RESOURCE LIBRARY
The State and Federal Program Source Map for Access & Reimbursement Professionals
Use the public source map to locate official coverage, payment, federal-plan, product, safety, compliance, and provider-enrollment destinations. Always verify current requirements in the controlling source.
ACCESS & REIMBURSEMENT SOURCE MAP
Use This Page When You Need to Verify
Part B vs. Part D Considerations
HCPCS, ASP, OPPS & Fee Schedule References
Medicare Advantage & Part D Plan Resources
Medicaid & State-Level Program Information
340B Covered Entity Information
TRICARE, FEHB, VA & IHS Pharmacy Resources
FDA Labeling, REMS, NDC, Orange Book & Purple Book
HIPAA, OIG, Open Payments & Exclusion Resources
Provider Enrollment, NPI & MAC Contractor Information
LEGAL PRINCIPLES & OVERSIGHT MAP
Keep the principle, source, and oversight purpose connected.
| Legal principle | Primary oversight agency(ies) | What they oversee |
|---|---|---|
| 1Patient Safety | Drug approval, safety monitoring, manufacturing quality, and adverse-event reporting. | |
| 2Regulatory Compliance | Compliance with approved labeling, promotion, manufacturing, and post-market requirements. | |
| 3Truthful & Non-Misleading Communications | Prescription-drug promotion, advertising, and marketing claims. | |
| 4Anti-Kickback & Improper Inducements | Anti-Kickback Statute, False Claims Act, and fraud enforcement. | |
| 5Patient Privacy & Confidentiality | Privacy and security requirements under HIPAA. | |
| 6Fair Competition (Antitrust) | Anti-competitive conduct, mergers, monopolization, and collusion. | |
| 7Transparency (Payments to HCPs) | Administration of the Open Payments Program. | |
| 8Product Quality & Manufacturing | Good Manufacturing Practice, inspections, recalls, and quality systems. | |
| 9Accurate Documentation & Recordkeeping | Data integrity, documentation accuracy, and regulatory records. | |
| 10Government Program Integrity | Medicare and Medicaid billing, reimbursement, fraud, waste, abuse, and enforcement. | |
| 11Ethical Promotion | Promotion consistent with FDA-approved labeling and regulations. | |
| 12Adverse Event & Product Complaint Reporting | Pharmacovigilance, post-marketing surveillance, and product-safety reporting. | |
| 13Corporate Integrity & Ethical Conduct | Corporate Integrity Agreements, compliance programs, and enforcement actions. |
ACCESS & REIMBURSEMENT SOURCE NAVIGATOR
Official resources grouped by the job they support.
Open a category to browse its source cards. A link is a starting point for verification, not a policy interpretation or applicability decision.
Medicare Coverage & Payment Tools10 resources
CMS Medicare Coverage Database
Search NCDs, LCDs, billing and coding articles, and code references.
Open official resource (opens in a new tab)Local Coverage Determinations
Review how Medicare contractors define local coverage.
Open official resource (opens in a new tab)Medicare Administrative Contractors
Identify the appropriate MAC and official contractor portal.
Open official resource (opens in a new tab)Physician Fee Schedule Lookup
Look up PFS payment rates, RVUs, locality, and code references.
Open official resource (opens in a new tab)Part B Drug ASP Pricing Files
Review CMS quarterly ASP pricing files.
Open official resource (opens in a new tab)HCPCS Level II Coding
Review CMS HCPCS Level II information and updates.
Open official resource (opens in a new tab)Hospital OPPS Addenda
Check OPPS status indicators, APC groups, and payment rates.
Open official resource (opens in a new tab)Medicare FFS Appeals / Redetermination
Find first-level appeal and redetermination information.
Open official resource (opens in a new tab)Medicare Secondary Payer
Review Medicare coordination-of-benefits context.
Open official resource (opens in a new tab)CMS Prior Authorization & Pre-Claim Review
Track Medicare FFS prior-authorization initiatives.
Open official resource (opens in a new tab)Medicare Part D & Affordability Resources7 resources
Medicare Part D Overview
Understand the prescription-drug benefit and plan structure.
Open official resource (opens in a new tab)CMS Part D Formulary Guidance
Review prescription-drug coverage and formulary framework.
Open official resource (opens in a new tab)Medicare Plan Compare
Compare health and drug plans by ZIP code.
