Paid workspace modules
Revenue cycle answers organized around the codes teams actually work
RCI organizes coverage, authorization, coding, billing, and payment answers into payer-specific workspaces. The demos below show how the same modules answer real questions across CPT/HCPCS service groups.
What's included
Three workspaces in every module
Coverage & Authorization
Coverage policy, medical necessity criteria, required documentation, prior authorization requirement, submission route, and payer caveats.
- NCD/LCD and payer policy
- Medical necessity evidence
- Prior auth status and route
Coding & Billing Policy
Rules that determine whether the code, diagnosis, modifier, units, place of service, bill type, and revenue code are ready for submission.
- CPT/HCPCS and ICD support
- NCCI, MUE, and modifier checks
- POS, bill type, and revenue code
Payment
Expected reimbursement, fee schedule basis, facility versus professional context, and site-of-service variance.
- PFS, OPPS, ASC, CLFS, DMEPOS
- Facility/nonfacility split
- Source-linked calculation
Modules
Organized by payer
Medicare Core
Starts at $4,500/monthThe required foundation for most teams: Traditional Medicare coverage, coding, billing, and payment logic across core service groups.
State Medicaid
Starts at $2,500/state/monthState-specific Medicaid rules, fee schedules, manuals, prior authorization lists, and managed-care policy references where applicable.
Commercial Payers
Starts at $2,000/payer/monthRequested payer modules for contracted commercial plans, with product-specific prior auth and medical policy nuance.
Service-group demos
Demo views by CPT/HCPCS family
Each demo shows how the payer modules answer different revenue cycle questions for a specific code family. Service-group views come with the modules — they are not billed separately.
MRI / CT
Advanced imaging is the clearest demo for prior auth, medical necessity, clinical documentation, and payer-specific evidence.
Chemistry / Labs
Routine chemistry is strongest for CPT plus ICD coverage support, frequency risk, ABN prompts, and CLFS payment.
E&M
E&M is a high-volume workflow for POS, modifier 25, NCCI/MUE context, and facility versus nonfacility payment.
Outpatient Procedures
Procedure workflows show how site of service changes bill type, revenue code, modifiers, edits, and expected payment.
DMEPOS / Supplies
DME prior auth matters for selected items, but the broader value is benefit category, documentation readiness, modifiers, units, and supplier billing.
Featured sample
Advanced Imaging: Lumbar spine MRI without contrast
CPT 72148 shows how a workspace brief combines coverage, medical necessity, prior authorization, documentation, and payer evidence in one operational answer.
Lumbar MRI workspace brief
Curated demo response. This view summarizes payer policy requirements and does not inspect a member chart, EMR, or live payer portal eligibility.
Payer answer matrix
Select a payer to inspect the authorization path and policy caveats.
UnitedHealthcare details
For this demo case, treat UHC commercial outpatient CPT 72148 as prior authorization required before the scheduled MRI.
Operational notes
- Verify the member product and ordering/rendering provider participation before submission.
- Use the UHC radiology prior authorization workflow and attach clinical documentation supporting medical necessity.
- If the case is urgent, inpatient, ER, or observation, validate the setting-specific exception before applying outpatient rules.
Exceptions and caveats
- Emergency room, urgent care, observation, and inpatient settings may follow different rules.
- Medicare Advantage and D-SNP products have separate UHC rules.
Sources for selected payer
UHC page describing advanced outpatient imaging prior authorization and setting/product caveats.
UHC commercial CPT list that includes lumbar spine MRI code 72148.