Integration pattern

Pre-Submission Enrichment

Before a claim goes to the payer, call RCIntel to check it. This is the highest-value integration — it catches the errors that turn into preventable denials.

For: RCM platforms, billing companies, clearinghouses, EHR vendors

How it works

architecture flow

Your EHR / RCM Platform
  │
  ├─ Claim ready for submission
  │
  ├─ Call RCIntel
  │   ├─ /v1/codes/{code}/payment          Expected payment        (available)
  │   ├─ /v1/codes/{code}/ncci             PTP edits + MUE limits  (available)
  │   └─ /v1/payers/{slug}/filing-deadline Timely-filing window    (available)
  │
  ├─ All checks pass → Submit to payer
  │
  └─ Errors found → Return to user with corrections

Code example

Estimate payment, check the coding edits, and confirm the claim is inside the payer's filing window before you submit:

python

import httpx

async def enrich_claim(api_key: str, claim: dict) -> dict:
    async with httpx.AsyncClient(
        base_url="https://api.your-domain.com",
        headers={"X-API-Key": api_key},
    ) as client:
        # Expected payment for this code at this facility
        pay = (await client.get(
            f"/v1/codes/{claim['cpt_code']}/payment",
            params={"ccn": claim["facility_ccn"],
                    "payer": claim.get("payer", "medicare")},
        )).json()

        # Coding edits: PTP pairs + MUE unit limits
        edits = (await client.get(
            f"/v1/codes/{claim['cpt_code']}/ncci"
        )).json()

        # Payer timely-filing window
        filing = (await client.get(
            f"/v1/payers/{claim['payer_slug']}/filing-deadline",
            params={
                "date_of_service": claim["date_of_service"],
                "plan_type": claim.get("plan_type", "commercial"),
                "state": claim.get("state"),  # USPS; required for Community Plan
            },
        )).json()

    errors = []
    mue = edits.get("mue_limit")
    if mue is not None and claim["units"] > mue:
        errors.append(f"Units {claim['units']} exceed MUE limit {mue}")

    return {
        "valid": len(errors) == 0,
        "errors": errors,
        "expected_payment": pay.get("allowed_amount"),
        "filing_days": filing.get("standard_days"),
        "filing_state_required": filing.get("state_required"),
        "filing_posted_states": filing.get("posted_states"),
        "filing_scope": filing.get("scope_label"),
    }

What it catches

Units over the MUE limit

CARC 4/16

Billed units exceed the medically-unlikely-edit ceiling for the code

PTP edit conflict

CARC 4

Two codes on the claim can't be billed together without a modifier

Expired filing deadline

CARC 29

Claim submitted after the payer's timely filing limit

Payment variance

Underpayment

Expected payment differs from what the claim was built to collect

Start enriching claims

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