Calculate Medi-Cal APR-DRG payment
curl --request POST \
--url https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"apr_drg": "194",
"length_of_stay": 3,
"oshpd_id": "106010735",
"patient_age": 64,
"soi": 1,
"total_charges": 50000
}
'import requests
url = "https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment"
payload = {
"apr_drg": "194",
"length_of_stay": 3,
"oshpd_id": "106010735",
"patient_age": 64,
"soi": 1,
"total_charges": 50000
}
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({
apr_drg: '194',
length_of_stay: 3,
oshpd_id: '106010735',
patient_age: 64,
soi: 1,
total_charges: 50000
})
};
fetch('https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment', 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/medi-cal/apr-drg/payment",
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([
'apr_drg' => '194',
'length_of_stay' => 3,
'oshpd_id' => '106010735',
'patient_age' => 64,
'soi' => 1,
'total_charges' => 50000
]),
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/medi-cal/apr-drg/payment"
payload := strings.NewReader("{\n \"apr_drg\": \"194\",\n \"length_of_stay\": 3,\n \"oshpd_id\": \"106010735\",\n \"patient_age\": 64,\n \"soi\": 1,\n \"total_charges\": 50000\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/medi-cal/apr-drg/payment")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"apr_drg\": \"194\",\n \"length_of_stay\": 3,\n \"oshpd_id\": \"106010735\",\n \"patient_age\": 64,\n \"soi\": 1,\n \"total_charges\": 50000\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment")
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 \"apr_drg\": \"194\",\n \"length_of_stay\": 3,\n \"oshpd_id\": \"106010735\",\n \"patient_age\": 64,\n \"soi\": 1,\n \"total_charges\": 50000\n}"
response = http.request(request)
puts response.read_body{
"allowed_amount": 123,
"calculation": {
"add_on_amount": 123,
"allowed_after_transfer_adjustment": 123,
"allowed_amount": 123,
"case_margin_status": "<string>",
"drg_base_payment": 123,
"drg_base_rate": 123,
"drg_payment_so_far": 123,
"estimated_cost": 123,
"estimated_gain": 123,
"estimated_loss": 123,
"high_side_outlier_applies": true,
"high_side_outlier_payment_increase": 123,
"interim_claim_payment": 123,
"lesser_of_amount": 123,
"low_side_outlier_applies": true,
"low_side_outlier_payment_decrease": 123,
"national_average_los": 123,
"payment_amount": 123,
"payment_relative_weight": 123,
"policy_adjustor_code": "<string>",
"policy_adjustor_value": 123,
"transfer_payment_adjustment": 123
},
"drg": {
"apr_drg": "<string>",
"description": "<string>",
"hsrv_casemix_relative_weight": 123,
"medicaid_care_category_adult": "<string>",
"medicaid_care_category_pediatric": "<string>",
"national_average_los": 123,
"policy_adjustor_a": 123,
"policy_adjustor_b": 123,
"policy_adjustor_c": 123,
"policy_adjustor_d": 123
},
"fiscal_year": "<string>",
"hospital": {
"admin2_level_190_rate": 123,
"admin2_level_199_rate": 123,
"ca_neutrality_adjusted_wage_index": 123,
"cost_to_charge_ratio": 123,
"designated_nicu": true,
"dhcs_designated_remote_rural": true,
"dph": true,
"ndph": true,
"oshpd_id": "<string>",
"oshpd_rural_hospital": true,
"provider_name": "<string>",
"rehab_rate": 123,
"unadjusted_base_rate": 123,
"wage_adjusted_base_rate": 123,
"wage_index": 123
},
"payer": "<string>",
"payment_amount": 123,
"policy": {
"add_on_amount": 123,
"casemix_adjustment_factor": 123,
"cost_outlier_threshold": 123,
"interim_claim_threshold": 123,
"interim_per_diem_amount": 123,
"marginal_cost_percentage": 123
},
"reliability": {
"generated_at": "<string>",
"data_sources": {},
"dataset_versions": {},
"degraded": false,
"warnings": [
"<string>"
]
},
"total_base_payment": 123,
"caveats": [
"<string>"
],
"discharge_date": "<string>"
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}knowledge
Calculate Medi-Cal APR-DRG payment
SFY 2025-26 Medi-Cal APR-DRG payment for an already-grouped APR-DRG+SOI.
Uses the DHCS calculator workbook (hospital characteristics, DRG table, policy constants). Does not group diagnoses or procedures.
