curl --request POST \
--url https://sandbox.rcintell.com/v1/encounter/claim-check \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"cpt_codes": [
"<string>"
],
"date_of_service": "<string>",
"payer_slug": "<string>",
"billing_provider": {
"facility_type": "<string>",
"network_status": "<string>",
"state": "<string>",
"type": "<string>"
},
"claim_type": "professional",
"diagnosis_codes": {
"other": [
"<string>"
],
"principal": "<string>"
},
"include_draft_rules": false,
"locality": "<string>",
"member_age": 123,
"place_of_service": "<string>",
"plan_type": "<string>",
"policy_document_ids": [
"<string>"
],
"prior_authorization_numbers": {},
"state": "<string>",
"type_of_bill": "<string>"
}
'import requests
url = "https://sandbox.rcintell.com/v1/encounter/claim-check"
payload = {
"cpt_codes": ["<string>"],
"date_of_service": "<string>",
"payer_slug": "<string>",
"billing_provider": {
"facility_type": "<string>",
"network_status": "<string>",
"state": "<string>",
"type": "<string>"
},
"claim_type": "professional",
"diagnosis_codes": {
"other": ["<string>"],
"principal": "<string>"
},
"include_draft_rules": False,
"locality": "<string>",
"member_age": 123,
"place_of_service": "<string>",
"plan_type": "<string>",
"policy_document_ids": ["<string>"],
"prior_authorization_numbers": {},
"state": "<string>",
"type_of_bill": "<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({
cpt_codes: ['<string>'],
date_of_service: '<string>',
payer_slug: '<string>',
billing_provider: {
facility_type: '<string>',
network_status: '<string>',
state: '<string>',
type: '<string>'
},
claim_type: 'professional',
diagnosis_codes: {other: ['<string>'], principal: '<string>'},
include_draft_rules: false,
locality: '<string>',
member_age: 123,
place_of_service: '<string>',
plan_type: '<string>',
policy_document_ids: ['<string>'],
prior_authorization_numbers: {},
state: '<string>',
type_of_bill: '<string>'
})
};
fetch('https://sandbox.rcintell.com/v1/encounter/claim-check', 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/claim-check",
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([
'cpt_codes' => [
'<string>'
],
'date_of_service' => '<string>',
'payer_slug' => '<string>',
'billing_provider' => [
'facility_type' => '<string>',
'network_status' => '<string>',
'state' => '<string>',
'type' => '<string>'
],
'claim_type' => 'professional',
'diagnosis_codes' => [
'other' => [
'<string>'
],
'principal' => '<string>'
],
'include_draft_rules' => false,
'locality' => '<string>',
'member_age' => 123,
'place_of_service' => '<string>',
'plan_type' => '<string>',
'policy_document_ids' => [
'<string>'
],
'prior_authorization_numbers' => [
],
'state' => '<string>',
'type_of_bill' => '<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/claim-check"
payload := strings.NewReader("{\n \"cpt_codes\": [\n \"<string>\"\n ],\n \"date_of_service\": \"<string>\",\n \"payer_slug\": \"<string>\",\n \"billing_provider\": {\n \"facility_type\": \"<string>\",\n \"network_status\": \"<string>\",\n \"state\": \"<string>\",\n \"type\": \"<string>\"\n },\n \"claim_type\": \"professional\",\n \"diagnosis_codes\": {\n \"other\": [\n \"<string>\"\n ],\n \"principal\": \"<string>\"\n },\n \"include_draft_rules\": false,\n \"locality\": \"<string>\",\n \"member_age\": 123,\n \"place_of_service\": \"<string>\",\n \"plan_type\": \"<string>\",\n \"policy_document_ids\": [\n \"<string>\"\n ],\n \"prior_authorization_numbers\": {},\n \"state\": \"<string>\",\n \"type_of_bill\": \"<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/claim-check")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"cpt_codes\": [\n \"<string>\"\n ],\n \"date_of_service\": \"<string>\",\n \"payer_slug\": \"<string>\",\n \"billing_provider\": {\n \"facility_type\": \"<string>\",\n \"network_status\": \"<string>\",\n \"state\": \"<string>\",\n \"type\": \"<string>\"\n },\n \"claim_type\": \"professional\",\n \"diagnosis_codes\": {\n \"other\": [\n \"<string>\"\n ],\n \"principal\": \"<string>\"\n },\n \"include_draft_rules\": false,\n \"locality\": \"<string>\",\n \"member_age\": 123,\n \"place_of_service\": \"<string>\",\n \"plan_type\": \"<string>\",\n \"policy_document_ids\": [\n \"<string>\"\n ],\n \"prior_authorization_numbers\": {},\n \"state\": \"<string>\",\n \"type_of_bill\": \"<string>\"\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://sandbox.rcintell.com/v1/encounter/claim-check")
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 \"cpt_codes\": [\n \"<string>\"\n ],\n \"date_of_service\": \"<string>\",\n \"payer_slug\": \"<string>\",\n \"billing_provider\": {\n \"facility_type\": \"<string>\",\n \"network_status\": \"<string>\",\n \"state\": \"<string>\",\n \"type\": \"<string>\"\n },\n \"claim_type\": \"professional\",\n \"diagnosis_codes\": {\n \"other\": [\n \"<string>\"\n ],\n \"principal\": \"<string>\"\n },\n \"include_draft_rules\": false,\n \"locality\": \"<string>\",\n \"member_age\": 123,\n \"place_of_service\": \"<string>\",\n \"plan_type\": \"<string>\",\n \"policy_document_ids\": [\n \"<string>\"\n ],\n \"prior_authorization_numbers\": {},\n \"state\": \"<string>\",\n \"type_of_bill\": \"<string>\"\n}"
response = http.request(request)
puts response.read_body{
"codes": [
"<string>"
],
"date_of_service": "<string>",
"payer_slug": "<string>",
"submit_ready": true,
"filing_status": {
"claim_type": "<string>",
"days_remaining": 123,
"deadline_date": "<string>",
"effective_days": 123,
"is_expired": true,
"standard_days": 123,
"override_applied": "<string>"
},
"ncci_clean": true,
"ncci_conflicts": [
{
"code1": "<string>",
"code2": "<string>",
"claim_type": "<string>",
"col1_proc_cd": "<string>",
"col2_proc_cd": "<string>",
"edit_scope": "<string>",
"effective_date": "<string>",
"is_bundled": true,
"modifier_allowed": true,
"modifier_indicator": "<string>",
"payer": "<string>",
"program": "<string>",
"ptp_rationale": "<string>",
"state": "<string>"
}
],
"pa_required_count": 0,
"pa_results": [
{
"code": "<string>",
"confidence": 123,
"determination": "<string>",
"pa_required": true,
"resolution_tier": "<string>",
"auth_type": "<string>",
"authorization_on_claim": true,
"delegation_vendor": "<string>",
"pa_threshold": 123,
"policy_documents": [
{
"document_id": "<string>",
"coverage": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"document_title": "<string>",
"misc_requirements": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"notification": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"other": {},
"prior_authorization": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"site_of_service_review": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
}
}
],
"required_documents": [
"<string>"
],
"threshold_remaining": 123
}
],
"payer_name": "<string>",
"payment_estimates": [
{
"code": "<string>",
"conversion_factor": 123,
"estimated_payment": 123,
"mp_rvu_adjusted": 123,
"pe_rvu_adjusted": 123,
"work_rvu_adjusted": 123,
"facility_rate": true,
"locality": "0000"
}
],
"total_estimated_payment": 0,
"warnings": [
{
"message": "<string>",
"severity": "<string>",
"code": "<string>"
}
]
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Pre-submission claim validation
Validate a finalized claim before submission: NCCI conflicts, timely filing deadline, payment estimates, and go/no-go verdict.
