> ## Documentation Index
> Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Pre-visit encounter readiness check

> Full encounter readiness assessment: PA status, NCCI validation,
GPCI-adjusted payment estimates, and billing warnings — all in one call.



## OpenAPI

````yaml /docs/openapi.client.json post /v1/encounter/check
openapi: 3.1.0
info:
  description: >-
    Client API for RCIntel. Admin ingest, catalog sync, and internal audit
    routes are omitted. See Guides → Which API to use.
  summary: Multi-tenant knowledge API for healthcare revenue cycle management.
  title: Healthcare Knowledge Layer
  version: 0.1.0
servers: []
security: []
tags:
  - description: >-
      Geographic payer policy lookup (national NCD vs MAC LCD vs state). Query
      payer, code, state, plan_type. Each row includes geo_scope and
      document_version.
    name: policies
  - description: >-
      Payer network directory — search payers, check prior auth requirements,
      view filing rules, denial patterns, and appeal levels.
    name: payers
  - description: >-
      Resolve healthcare billing knowledge across the L1-L6 layer stack.
      Includes payment calculation, billing guidance, and per-layer queries.
    name: knowledge
  - description: >-
      CMS Fee Schedule lookups — OPPS (Addendum B / APC), DMEPOS (state-level
      pricing), and Clinical Lab Fee Schedule (CLFS).
    name: fee-schedules
  - description: >-
      NCCI (National Correct Coding Initiative) — dedicated MUE limits, PTP
      bundling edits, add-on code edits, and code pair validation.
    name: ncci
  - description: >-
      Service code intelligence — CPT/HCPCS lookup, RVU data, NCCI edits,
      payment calculation, implant/GUDID search, and service group
      classification.
    name: codes
  - description: >-
      Submit asynchronous AI agent jobs for code research, medical necessity,
      and denial resolution. Poll for results and retrieve reasoning traces.
    name: agents
  - description: >-
      Register and manage healthcare facilities by CCN (Medicare Provider
      Number). Each facility is the root entity for knowledge resolution.
    name: facilities
  - description: >-
      NPI Registry — live search against CMS NPPES API for provider and
      organization National Provider Identifiers.
    name: npi
  - description: >-
      OpenFDA drug product lookup by NDC. Includes product-level fields with
      normalized ingredient and package detail.
    name: drugs
  - description: Health checks, service metadata, and Prometheus metrics.
    name: system
paths:
  /v1/encounter/check:
    post:
      tags:
        - encounter
      summary: Pre-visit encounter readiness check
      description: |-
        Full encounter readiness assessment: PA status, NCCI validation,
        GPCI-adjusted payment estimates, and billing warnings — all in one call.
      operationId: check_encounter_v1_encounter_check_post
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/EncounterCheckRequest'
        required: true
      responses:
        '200':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EncounterCheckResponse'
          description: Successful Response
        '422':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
          description: Validation Error
      security:
        - APIKeyHeader: []
components:
  schemas:
    EncounterCheckRequest:
      description: >-
        Pre-visit encounter readiness check — bundles PA, NCCI, payment, and
        billing.
      properties:
        ccn:
          anyOf:
            - type: string
            - type: 'null'
          description: Facility CCN (enables GPCI + billing guide)
          title: Ccn
        cpt_codes:
          description: CPT/HCPCS codes planned for the encounter
          items:
            type: string
          maxItems: 25
          minItems: 1
          title: Cpt Codes
          type: array
        date_of_service:
          anyOf:
            - type: string
            - type: 'null'
          description: Planned date of service (YYYY-MM-DD)
          title: Date Of Service
        locality:
          anyOf:
            - type: string
            - type: 'null'
          description: GPCI locality code for payment estimates
          title: Locality
        payer_slug:
          description: Payer slug or alias
          title: Payer Slug
          type: string
        place_of_service:
          anyOf:
            - type: string
            - type: 'null'
          description: Place of service code (e.g. 11=office)
          title: Place Of Service
        plan_type:
          anyOf:
            - type: string
            - type: 'null'
          description: 'Plan type: commercial, medicaid, hmo, etc.'
          title: Plan Type
        service_category:
          anyOf:
            - type: string
            - type: 'null'
          description: Service category for PA fallback
          title: Service Category
        state:
          anyOf:
            - type: string
            - type: 'null'
          description: State abbreviation for state-specific rules
          title: State
        visit_count:
          anyOf:
            - type: integer
            - type: 'null'
          description: Current visit count for threshold checks
          title: Visit Count
      required:
        - payer_slug
        - cpt_codes
      title: EncounterCheckRequest
      type: object
    EncounterCheckResponse:
      description: Complete encounter readiness assessment.
      properties:
        ccn:
          anyOf:
            - type: string
            - type: 'null'
          title: Ccn
        codes:
          items:
            type: string
          title: Codes
          type: array
        date_of_service:
          anyOf:
            - type: string
            - type: 'null'
          title: Date Of Service
        encounter_ready:
          description: True when no critical blockers found
          title: Encounter Ready
          type: boolean
        ncci_clean:
          default: true
          title: Ncci Clean
          type: boolean