POST
/
v1
/
medi-cal
/
apr-drg
/
payment
Calculate Medi-Cal APR-DRG payment
curl --request POST \
--url https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment \
--header 'Content-Type: application/json' \
--header 'X-API-Key: <api-key>' \
--data '
{
"apr_drg": "194",
"length_of_stay": 3,
"oshpd_id": "106010735",
"patient_age": 64,
"soi": 1,
"total_charges": 50000
}
'import requests
url = "https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment"
payload = {
"apr_drg": "194",
"length_of_stay": 3,
"oshpd_id": "106010735",
"patient_age": 64,
"soi": 1,
"total_charges": 50000
}
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({
apr_drg: '194',
length_of_stay: 3,
oshpd_id: '106010735',
patient_age: 64,
soi: 1,
total_charges: 50000
})
};
fetch('https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment', 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/medi-cal/apr-drg/payment",
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([
'apr_drg' => '194',
'length_of_stay' => 3,
'oshpd_id' => '106010735',
'patient_age' => 64,
'soi' => 1,
'total_charges' => 50000
]),
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/medi-cal/apr-drg/payment"
payload := strings.NewReader("{\n \"apr_drg\": \"194\",\n \"length_of_stay\": 3,\n \"oshpd_id\": \"106010735\",\n \"patient_age\": 64,\n \"soi\": 1,\n \"total_charges\": 50000\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/medi-cal/apr-drg/payment")
.header("X-API-Key", "<api-key>")
.header("Content-Type", "application/json")
.body("{\n \"apr_drg\": \"194\",\n \"length_of_stay\": 3,\n \"oshpd_id\": \"106010735\",\n \"patient_age\": 64,\n \"soi\": 1,\n \"total_charges\": 50000\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://api-dev.rcintell.com/v1/medi-cal/apr-drg/payment")
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 \"apr_drg\": \"194\",\n \"length_of_stay\": 3,\n \"oshpd_id\": \"106010735\",\n \"patient_age\": 64,\n \"soi\": 1,\n \"total_charges\": 50000\n}"
response = http.request(request)
puts response.read_body{
"allowed_amount": 123,
"calculation": {
"add_on_amount": 123,
"allowed_after_transfer_adjustment": 123,
"allowed_amount": 123,
"case_margin_status": "<string>",
"drg_base_payment": 123,
"drg_base_rate": 123,
"drg_payment_so_far": 123,
"estimated_cost": 123,
"estimated_gain": 123,
"estimated_loss": 123,
"high_side_outlier_applies": true,
"high_side_outlier_payment_increase": 123,
"interim_claim_payment": 123,
"lesser_of_amount": 123,
"low_side_outlier_applies": true,
"low_side_outlier_payment_decrease": 123,
"national_average_los": 123,
"payment_amount": 123,
"payment_relative_weight": 123,
"policy_adjustor_code": "<string>",
"policy_adjustor_value": 123,
"transfer_payment_adjustment": 123
},
"drg": {
"apr_drg": "<string>",
"description": "<string>",
"hsrv_casemix_relative_weight": 123,
"medicaid_care_category_adult": "<string>",
"medicaid_care_category_pediatric": "<string>",
"national_average_los": 123,
"policy_adjustor_a": 123,
"policy_adjustor_b": 123,
"policy_adjustor_c": 123,
"policy_adjustor_d": 123
},
"fiscal_year": "<string>",
"hospital": {
"admin2_level_190_rate": 123,
"admin2_level_199_rate": 123,
"ca_neutrality_adjusted_wage_index": 123,
"cost_to_charge_ratio": 123,
"designated_nicu": true,
"dhcs_designated_remote_rural": true,
"dph": true,
"ndph": true,
"oshpd_id": "<string>",
"oshpd_rural_hospital": true,
"provider_name": "<string>",
"rehab_rate": 123,
"unadjusted_base_rate": 123,
"wage_adjusted_base_rate": 123,
"wage_index": 123
},
"payer": "<string>",
"payment_amount": 123,
"policy": {
"add_on_amount": 123,
"casemix_adjustment_factor": 123,
"cost_outlier_threshold": 123,
"interim_claim_threshold": 123,
"interim_per_diem_amount": 123,
"marginal_cost_percentage": 123
},
"reliability": {
"generated_at": "<string>",
"data_sources": {},
"dataset_versions": {},
"degraded": false,
"warnings": [
"<string>"
]
},
"total_base_payment": 123,
"caveats": [
"<string>"
],
"discharge_date": "<string>"
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Authorizations
Body
application/json
Calculate SFY 2025-26 Medi-Cal APR-DRG payment for a known DRG+SOI.
APR-DRG code, optionally with SOI (e.g. 194 or 194-1)
Required range:
x >= 0OSHPD hospital ID from the DHCS workbook
Example:
"106010735"
Required range:
x >= 0Severity of illness 1-4
Required range:
1 <= x <= 4Required range:
x >= 0Override hospital CCR
Required range:
x >= 0Override hospital NICU designation
Override wage-adjusted DRG base rate
Required range:
x >= 0Required range:
x >= 0Required range:
x >= 0Response
SFY 2025-26 DHCS APR-DRG estimate for a known DRG+SOI
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User-visible reliability metadata attached to API responses.
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