curl --request POST \
--url https://sandbox.rcintell.com/v1/encounter/coverage \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"lines": [
{
"code": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"line_id": "<string>"
}
],
"claim_type": "professional",
"date_of_service": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"payer": "<string>",
"state": "<string>"
}
'import requests
url = "https://sandbox.rcintell.com/v1/encounter/coverage"
payload = {
"lines": [
{
"code": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"line_id": "<string>"
}
],
"claim_type": "professional",
"date_of_service": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"payer": "<string>",
"state": "<string>"
}
headers = {
"X-API-Key": "<api-key>",
"Content-Type": "application/json"
}
response = requests.post(url, json=payload, headers=headers)
print(response.text)const options = {
method: 'POST',
headers: {'X-API-Key': '<api-key>', 'Content-Type': 'application/json'},
body: JSON.stringify({
lines: [
{
code: '<string>',
dx: [{code: '<string>', qualifier: 'ABF'}],
line_id: '<string>'
}
],
claim_type: 'professional',
date_of_service: '<string>',
dx: [{code: '<string>', qualifier: 'ABF'}],
payer: '<string>',
state: '<string>'
})
};
fetch('https://sandbox.rcintell.com/v1/encounter/coverage', options)
.then(res => res.json())
.then(res => console.log(res))
.catch(err => console.error(err));<?php
$curl = curl_init();
curl_setopt_array($curl, [
CURLOPT_URL => "https://sandbox.rcintell.com/v1/encounter/coverage",
CURLOPT_RETURNTRANSFER => true,
CURLOPT_ENCODING => "",
CURLOPT_MAXREDIRS => 10,
CURLOPT_TIMEOUT => 30,
CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
CURLOPT_CUSTOMREQUEST => "POST",
CURLOPT_POSTFIELDS => json_encode([
'lines' => [
[
'code' => '<string>',
'dx' => [
[
'code' => '<string>',
'qualifier' => 'ABF'
]
],
'line_id' => '<string>'
]
],
'claim_type' => 'professional',
'date_of_service' => '<string>',
'dx' => [
[
'code' => '<string>',
'qualifier' => 'ABF'
]
],
'payer' => '<string>',
'state' => '<string>'
]),
CURLOPT_HTTPHEADER => [
"Content-Type: application/json",
"X-API-Key: <api-key>"
],
]);
$response = curl_exec($curl);
$err = curl_error($curl);
curl_close($curl);
if ($err) {
echo "cURL Error #:" . $err;
} else {
echo $response;
}package main
import (
"fmt"
"strings"
"net/http"
"io"
)
func main() {
url := "https://sandbox.rcintell.com/v1/encounter/coverage"
payload := strings.NewReader("{\n \"lines\": [\n {\n \"code\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"line_id\": \"<string>\"\n }\n ],\n \"claim_type\": \"professional\",\n \"date_of_service\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"payer\": \"<string>\",\n \"state\": \"<string>\"\n}")
req, _ := http.NewRequest("POST", url, payload)
req.Header.Add("X-API-Key", "<api-key>")
req.Header.Add("Content-Type", "application/json")
res, _ := http.DefaultClient.Do(req)
defer res.Body.Close()
body, _ := io.ReadAll(res.Body)
fmt.Println(string(body))
}HttpResponse<String> response = Unirest.post("https://sandbox.rcintell.com/v1/encounter/coverage")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"lines\": [\n {\n \"code\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"line_id\": \"<string>\"\n }\n ],\n \"claim_type\": \"professional\",\n \"date_of_service\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"payer\": \"<string>\",\n \"state\": \"<string>\"\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://sandbox.rcintell.com/v1/encounter/coverage")
http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true
request = Net::HTTP::Post.new(url)
request["X-API-Key"] = '<api-key>'
request["Content-Type"] = 'application/json'
request.body = "{\n \"lines\": [\n {\n \"code\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"line_id\": \"<string>\"\n }\n ],\n \"claim_type\": \"professional\",\n \"date_of_service\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"payer\": \"<string>\",\n \"state\": \"<string>\"\n}"
response = http.request(request)
puts response.read_body{
"claim_type": "<string>",
"coverage_clean": true,
"contractor_id": "<string>",
"coverage": [
{
"code": "<string>",
"coverage_status": "<string>",
"dx_required": false,
"geo_scope": "<string>",
"lcd_id": "<string>",
"line_id": "<string>",
"matched_dx": [
"<string>"
],
"ncd_id": "<string>",
"policy_title": "<string>",
"primary_covered": false,
"primary_dx": "<string>",
"source": "<string>",
"source_url": "<string>"
}
],
"date_of_service": "<string>",
"state": "<string>",
"warnings": [
{
"message": "<string>",
"severity": "<string>",
"code": "<string>"
}
]
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}LCD/NCD medical-necessity coverage check
Coverage-only medical-necessity check: match each procedure’s diagnoses against the applicable Medicare local (LCD) and national (NCD) coverage determinations, localized by state → MAC jurisdiction. Does not run NCCI, MUE, timely filing, or payment.