curl --request POST \
--url https://sandbox.rcintell.com/v1/encounter/claim-check \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"cpt_codes": [
"<string>"
],
"date_of_service": "<string>",
"payer_slug": "<string>",
"billing_provider": {
"facility_type": "<string>",
"network_status": "<string>",
"state": "<string>",
"type": "<string>"
},
"claim_type": "professional",
"diagnosis_codes": {
"other": [
"<string>"
],
"principal": "<string>"
},
"include_draft_rules": false,
"locality": "<string>",
"member_age": 123,
"place_of_service": "<string>",
"plan_type": "<string>",
"policy_document_ids": [
"<string>"
],
"prior_authorization_numbers": {},
"state": "<string>",
"type_of_bill": "<string>"
}
'import requests
url = "https://sandbox.rcintell.com/v1/encounter/claim-check"
payload = {
"cpt_codes": ["<string>"],
"date_of_service": "<string>",
"payer_slug": "<string>",
"billing_provider": {
"facility_type": "<string>",
"network_status": "<string>",
"state": "<string>",
"type": "<string>"
},
"claim_type": "professional",
"diagnosis_codes": {
"other": ["<string>"],
"principal": "<string>"
},
"include_draft_rules": False,
"locality": "<string>",
"member_age": 123,
"place_of_service": "<string>",
"plan_type": "<string>",
"policy_document_ids": ["<string>"],
"prior_authorization_numbers": {},
"state": "<string>",
"type_of_bill": "<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({
cpt_codes: ['<string>'],
date_of_service: '<string>',
payer_slug: '<string>',
billing_provider: {
facility_type: '<string>',
network_status: '<string>',
state: '<string>',
type: '<string>'
},
claim_type: 'professional',
diagnosis_codes: {other: ['<string>'], principal: '<string>'},
include_draft_rules: false,
locality: '<string>',
member_age: 123,
place_of_service: '<string>',
plan_type: '<string>',
policy_document_ids: ['<string>'],
prior_authorization_numbers: {},
state: '<string>',
type_of_bill: '<string>'
})
};
fetch('https://sandbox.rcintell.com/v1/encounter/claim-check', 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/claim-check",
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([
'cpt_codes' => [
'<string>'
],
'date_of_service' => '<string>',
'payer_slug' => '<string>',
'billing_provider' => [
'facility_type' => '<string>',
'network_status' => '<string>',
'state' => '<string>',
'type' => '<string>'
],
'claim_type' => 'professional',
'diagnosis_codes' => [
'other' => [
'<string>'
],
'principal' => '<string>'
],
'include_draft_rules' => false,
'locality' => '<string>',
'member_age' => 123,
'place_of_service' => '<string>',
'plan_type' => '<string>',
'policy_document_ids' => [
'<string>'
],
'prior_authorization_numbers' => [
],
'state' => '<string>',
'type_of_bill' => '<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/claim-check"
payload := strings.NewReader("{\n \"cpt_codes\": [\n \"<string>\"\n ],\n \"date_of_service\": \"<string>\",\n \"payer_slug\": \"<string>\",\n \"billing_provider\": {\n \"facility_type\": \"<string>\",\n \"network_status\": \"<string>\",\n \"state\": \"<string>\",\n \"type\": \"<string>\"\n },\n \"claim_type\": \"professional\",\n \"diagnosis_codes\": {\n \"other\": [\n \"<string>\"\n ],\n \"principal\": \"<string>\"\n },\n \"include_draft_rules\": false,\n \"locality\": \"<string>\",\n \"member_age\": 123,\n \"place_of_service\": \"<string>\",\n \"plan_type\": \"<string>\",\n \"policy_document_ids\": [\n \"<string>\"\n ],\n \"prior_authorization_numbers\": {},\n \"state\": \"<string>\",\n \"type_of_bill\": \"<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/claim-check")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"cpt_codes\": [\n \"<string>\"\n ],\n \"date_of_service\": \"<string>\",\n \"payer_slug\": \"<string>\",\n \"billing_provider\": {\n \"facility_type\": \"<string>\",\n \"network_status\": \"<string>\",\n \"state\": \"<string>\",\n \"type\": \"<string>\"\n },\n \"claim_type\": \"professional\",\n \"diagnosis_codes\": {\n \"other\": [\n \"<string>\"\n ],\n \"principal\": \"<string>\"\n },\n \"include_draft_rules\": false,\n \"locality\": \"<string>\",\n \"member_age\": 123,\n \"place_of_service\": \"<string>\",\n \"plan_type\": \"<string>\",\n \"policy_document_ids\": [\n \"<string>\"\n ],\n \"prior_authorization_numbers\": {},\n \"state\": \"<string>\",\n \"type_of_bill\": \"<string>\"\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://sandbox.rcintell.com/v1/encounter/claim-check")