Open official resource (opens in a new tab)Medicare Prescription Payment Plan
Review CMS guidance on monthly Part D out-of-pocket payments.
Open official resource (opens in a new tab)Part D Coverage Determinations
Review coverage determination and exception processes.
Open official resource (opens in a new tab)Part D Redeterminations
Review redetermination timing and process.
Open official resource (opens in a new tab)SSA Extra Help
Official Extra Help information for prescription-drug costs.
Open official resource (opens in a new tab)Medicaid, CHIP & 340B Resources7 resources
Medicaid State Profiles
Review state Medicaid and CHIP profiles.
Open official resource (opens in a new tab)Medicaid State Overviews
Access federal program summaries and transparency resources.
Open official resource (opens in a new tab)340B Drug Pricing Program
Review HRSA’s official 340B information.
Open official resource (opens in a new tab)340B OPAIS
Search covered entities, contract pharmacies, and manufacturers.
Open official resource (opens in a new tab)340B Covered Entity Search
Verify covered-entity participation.
Open official resource (opens in a new tab)340B Eligibility & Registration
Review eligibility and registration information.
Open official resource (opens in a new tab)HHS Poverty Guidelines
Official income-guideline context.
Open official resource (opens in a new tab)Federal Health Plan & Government Pharmacy Resources6 resources
TRICARE Pharmacy Program
Review TRICARE prescription-drug coverage.
Open official resource (opens in a new tab)TRICARE Prior Authorization / Medical Necessity
Find TRICARE pharmacy authorization forms and guidance.
Open official resource (opens in a new tab)OPM FEHB Plan Compare
Compare FEHB plans; verify benefits in brochures.
Open official resource (opens in a new tab)OPM FEHB Plan Brochures
Access plan brochures and carrier information.
Open official resource (opens in a new tab)VA Formulary Advisor
Search the VA National Formulary and Criteria for Use.
Open official resource (opens in a new tab)IHS National Core Formulary
Review Indian Health Service formulary information.
Open official resource (opens in a new tab)FDA Product, Labeling & Safety Resources9 resources
FDA Drug Approvals & Databases
FDA hub for drug databases and labeling tools.
Open official resource (opens in a new tab)Orange Book
Verify approved small-molecule products and therapeutic equivalence.
Open official resource (opens in a new tab)Purple Book
Verify licensed biologics, biosimilars, and interchangeables.
Open official resource (opens in a new tab)NDC Directory
Search NDC information submitted to FDA.
Open official resource (opens in a new tab)FDA REMS
Review Risk Evaluation and Mitigation Strategies.
Open official resource (opens in a new tab)FDA REMS Public Dashboard
Explore REMS data and public reports.
Open official resource (opens in a new tab)FDA MedWatch
Review safety alerts and adverse-event reporting.
Open official resource (opens in a new tab)ClinicalTrials.gov
Search studies, trial records, and available results.
Open official resource (opens in a new tab)FDA Drug Shortages
Check current FDA shortage information.
Open official resource (opens in a new tab)Compliance, Privacy & Transparency Resources6 resources
HHS HIPAA Privacy Rule
Review federal privacy standards.
Open official resource (opens in a new tab)HHS HIPAA for Professionals
Access HHS/OCR professional guidance.
Open official resource (opens in a new tab)OIG Compliance Guidance
Review OIG compliance-program guidance.
Open official resource (opens in a new tab)OIG Special Fraud Alerts & Bulletins
Track fraud-and-abuse alerts and bulletins.
Open official resource (opens in a new tab)OIG LEIE Exclusions Search
Search excluded individuals and entities.
Open official resource (opens in a new tab)Open Payments
Search CMS Open Payments data.
Open official resource (opens in a new tab)Provider Verification & Enrollment Resources4 resources
NPPES NPI Registry
Look up active NPI records.
Open official resource (opens in a new tab)PECOS
Access Medicare provider enrollment information.
Open official resource (opens in a new tab)Medicare Provider Enrollment
Review enrollment resources for providers and suppliers.
Open official resource (opens in a new tab)PECOS Application Status
Check provider or supplier enrollment application status.
Open official resource (opens in a new tab)FIND THE RIGHT REIMBURSEMENT SOURCE FASTER
Start with the official source, then verify the current requirement.
Use the navigator above for public source research. Member documents and downloads remain inside the protected member library and are not represented by placeholder public cards.