curl --request POST \
--url https://sandbox.rcintell.com/v1/encounter/coverage \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"lines": [
{
"code": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"line_id": "<string>"
}
],
"claim_type": "professional",
"date_of_service": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"payer": "<string>",
"state": "<string>"
}
'import requests
url = "https://sandbox.rcintell.com/v1/encounter/coverage"
payload = {
"lines": [
{
"code": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"line_id": "<string>"
}
],
"claim_type": "professional",
"date_of_service": "<string>",
"dx": [
{
"code": "<string>",
"qualifier": "ABF"
}
],
"payer": "<string>",
"state": "<string>"
}
headers = {
"X-API-Key": "<api-key>",
"Content-Type": "application/json"
}
response = requests.post(url, json=payload, headers=headers)
print(response.text)const options = {
method: 'POST',
headers: {'X-API-Key': '<api-key>', 'Content-Type': 'application/json'},
body: JSON.stringify({
lines: [
{
code: '<string>',
dx: [{code: '<string>', qualifier: 'ABF'}],
line_id: '<string>'
}
],
claim_type: 'professional',
date_of_service: '<string>',
dx: [{code: '<string>', qualifier: 'ABF'}],
payer: '<string>',
state: '<string>'
})
};
fetch('https://sandbox.rcintell.com/v1/encounter/coverage', options)
.then(res => res.json())
.then(res => console.log(res))
.catch(err => console.error(err));<?php
$curl = curl_init();
curl_setopt_array($curl, [
CURLOPT_URL => "https://sandbox.rcintell.com/v1/encounter/coverage",
CURLOPT_RETURNTRANSFER => true,
CURLOPT_ENCODING => "",
CURLOPT_MAXREDIRS => 10,
CURLOPT_TIMEOUT => 30,
CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
CURLOPT_CUSTOMREQUEST => "POST",
CURLOPT_POSTFIELDS => json_encode([
'lines' => [
[
'code' => '<string>',
'dx' => [
[
'code' => '<string>',
'qualifier' => 'ABF'
]
],
'line_id' => '<string>'
]
],
'claim_type' => 'professional',
'date_of_service' => '<string>',
'dx' => [
[
'code' => '<string>',
'qualifier' => 'ABF'
]
],
'payer' => '<string>',
'state' => '<string>'
]),
CURLOPT_HTTPHEADER => [
"Content-Type: application/json",
"X-API-Key: <api-key>"
],
]);
$response = curl_exec($curl);
$err = curl_error($curl);
curl_close($curl);
if ($err) {
echo "cURL Error #:" . $err;
} else {
echo $response;
}package main
import (
"fmt"
"strings"
"net/http"
"io"
)
func main() {
url := "https://sandbox.rcintell.com/v1/encounter/coverage"
payload := strings.NewReader("{\n \"lines\": [\n {\n \"code\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"line_id\": \"<string>\"\n }\n ],\n \"claim_type\": \"professional\",\n \"date_of_service\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"payer\": \"<string>\",\n \"state\": \"<string>\"\n}")
req, _ := http.NewRequest("POST", url, payload)
req.Header.Add("X-API-Key", "<api-key>")
req.Header.Add("Content-Type", "application/json")
res, _ := http.DefaultClient.Do(req)
defer res.Body.Close()
body, _ := io.ReadAll(res.Body)
fmt.Println(string(body))
}HttpResponse<String> response = Unirest.post("https://sandbox.rcintell.com/v1/encounter/coverage")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"lines\": [\n {\n \"code\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"line_id\": \"<string>\"\n }\n ],\n \"claim_type\": \"professional\",\n \"date_of_service\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"payer\": \"<string>\",\n \"state\": \"<string>\"\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://sandbox.rcintell.com/v1/encounter/coverage")
http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true
request = Net::HTTP::Post.new(url)
request["X-API-Key"] = '<api-key>'
request["Content-Type"] = 'application/json'
request.body = "{\n \"lines\": [\n {\n \"code\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"line_id\": \"<string>\"\n }\n ],\n \"claim_type\": \"professional\",\n \"date_of_service\": \"<string>\",\n \"dx\": [\n {\n \"code\": \"<string>\",\n \"qualifier\": \"ABF\"\n }\n ],\n \"payer\": \"<string>\",\n \"state\": \"<string>\"\n}"
response = http.request(request)
puts response.read_body{
"claim_type": "<string>",
"coverage_clean": true,
"contractor_id": "<string>",
"coverage": [
{
"code": "<string>",
"coverage_status": "<string>",
"dx_required": false,
"geo_scope": "<string>",
"lcd_id": "<string>",
"line_id": "<string>",
"matched_dx": [
"<string>"
],
"ncd_id": "<string>",
"policy_title": "<string>",
"primary_covered": false,
"primary_dx": "<string>",
"source": "<string>",
"source_url": "<string>"
}
],
"date_of_service": "<string>",
"state": "<string>",
"warnings": [
{
"message": "<string>",
"severity": "<string>",
"code": "<string>"
}
]
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Authorizations
Body
LCD/NCD medical-necessity coverage check for a claim's procedure lines.
Coverage-only: this evaluates whether each procedure's diagnoses satisfy the applicable Medicare local (LCD) and national (NCD) coverage determinations. It does NOT run NCCI, MUE, timely filing, or payment.
Procedure lines to evaluate
1 - 50 elementsShow child attributes
Show child attributes
professional (per-line DX) or institutional (claim-level DX)
Date of service (YYYY-MM-DD)
Claim-level ICD-10 diagnoses (837 loop 2300 HI). Applied to every line for institutional claims; used as a fallback for professional lines that carry no DX. The ABK-qualified (or first-listed) entry is the principal diagnosis.
Show child attributes
Show child attributes
Reserved: payer overlay on top of the Medicare base layer. Not yet applied — non-Medicare values return the Medicare base with a warning.
2-letter state → MAC jurisdiction for LCD localization (NCDs are national)
Response
Successful Response
Coverage-only medical-necessity assessment for a claim.
True when no line has a coverage blocker (dx_not_on_lcd/dx_required/not_covered)
Resolved MAC jurisdiction, e.g. JL
Show child attributes
Show child attributes
Show child attributes
Show child attributes