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 \"cpt_codes\": [\n \"<string>\"\n ],\n \"date_of_service\": \"<string>\",\n \"payer_slug\": \"<string>\",\n \"billing_provider\": {\n \"facility_type\": \"<string>\",\n \"network_status\": \"<string>\",\n \"state\": \"<string>\",\n \"type\": \"<string>\"\n },\n \"claim_type\": \"professional\",\n \"diagnosis_codes\": {\n \"other\": [\n \"<string>\"\n ],\n \"principal\": \"<string>\"\n },\n \"include_draft_rules\": false,\n \"locality\": \"<string>\",\n \"member_age\": 123,\n \"place_of_service\": \"<string>\",\n \"plan_type\": \"<string>\",\n \"policy_document_ids\": [\n \"<string>\"\n ],\n \"prior_authorization_numbers\": {},\n \"state\": \"<string>\",\n \"type_of_bill\": \"<string>\"\n}"
response = http.request(request)
puts response.read_body{
"codes": [
"<string>"
],
"date_of_service": "<string>",
"payer_slug": "<string>",
"submit_ready": true,
"filing_status": {
"claim_type": "<string>",
"days_remaining": 123,
"deadline_date": "<string>",
"effective_days": 123,
"is_expired": true,
"standard_days": 123,
"override_applied": "<string>"
},
"ncci_clean": true,
"ncci_conflicts": [
{
"code1": "<string>",
"code2": "<string>",
"claim_type": "<string>",
"col1_proc_cd": "<string>",
"col2_proc_cd": "<string>",
"edit_scope": "<string>",
"effective_date": "<string>",
"is_bundled": true,
"modifier_allowed": true,
"modifier_indicator": "<string>",
"payer": "<string>",
"program": "<string>",
"ptp_rationale": "<string>",
"state": "<string>"
}
],
"pa_required_count": 0,
"pa_results": [
{
"code": "<string>",
"confidence": 123,
"determination": "<string>",
"pa_required": true,
"resolution_tier": "<string>",
"auth_type": "<string>",
"authorization_on_claim": true,
"delegation_vendor": "<string>",
"pa_threshold": 123,
"policy_documents": [
{
"document_id": "<string>",
"coverage": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"document_title": "<string>",
"misc_requirements": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"notification": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"other": {},
"prior_authorization": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
},
"site_of_service_review": {
"value": "<string>",
"because": "<string>",
"near_miss": [
{}
],
"pages": [
123
],
"rule_id": "<string>",
"rule_ids": [
"<string>"
],
"section": "<string>"
}
}
],
"required_documents": [
"<string>"
],
"threshold_remaining": 123
}
],
"payer_name": "<string>",
"payment_estimates": [
{
"code": "<string>",
"conversion_factor": 123,
"estimated_payment": 123,
"mp_rvu_adjusted": 123,
"pe_rvu_adjusted": 123,
"work_rvu_adjusted": 123,
"facility_rate": true,
"locality": "0000"
}
],
"total_estimated_payment": 0,
"warnings": [
{
"message": "<string>",
"severity": "<string>",
"code": "<string>"
}
]
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Authorizations
Body
Pre-submission claim validation — lighter than encounter check.
Finalized CPT/HCPCS codes on the claim
1 - 25 elementsDate of service (YYYY-MM-DD)
Payer slug
The rendering / billing provider, for document rules that depend on it.
Show child attributes
Show child attributes
Claim type: professional, institutional, dental
Show child attributes
Show child attributes
Also use draft (unreviewed) rules
GPCI locality code
Member age in years
POS code or CMS name, e.g. '22'
Plan type for filing rule overrides
Parsed payer policy documents whose approved rules to apply
Authorization number per code, e.g. {'J0897': 'A12345'}
Show child attributes
Show child attributes
State code for filing rule overrides
Institutional type of bill, e.g. '0131' (013x = outpatient, 011x = inpatient)
Response
Successful Response
Pre-submission claim validation result.
True when no blockers found (NCCI clean + filing valid)
Timely filing status for the claim.
Show child attributes
Show child attributes
Show child attributes
Show child attributes
PA per code from the requested payer policy documents
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes