curl --request POST \
--url https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"ccn": "170001",
"dx": [
"M17.11",
"E11.9"
],
"lines": [
{
"code": "99213",
"units": 1
},
{
"code": "36415",
"units": 1
}
]
}
'import requests
url = "https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim"
payload = {
"ccn": "170001",
"dx": ["M17.11", "E11.9"],
"lines": [
{
"code": "99213",
"units": 1
},
{
"code": "36415",
"units": 1
}
]
}
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({
ccn: '170001',
dx: ['M17.11', 'E11.9'],
lines: [{code: '99213', units: 1}, {code: '36415', units: 1}]
})
};
fetch('https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim', 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://api-dev.rcintell.com/v1/knowledge/payment-calc/claim",
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([
'ccn' => '170001',
'dx' => [
'M17.11',
'E11.9'
],
'lines' => [
[
'code' => '99213',
'units' => 1
],
[
'code' => '36415',
'units' => 1
]
]
]),
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://api-dev.rcintell.com/v1/knowledge/payment-calc/claim"
payload := strings.NewReader("{\n \"ccn\": \"170001\",\n \"dx\": [\n \"M17.11\",\n \"E11.9\"\n ],\n \"lines\": [\n {\n \"code\": \"99213\",\n \"units\": 1\n },\n {\n \"code\": \"36415\",\n \"units\": 1\n }\n ]\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://api-dev.rcintell.com/v1/knowledge/payment-calc/claim")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"ccn\": \"170001\",\n \"dx\": [\n \"M17.11\",\n \"E11.9\"\n ],\n \"lines\": [\n {\n \"code\": \"99213\",\n \"units\": 1\n },\n {\n \"code\": \"36415\",\n \"units\": 1\n }\n ]\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim")
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 \"ccn\": \"170001\",\n \"dx\": [\n \"M17.11\",\n \"E11.9\"\n ],\n \"lines\": [\n {\n \"code\": \"99213\",\n \"units\": 1\n },\n {\n \"code\": \"36415\",\n \"units\": 1\n }\n ]\n}"
response = http.request(request)
puts response.read_body{
"ccn": "<string>",
"lines": [
{
"code": "<string>",
"line_id": "<string>",
"dme_allowed": 123,
"facility_allowed": 123,
"found": true,
"lab_allowed": 123,
"modifier": "<string>",
"mue_exceeded": false,
"mue_value": 123,
"multiple_procedure_discount": 1,
"notes": [
"<string>"
],
"opps_status_indicator": "<string>",
"packaged": false,
"payment": {
"code": "<string>",
"conversion_factor": 123,
"applicable_blocks": [
"<string>"
],
"ccn": "<string>",
"date_of_service": "<string>",
"dme": {
"allowed_dme_payment": 123,
"dme_payment_rate": 123,
"is_rural": false,
"rate_used": "non_rural",
"state": "<string>"
},
"estimated_payment": 123,
"facility": {
"ccn": "<string>",
"cbsa": "<string>",
"county": "<string>",
"facility_type": "<string>",
"is_rural": true,
"locality_name": "<string>",
"locality_number": "<string>",
"name": "<string>",
"pos_code": "<string>",
"registered": true,
"state": "<string>",
"wage_index": 123
},
"facility_rate": true,
"lab": {
"allowed_lab_payment": 123,
"lab_payment_rate": 123,
"indicator": "<string>"
},
"locality": "<string>",
"mp_gpci": 123,
"mp_rvu_adjusted": 123,
"outpatient_facility": {
"allowed_fac_payment": 123,
"opps_payment_rate": 123,
"apc_code": "<string>",
"labor_share": 0.6,
"non_labor_share": 0.4,
"relative_weight": 123,
"status_indicator": "<string>",
"wage_index": 1
},
"pe_gpci": 123,
"pe_rvu_adjusted": 123,
"physician": {
"allowed_phy_payment": 123,
"conversion_factor": 123,
"mp_gpci": 123,
"mp_rvu": 123,
"mp_rvu_adjusted": 123,
"pe_gpci": 123,
"pe_rvu": 123,
"pe_rvu_adjusted": 123,
"pw_gpci": 123,
"total_adjusted_rvu": 123,
"work_rvu": 123,
"work_rvu_adjusted": 123,
"pe_rvu_source": "facility",
"rvu_quarter": 123,
"rvu_source": "postgres",
"rvu_year": 123
},
"policy_rules": [
{
"code": "<string>",
"doc_id": "<string>",
"kind": "<string>",
"pdf_uri": "<string>",
"rule_text": "<string>",
"source_key": "<string>",
"action": "<string>",
"change_type": "<string>",
"discovery_depth": 0,
"effective_from": "<string>",
"license_kind": "public",
"lineage_root_doc_id": "<string>",
"parent_doc_id": "<string>",
"trigger_condition": "<string>"
}
],
"pw_gpci": 123,
