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Claims Resources

Northshore is pleased to share links to various on-line resources that are useful in the management and handling of Medical Claims. Enjoy!
Medicare / Medicaid Resources
U.S. Gov't: Mediare/Medicaid (CMS) Authoritative resource for Medicare and Medicaid information.
CMS - Physicians (RBRVS) Fee Schedule Source for RBRVS RVU (relative value units) data files.
CMS - Physicians (RBRVS) Fee Schedule Lookup CMS RBRVS on-line lookup for HCPCS codes. From 2000 to present.
CMS - Ambulatory Surgical Center (ASC) Source for ASC specifications and data files.
CMS - Clinical Lab Fee Schedule Source for Lab Fee Schedule specifications and data files.
CMS - Durable Medical Equip, Prosthetics/ Orthothics & Supplies (DMEPOS) Source for DMEPOS specifications and requirements.
CMS - Part B Drug Average Sales Price (ASP) Source for Medicare Part B ASP specifications and requirements.

Cancer Treatment Resources

National Cancer Institute Useful resource for cancer drug information, clinical trial information, approved treatment options for different types of cancers.
National Comprehensive Cancer Network (NCCN) The NCCN Compendium is recognized by CMS as an authoritative reference for oncology coverage policy. This is a good reference for confirming appropriate, medically-necessary care.

Drug Resources

FDA - Drug Resources Comprehensive government FDA resource for a varierty of drug topics.
Medline Drug/Herbs/Supplements  Reference for information about specific drugs, herbs and supplements.
Pharmacy & Therapuetics Community Resource for pharmaceutical news, policies and guidelines.

General Claim Coding References

ICD-9/ICD-10/HCPCS Codes On line code lookup resource.
CPT Codes On line code lookup resource.
DRG Codes On line code lookup resource.
General Coding Information Good resource for various medical coding topics..

Regulatory Compliance

Dept Labor - ERISA Authoritative resource for the Employee Retirement Income Security Act of 1974 (ERISA)
Dept Labor - Health Plans & Benefits Authoritative resource for Federal regulations pertaining to health plans and benefits, including ERISA, COBRA, HIPAA, MHPA etc
US Affordable Care Act Useful information on understanding the provisions of Affordable Care Act, as well as a timeline of when each of the changes will be implemented.
Joint Commission Authoritative resource for looking up Joint Commission accreditation and certification for many types of health care organizations

Association of Governmental Risk Pools       CPCU Society    Managed Care Resource Association    Public Risk Management Association    Self-Insured Institute of America    National Association of Subrogation Professionals   
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