Compose directory + PA + fee + policy for a claim
curl --request GET \
--url https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence \
--header 'X-API-Key: <api-key>'import requests
url = "https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence"
headers = {"X-API-Key": "<api-key>"}
response = requests.get(url, headers=headers)
print(response.text)const options = {method: 'GET', headers: {'X-API-Key': '<api-key>'}};
fetch('https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence', 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/payers/{slug}/claim-intelligence",
CURLOPT_RETURNTRANSFER => true,
CURLOPT_ENCODING => "",
CURLOPT_MAXREDIRS => 10,
CURLOPT_TIMEOUT => 30,
CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
CURLOPT_CUSTOMREQUEST => "GET",
CURLOPT_HTTPHEADER => [
"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"
"net/http"
"io"
)
func main() {
url := "https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence"
req, _ := http.NewRequest("GET", url, nil)
req.Header.Add("X-API-Key", "<api-key>")
res, _ := http.DefaultClient.Do(req)
defer res.Body.Close()
body, _ := io.ReadAll(res.Body)
fmt.Println(string(body))
}HttpResponse<String> response = Unirest.get("https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence")
.header("X-API-Key", "<api-key>")
.asString();require 'uri'
require 'net/http'
url = URI("https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence")
http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true
request = Net::HTTP::Get.new(url)
request["X-API-Key"] = '<api-key>'
response = http.request(request)
puts response.read_body{
"code": "<string>",
"payer_name": "<string>",
"payer_slug": "<string>",
"payer_type": "<string>",
"appeal_rules": [
{
"appeal_level": 123,
"deadline_days": 123,
"external_review_deadline_days": 123,
"level_name": "<string>",
"peer_to_peer_available": false,
"required_documents": [
"<string>"
],
"state_specific_rules": {},
"submission_method": "<string>",
"success_rate": 123
}
],
"denial_patterns": [
{
"auto_appealable": false,
"avg_resolution_days": 123,
"denial_category": "<string>",
"denial_code": "<string>",
"documentation_needed": [
"<string>"
],
"frequency_rank": 123,
"remark_code": "<string>",
"resolution_steps": [
"<string>"
],
"root_cause": "<string>",
"success_rate": 123
}
],
"edi_payer_ids": {},
"fee": {
"code": "<string>",
"conversion_factor": 123,
"modifier": "<string>",
"mp_rvu": 123,
"pe_rvu_facility": 123,
"pe_rvu_nonfacility": 123,
"quarter": 123,
"source": "<string>",
"work_rvu": 123,
"year": 123
},
"filing_rules": [
{
"standard_days": 123,
"claim_type": "<string>",
"effective_date": "2023-11-07T05:31:56Z",
"expiration_date": "2023-11-07T05:31:56Z",
"plan_override_days": {},
"state_override_days": {}
}
],
"modifier": "<string>",
"plan_type": "<string>",
"policy_rules": [
{
"code": "<string>",
"action": "<string>",
"change_type": "<string>",
"doc_id": "",
"effective_from": "<string>",
"kind": "",
"license_kind": "<string>",
"payer_slug": "<string>",
"pdf_uri": "<string>",
"rule_text": "",
"source_key": "",
"trigger_condition": "<string>"
}
],
"prior_auth": {},
"prior_auth_rules": [
{
"service_category": "<string>",
"delegation_vendor": "<string>",
"gold_card_eligible": false,
"pa_required": true,
"portal_url": "<string>",
"required_documents": [
"<string>"
],
"turnaround_standard_days": 123,
"turnaround_urgent_hours": 123
}
]
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}payers
Compose directory + PA + fee + policy for a claim
Single-call claim context for Kustode / pilot integrations.
Combines Postgres payer knowledge (filing, appeals, denial patterns, PA rules), CRD-style prior-auth determination, ClickHouse fee RVUs, and CMS/payer policy rules for the given code.
