- CPT Codes
- HCPC Codes
- ICD Codes
- LCD/ NCD articles, policies
We provide class-leading applications and content to hospitals and clinics — and, combined with our vendor partners, more than 700 million claims run through solutions using our coding, billing, and compliance content each year, and we take that responsibility very seriously.
The core of our business is effectively developing, structuring, and maintaining regulatory and coding content. Our Best in KLAS solutions’ distinctive power is based in the accuracy, richness, and depth of that content, and our ability to present it with clarity in a variety of real-world, working contexts.
VitalIntelligence helps our vendor partners focus on their businesses — everything from EMR/EHR software vendors to clearinghouses and revenue cycle vendors — without getting caught up in the time-consuming complexities and ever-changing terrain of regulatory rules, regulations, and logic.
With VitalIntelligence, our partners can embed this richer, always up-to-date content in their own solutions — creating significant, measurable benefit for their users.
With ICD-10, the industry went from a potential pool of approximately one million medical necessity edits (MNE), to over 20 million and growing. We built our solutions on this far-richer foundation, and we remain unique in our ability to manage this complexity, providing our users and partners medical necessity edits that accurately reflect the multi-factor logic of today's complex regulatory environment.
Most MNE vendors don’t have capabilities to handle today’s complex edits, and fail to process complex code combinations. This often gives you false “green lights,” or "red lights" – both harmful and costly. The common "yellow-light" outcome is also costly, as it means you have to do the research and make a determination yourself, or guess.
Our proprietary edit engine can process complex edits (logic loops) that look past the simple code relationship to show that either additional diagnoses, HCPCS, or an ABN is needed. We see this as going from 1D data to 3D medical necessity validations. You will experience it as fewer warnings, and more accurate pass and fail results that includes messaging derived from the policies. This means less time spent on research and more accurate reimbursement.
Our edits are updated on a weekly basis rather than the industry norm of quarterly, further enhancing accuracy. We also provide our users with a weekly report of detailed coverage changes, making it easy to identify changes that are pertinent to your users.Get More Info
Our white-labeled solutions allow you to focus on your core competency while we focus on ours. We work hard to assure that our data is up-to-date and reliable, but we're equally obsessed with assuring that both the information and decision-guidance we provide are intuitive and easy to follow. We're able to deliver our data — and the complexity that creates so much value — in a variety of forms to meet your specific needs.
Compared to others of its kind, VitalIntelligence is much more comprehensive. Our users can quickly customize data and access all of the information, providing an invaluable difference.Pilot Information Systems, Inc.
More than just medical necessity, we provide a comprehensive list of coding and regulatory content to our partners, delivered in a way that improves their users' experience. Here's a high-level overview of the data assets we provide:
VitalIntelligence provides data in a wide range of file formats, and we're well equipped to handle customized formats and unique delivery-cadences. We can seamlessly integrate into your organization’s existing solutions via the VitalIntelligence API, through HTML Controls, or, if you prefer, through delivery of raw data files.
We're flexible, precise, and thorough, no matter what delivery method(s) you chose.
Raw Data Files
Access files on a scheduled basis in either a flat (CSV) or XML file format.
Web Services API
Enabling integration of our content with your own UI and functionality.
For referential coding functionality with built-in navigation logic for easy deployment to end-users.
For a comprehensive understanding of the efficiencies you can gain from our proprietary data, and to see the superiority of our medical necessity edits, schedule a personalized demonstration of VitalIntelligence. Bring your most experienced experts: they'll see the difference right away.Schedule a Meeting