiction.
Fee schedules
Physician Fee Schedule, OPPS, IPPS, ESRD, and clinical lab updates with the codes they reprice.
Federal Register rules
Proposed and final Medicare rules, read for the provisions that change coverage or payment.
Coding edits
NCCI edit changes and code additions/deletions that affect Medicare claims.
Integrity & audit signals
OIG Work Plan items and program-integrity activity that flag audit and recoupment risk.
How it works
From source to action, every day
We monitor the sources
CMS, every Medicare Administrative Contractor, and the Federal Register — scanned continuously, with the originating government document linked on every alert.
AI translates the impact
Dense regulatory text is distilled into the specialties, codes, and dollar exposure that actually affect your claims, then ranked by a signal score.
You act before it bills
Severity-ranked alerts with plain-language action guidance — plus audit-ready exports — reach the right team in time to change the claim.
Why automated monitoring
Why it beats manual source-watching
Two policy layers, one feed
National CMS policy and seven contractors’ regional policy rarely change in sync. Monitoring both in a single signal-scored feed is the only way to see the whole Medicare picture.
The denial layer is the contractor layer
Most Medicare denials trace to LCD coverage criteria, not headline national rules — so monitoring that doesn’t cover all seven MACs misses where the money leaks.
Impact-ranked, source-linked
Every Medicare change is scored by urgency and authority and links to the source document, so your team acts on what matters and can cite it.
Who it’s for
- Revenue cycle leaders protecting net collections
- Coding professionals keeping pace with code and coverage changes
- Compliance officers building audit-ready documentation
- Healthcare finance executives quantifying reimbursement risk
- Reimbursement analysts replacing manual source-watching
- Specialty practice and billing-company leaders
Get CMS & MAC policy alerts by email — free
A weekly digest of the signal-scored changes that affect what you bill. No subscription required.
Frequently asked questions
What is Medicare policy monitoring?
Medicare policy monitoring is the continuous tracking of the coverage, coding, and payment changes published by CMS and the Medicare Administrative Contractors, so billing and compliance teams can act before a change affects their claims. CLV Intelligence monitors both the national (CMS) and regional (MAC) layers every business day and ranks changes by impact.
Which Medicare policies does CLV Intelligence track?
CLV Intelligence tracks CMS transmittals and National Coverage Determinations, the Physician Fee Schedule and other fee schedules, Federal Register Medicare rules, NCCI edits, OIG Work Plan activity, and the Local Coverage Determinations of all seven MACs (Noridian, CGS Administrators, First Coast, National Government Services, Novitas Solutions, Palmetto GBA, WPS).
Why monitor MACs and not just CMS?
Because the Medicare Administrative Contractors set the Local Coverage Determinations that govern medical necessity in each jurisdiction — and that’s where most Medicare denials originate. National CMS policy alone doesn’t tell you whether your MAC just changed the coverage criteria for a code you bill.
How current is the data?
Sources are scanned every business day, so most Medicare policy changes surface as signal-scored alerts within a day of publication. You can see the live ingestion status at clvintelligence.com/data-status.
Is CLV Intelligence a substitute for compliance or legal advice?
No. CLV Intelligence surfaces, summarizes, and signal-scores official policy changes so your team can act in time, but it is not legal, billing, or compliance advice and it is not an audit certification. Every alert links to the originating government source so you can review the exact language, and final interpretation should be confirmed with qualified compliance counsel.
Explore the platform
CMS monitoring software
Track every CMS transmittal, NCD, and rule
LCD monitoring software
Local Coverage Determinations by MAC
NCD tracking platform
National coverage, the day it changes
Specialty reimbursement alerts
CMS & MAC alerts mapped to your specialty
Live alert feed
The latest signal-scored policy changes
Stop finding out after the claim denies.
See the live feed of CMS and MAC policy changes, or talk to us about coverage for your team.