GET
/
v1
/
payers
/
{slug}
/
claim-intelligence
Compose directory + PA + fee + policy for a claim
curl --request GET \
--url https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence \
--header 'X-API-Key: <api-key>'import requests
url = "https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence"
headers = {"X-API-Key": "<api-key>"}
response = requests.get(url, headers=headers)
print(response.text)const options = {method: 'GET', headers: {'X-API-Key': '<api-key>'}};
fetch('https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence', 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/payers/{slug}/claim-intelligence",
CURLOPT_RETURNTRANSFER => true,
CURLOPT_ENCODING => "",
CURLOPT_MAXREDIRS => 10,
CURLOPT_TIMEOUT => 30,
CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
CURLOPT_CUSTOMREQUEST => "GET",
CURLOPT_HTTPHEADER => [
"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"
"net/http"
"io"
)
func main() {
url := "https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence"
req, _ := http.NewRequest("GET", url, nil)
req.Header.Add("X-API-Key", "<api-key>")
res, _ := http.DefaultClient.Do(req)
defer res.Body.Close()
body, _ := io.ReadAll(res.Body)
fmt.Println(string(body))
}HttpResponse<String> response = Unirest.get("https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence")
.header("X-API-Key", "<api-key>")
.asString();require 'uri'
require 'net/http'
url = URI("https://api-dev.rcintell.com/v1/payers/{slug}/claim-intelligence")
http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true
request = Net::HTTP::Get.new(url)
request["X-API-Key"] = '<api-key>'
response = http.request(request)
puts response.read_body{
"code": "<string>",
"payer_name": "<string>",
"payer_slug": "<string>",
"payer_type": "<string>",
"appeal_rules": [
{
"appeal_level": 123,
"deadline_days": 123,
"external_review_deadline_days": 123,
"level_name": "<string>",
"peer_to_peer_available": false,
"required_documents": [
"<string>"
],
"state_specific_rules": {},
"submission_method": "<string>",
"success_rate": 123
}
],
"denial_patterns": [
{
"auto_appealable": false,
"avg_resolution_days": 123,
"denial_category": "<string>",
"denial_code": "<string>",
"documentation_needed": [
"<string>"
],
"frequency_rank": 123,
"remark_code": "<string>",
"resolution_steps": [
"<string>"
],
"root_cause": "<string>",
"success_rate": 123
}
],
"edi_payer_ids": {},
"fee": {
"code": "<string>",
"conversion_factor": 123,
"modifier": "<string>",
"mp_rvu": 123,
"pe_rvu_facility": 123,
"pe_rvu_nonfacility": 123,
"quarter": 123,
"source": "<string>",
"work_rvu": 123,
"year": 123
},
"filing_rules": [
{
"standard_days": 123,
"claim_type": "<string>",
"effective_date": "2023-11-07T05:31:56Z",
"expiration_date": "2023-11-07T05:31:56Z",
"plan_override_days": {},
"state_override_days": {}
}
],
"modifier": "<string>",
"plan_type": "<string>",
"policy_rules": [
{
"code": "<string>",
"action": "<string>",
"change_type": "<string>",
"doc_id": "",
"effective_from": "<string>",
"kind": "",
"license_kind": "<string>",
"payer_slug": "<string>",
"pdf_uri": "<string>",
"rule_text": "",
"source_key": "",
"trigger_condition": "<string>"
}
],
"prior_auth": {},
"prior_auth_rules": [
{
"service_category": "<string>",
"delegation_vendor": "<string>",
"gold_card_eligible": false,
"pa_required": true,
"portal_url": "<string>",
"required_documents": [
"<string>"
],
"turnaround_standard_days": 123,
"turnaround_urgent_hours": 123
}
]
}{
"detail": [
{
"loc": [
"<string>"
],
"msg": "<string>",
"type": "<string>",
"ctx": {},
"input": "<unknown>"
}
]
}Authorizations
Path Parameters
Normalized payer slug identifier.
Query Parameters
CPT/HCPCS code (e.g. 90837)
Minimum string length:
1Modifier (e.g. HO)
Plan type for PA resolution
Service category for PA fallback
State code
Response
Successful Response
Single-call compose of directory + PA + fee + policy for a claim context.
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Fee-schedule / RVU slice for claim intelligence.
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