"qpp": true,
"reliability": {
"generated_at": "<string>",
"data_sources": {},
"dataset_versions": {},
"degraded": false,
"warnings": [
"<string>"
]
},
"total_adjusted_rvu": 123,
"work_rvu_adjusted": 123
},
"physician_allowed": 123,
"units": 1
}
],
"totals": {
"dme": 0,
"lab": 0,
"outpatient_facility": 0,
"physician": 0
},
"applicable_blocks": [
"<string>"
],
"coverage": [
{
"code": "<string>",
"coverage_status": "<string>",
"dx_required": false,
"lcd_id": "<string>",
"matched_dx": [
"<string>"
],
"ncd_id": "<string>",
"source_url": "<string>"
}
],
"dx": [
"<string>"
],
"methodology": "<string>",
"ncci_clean": true,
"ncci_conflicts": [
{
"code1": "<string>",
"code2": "<string>",
"claim_type": "<string>",
"col1_proc_cd": "<string>",
"col2_proc_cd": "<string>",
"effective_date": "<string>",
"is_bundled": true,
"modifier_allowed": true,
"modifier_indicator": "<string>",
"ptp_rationale": "<string>"
}
],
"policy_rules": [
{
"code": "<string>",
"doc_id": "<string>",
"kind": "<string>",
"pdf_uri": "<string>",
"rule_text": "<string>",
"source_key": "<string>",
"action": "<string>",
"change_type": "<string>",
"discovery_depth": 0,
"effective_from": "<string>",
"license_kind": "public",
"lineage_root_doc_id": "<string>",
"parent_doc_id": "<string>",
"trigger_condition": "<string>"
}
],
"reliability": {
"generated_at": "<string>",
"data_sources": {},
"dataset_versions": {},
"degraded": false,
"warnings": [
"<string>"
]
}
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Calculate claim-scoped payment
Compose payment for a whole claim: lines[] plus dx[] at a CCN.
Each line runs the same four-block composer as GET /v1/codes/{code}/payment.
OPPS status-indicator packaging (N / Q1 / Q2 / J1) and T-status 50%
multiple-procedure reduction are applied across the claim. NCCI PTP is
checked on unique codes; MUE is compared to summed units per code. LCD
covered DX (when loaded) is matched against dx.
curl --request POST \
--url https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"ccn": "170001",
"dx": [
"M17.11",
"E11.9"
],
"lines": [
{
"code": "99213",
"units": 1
},
{
"code": "36415",
"units": 1
}
]
}
'import requests
url = "https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim"
payload = {
"ccn": "170001",
"dx": ["M17.11", "E11.9"],
"lines": [
{
"code": "99213",
"units": 1
},
{
"code": "36415",
"units": 1
}
]
}
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({
ccn: '170001',
dx: ['M17.11', 'E11.9'],
lines: [{code: '99213', units: 1}, {code: '36415', units: 1}]
})
};
fetch('https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim', 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://api-dev.rcintell.com/v1/knowledge/payment-calc/claim",
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([
'ccn' => '170001',
'dx' => [
'M17.11',
'E11.9'
],
'lines' => [
[
'code' => '99213',
'units' => 1
],
[
'code' => '36415',
'units' => 1
]
]
]),
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://api-dev.rcintell.com/v1/knowledge/payment-calc/claim"
payload := strings.NewReader("{\n \"ccn\": \"170001\",\n \"dx\": [\n \"M17.11\",\n \"E11.9\"\n ],\n \"lines\": [\n {\n \"code\": \"99213\",\n \"units\": 1\n },\n {\n \"code\": \"36415\",\n \"units\": 1\n }\n ]\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://api-dev.rcintell.com/v1/knowledge/payment-calc/claim")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"ccn\": \"170001\",\n \"dx\": [\n \"M17.11\",\n \"E11.9\"\n ],\n \"lines\": [\n {\n \"code\": \"99213\",\n \"units\": 1\n },\n {\n \"code\": \"36415\",\n \"units\": 1\n }\n ]\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://api-dev.rcintell.com/v1/knowledge/payment-calc/claim")
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 \"ccn\": \"170001\",\n \"dx\": [\n \"M17.11\",\n \"E11.9\"\n ],\n \"lines\": [\n {\n \"code\": \"99213\",\n \"units\": 1\n },\n {\n \"code\": \"36415\",\n \"units\": 1\n }\n ]\n}"
response = http.request(request)
puts response.read_body{
"ccn": "<string>",
"lines": [
{
"code": "<string>",
"line_id": "<string>",
"dme_allowed": 123,
"facility_allowed": 123,
"found": true,