        ncci_conflicts:
          items:
            $ref: '#/components/schemas/NCCIBatchConflict'
          title: Ncci Conflicts
          type: array
        pa_required_count:
          default: 0
          title: Pa Required Count
          type: integer
        pa_results:
          items:
            $ref: '#/components/schemas/EncounterPAResult'
          title: Pa Results
          type: array
        payer_name:
          anyOf:
            - type: string
            - type: 'null'
          title: Payer Name
        payer_slug:
          title: Payer Slug
          type: string
        payment_estimates:
          items:
            $ref: '#/components/schemas/EncounterPaymentEstimate'
          title: Payment Estimates
          type: array
        total_estimated_payment:
          default: 0
          title: Total Estimated Payment
          type: number
        warnings:
          items:
            $ref: '#/components/schemas/EncounterWarning'
          title: Warnings
          type: array
      required:
        - payer_slug
        - codes
        - encounter_ready
      title: EncounterCheckResponse
      type: object
    HTTPValidationError:
      properties:
        detail:
          items:
            $ref: '#/components/schemas/ValidationError'
          title: Detail
          type: array
      title: HTTPValidationError
      type: object
    NCCIBatchConflict:
      description: A single PTP conflict found within the batch.
      properties:
        claim_type:
          anyOf:
            - type: string
            - type: 'null'
          title: Claim Type
        code1:
          title: Code1
          type: string
        code2:
          title: Code2
          type: string
        col1_proc_cd:
          anyOf:
            - type: string
            - type: 'null'
          title: Col1 Proc Cd
        col2_proc_cd:
          anyOf:
            - type: string
            - type: 'null'
          title: Col2 Proc Cd
        effective_date:
          anyOf:
            - type: string
            - type: 'null'
          title: Effective Date
        is_bundled:
          default: true
          title: Is Bundled
          type: boolean
        modifier_allowed:
          anyOf:
            - type: boolean
            - type: 'null'
          title: Modifier Allowed
        modifier_indicator:
          anyOf:
            - type: string
            - type: 'null'
          title: Modifier Indicator
        ptp_rationale:
          anyOf:
            - type: string
            - type: 'null'
          title: Ptp Rationale
      required:
        - code1
        - code2
      title: NCCIBatchConflict
      type: object
    EncounterPAResult:
      description: PA determination for a single code in the encounter.
      properties:
        auth_type:
          anyOf:
            - type: string
            - type: 'null'
          title: Auth Type
        code:
          title: Code
          type: string
        confidence:
          title: Confidence
          type: number
        delegation_vendor:
          anyOf:
            - type: string
            - type: 'null'
          title: Delegation Vendor
        determination:
          title: Determination
          type: string
        pa_required:
          title: Pa Required
          type: boolean
        pa_threshold:
          anyOf:
            - type: integer
            - type: 'null'
          title: Pa Threshold
        required_documents:
          items:
            type: string
          title: Required Documents
          type: array
        resolution_tier:
          title: Resolution Tier
          type: string
        threshold_remaining:
          anyOf:
            - type: integer
            - type: 'null'
          title: Threshold Remaining
      required:
        - code
        - pa_required
        - determination
        - confidence
        - resolution_tier
      title: EncounterPAResult
      type: object
    EncounterPaymentEstimate:
      description: Payment estimate for a single code.
      properties:
        code:
          title: Code
          type: string
        conversion_factor:
          title: Conversion Factor
          type: number
        estimated_payment:
          title: Estimated Payment
          type: number
        facility_rate:
          default: true
          title: Facility Rate
          type: boolean
        locality:
          default: '0000'
          title: Locality
          type: string
        mp_rvu_adjusted:
          title: Mp Rvu Adjusted
          type: number
        pe_rvu_adjusted:
          title: Pe Rvu Adjusted
          type: number
        work_rvu_adjusted:
          title: Work Rvu Adjusted
          type: number
      required:
        - code
        - estimated_payment
        - work_rvu_adjusted
        - pe_rvu_adjusted
        - mp_rvu_adjusted
        - conversion_factor
      title: EncounterPaymentEstimate
      type: object
    EncounterWarning:
      description: A warning or advisory generated during encounter analysis.
      properties:
        code:
          anyOf:
            - type: string
            - type: 'null'
          title: Code
        message:
          title: Message
          type: string
        severity:
          description: info, warning, or critical
          title: Severity
          type: string
      required:
        - severity
        - message
      title: EncounterWarning
      type: object
    ValidationError:
      properties:
        ctx:
          title: Context
          type: object
        input:
          title: Input
        loc:
          items:
            anyOf:
              - type: string
              - type: integer
          title: Location
          type: array
        msg:
          title: Message
          type: string
        type:
          title: Error Type
          type: string
      required:
        - loc
        - msg
        - type
      title: ValidationError
      type: object
  securitySchemes:
    APIKeyHeader:
      in: header
      name: X-API-Key
      type: apiKey

````