What we cover
AuthMatch is built for CMS-regulated lines of US prior authorization. The list below is the public-domain corpus our matcher consults at intake — sourced directly from CMS and the MAC contractors (NCDs, LCDs, MAC Articles, and the CMS Internet-Only Manuals). Every item has a refresh cadence and a last-refresh timestamp you can audit.
Corpus inventory + freshness
Updated automatically by scheduled cron jobs. Counts and timestamps below are pulled live from the database.
| Source | Description | Rows | Last refresh | Cadence |
|---|---|---|---|---|
| ncd | CMS National Coverage Determinations | 362 | today | Daily 03:00 UTC |
| lcd | Medicare Administrative Contractor LCDs | 867 | today | Daily 03:00 UTC |
| article | MAC Articles (companion to LCDs) | 1,989 | today | Daily 03:15 UTC |
| cms_manuals | CMS Internet-Only Manuals (Pub 100-02 / 100-03 / 100-04) | 16 | 2 days ago | Weekly Sunday 03:45 UTC |
| ncci_ptp | NCCI Procedure-to-Procedure edits (advisory pre-matcher) | 3 | 2 days ago | Weekly Sunday 03:30 UTC |
| ncci_mue | NCCI Medically Unlikely Edits (advisory pre-matcher) | 3 | 2 days ago | Weekly Sunday 03:30 UTC |
| ncci_addon | NCCI Add-on edits (advisory pre-matcher) | 2 | 2 days ago | Weekly Sunday 03:30 UTC |
- · Custom payer policies are tenant-scoped and intentionally excluded from this public summary.
- · AuthMatch does not redistribute MCG, InterQual, or other third-party licensed content.
Inventory generated 2026-06-30 07:27:47 UTC.
What this means for payers
2024 MA Final Rule alignment. Medicare Advantage plans must follow traditional Medicare coverage criteria (NCD > LCD > Article) when those criteria exist. AuthMatch's matcher encodes this precedence as the controlling order on every case — keeping MA adjudications squarely on the CMS public-domain corpus the rule requires.
CMS-0057-F (effective Jan 1, 2027). Payers must expose Da Vinci PAS, CRD, and DTR FHIR R4 endpoints. AuthMatch already implements all three with conformant CapabilityStatement, SMART Backend Services security, and a published conformance test suite. See the conformance result document for the gap analysis.
What we deliberately do not cover
- Licensed third-party criteria libraries. AuthMatch does not redistribute proprietary clinical content. Tenants that license such libraries themselves can upload their own copies into the tenant-scoped custom policy library; AuthMatch never holds them centrally.
- Inpatient admission, level-of-care, and length-of-stay benchmarks. These are proprietary content with no CMS public-domain equivalent. Out of scope for V1.
- Commercial-plan medical-necessity criteria. Every commercial payer authors its own; CMS does not publish these. Tenants supply their own commercial criteria via the custom-policy upload flow.
- Behavioral-health acuity beyond CMS-published surfaces. Out of scope for V1.
These are deliberate V1 boundaries — explicit non-goals, not future TODOs to apologise for.
Talk to us
Building a CMS-0057-F prior-auth pipeline? Need to validate Da Vinci PAS conformance before contracting? Reach out via your usual channel — we'll send a synthetic test Bundle to walk through.