"lab_allowed": 123,
"modifier": "<string>",
"mue_exceeded": false,
"mue_value": 123,
"multiple_procedure_discount": 1,
"notes": [
"<string>"
],
"opps_status_indicator": "<string>",
"packaged": false,
"payment": {
"code": "<string>",
"conversion_factor": 123,
"applicable_blocks": [
"<string>"
],
"ccn": "<string>",
"date_of_service": "<string>",
"dme": {
"allowed_dme_payment": 123,
"dme_payment_rate": 123,
"is_rural": false,
"rate_used": "non_rural",
"state": "<string>"
},
"estimated_payment": 123,
"facility": {
"ccn": "<string>",
"cbsa": "<string>",
"county": "<string>",
"facility_type": "<string>",
"is_rural": true,
"locality_name": "<string>",
"locality_number": "<string>",
"name": "<string>",
"pos_code": "<string>",
"registered": true,
"state": "<string>",
"wage_index": 123
},
"facility_rate": true,
"lab": {
"allowed_lab_payment": 123,
"lab_payment_rate": 123,
"indicator": "<string>"
},
"locality": "<string>",
"mp_gpci": 123,
"mp_rvu_adjusted": 123,
"outpatient_facility": {
"allowed_fac_payment": 123,
"opps_payment_rate": 123,
"apc_code": "<string>",
"labor_share": 0.6,
"non_labor_share": 0.4,
"relative_weight": 123,
"status_indicator": "<string>",
"wage_index": 1
},
"pe_gpci": 123,
"pe_rvu_adjusted": 123,
"physician": {
"allowed_phy_payment": 123,
"conversion_factor": 123,
"mp_gpci": 123,
"mp_rvu": 123,
"mp_rvu_adjusted": 123,
"pe_gpci": 123,
"pe_rvu": 123,
"pe_rvu_adjusted": 123,
"pw_gpci": 123,
"total_adjusted_rvu": 123,
"work_rvu": 123,
"work_rvu_adjusted": 123,
"pe_rvu_source": "facility",
"rvu_quarter": 123,
"rvu_source": "postgres",
"rvu_year": 123
},
"policy_rules": [
{
"code": "<string>",
"doc_id": "<string>",
"kind": "<string>",
"pdf_uri": "<string>",
"rule_text": "<string>",
"source_key": "<string>",
"action": "<string>",
"change_type": "<string>",
"discovery_depth": 0,
"effective_from": "<string>",
"license_kind": "public",
"lineage_root_doc_id": "<string>",
"parent_doc_id": "<string>",
"trigger_condition": "<string>"
}
],
"pw_gpci": 123,
"qpp": true,
"reliability": {
"generated_at": "<string>",
"data_sources": {},
"dataset_versions": {},
"degraded": false,
"warnings": [
"<string>"
]
},
"total_adjusted_rvu": 123,
"work_rvu_adjusted": 123
},
"physician_allowed": 123,
"units": 1
}
],
"totals": {
"dme": 0,
"lab": 0,
"outpatient_facility": 0,
"physician": 0
},
"applicable_blocks": [
"<string>"
],
"coverage": [
{
"code": "<string>",
"coverage_status": "<string>",
"dx_required": false,
"lcd_id": "<string>",
"matched_dx": [
"<string>"
],
"ncd_id": "<string>",
"source_url": "<string>"
}
],
"dx": [
"<string>"
],
"methodology": "<string>",
"ncci_clean": true,
"ncci_conflicts": [
{
"code1": "<string>",
"code2": "<string>",
"claim_type": "<string>",
"col1_proc_cd": "<string>",
"col2_proc_cd": "<string>",
"effective_date": "<string>",
"is_bundled": true,
"modifier_allowed": true,
"modifier_indicator": "<string>",
"ptp_rationale": "<string>"
}
],
"policy_rules": [
{
"code": "<string>",
"doc_id": "<string>",
"kind": "<string>",
"pdf_uri": "<string>",
"rule_text": "<string>",
"source_key": "<string>",
"action": "<string>",
"change_type": "<string>",
"discovery_depth": 0,
"effective_from": "<string>",
"license_kind": "public",
"lineage_root_doc_id": "<string>",
"parent_doc_id": "<string>",
"trigger_condition": "<string>"
}
],
"reliability": {
"generated_at": "<string>",
"data_sources": {},
"dataset_versions": {},
"degraded": false,
"warnings": [
"<string>"
]
}
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Authorizations
Body
Claim-scoped payment composition: many lines + a DX list at one CCN.
6-digit Medicare Provider Number
^\d{6}$1 - 25 elementsShow child attributes
Show child attributes
YYYY-MM-DD for NCCI/MUE versioning
ICD-10-CM diagnosis codes
Payer name (unused by fee-schedule math)
Claim-level POS default
Use QPP conversion factor
Response
Per-line allowed amounts, OPPS packaging, NCCI, DX coverage
Claim rollup: per-line allowed, OPPS packaging, NCCI, DX coverage.
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
User-visible reliability metadata attached to API responses.
Show child attributes
Show child attributes