> ## 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.

# Look up a denial code for a specific payer

> Get denial pattern data for a specific denial code at a specific payer.



## OpenAPI

````yaml /docs/openapi.client.json get /v1/payers/{slug}/denial-codes/{code}
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/payers/{slug}/denial-codes/{code}:
    get:
      tags:
        - payers
      summary: Look up a denial code for a specific payer
      description: Get denial pattern data for a specific denial code at a specific payer.
      operationId: get_denial_code_v1_payers__slug__denial_codes__code__get
      parameters:
        - description: Normalized payer slug identifier.
          in: path
          name: slug
          required: true
          schema:
            title: Slug
            type: string
        - description: >-
            Billing or terminology code value (CPT/HCPCS/NDC/etc depending on
            endpoint context).
          in: path
          name: code
          required: true
          schema:
            title: Code
            type: string
      responses:
        '200':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/DenialCodeLookupResponse'
          description: Successful Response
        '422':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
          description: Validation Error
      security:
        - APIKeyHeader: []
components:
  schemas:
    DenialCodeLookupResponse:
      description: Denial code resolution across one or all payers.
      properties:
        denial_code:
          title: Denial Code
          type: string
        payer_count:
          default: 0
          description: Number of payers with data for this code
          title: Payer Count
          type: integer
        reliability:
          $ref: '#/components/schemas/ReliabilityMetadata'
          description: User-visible reliability metadata for denial lookup resolution.
        results:
          items:
            $ref: '#/components/schemas/DenialPatternResponse'
          title: Results
          type: array
        total_results:
          default: 0
          title: Total Results
          type: integer
        x12_master:
          description: X12 master CARC metadata from the pipeline-backed catalog.
          items:
            $ref: '#/components/schemas/X12MasterDenialResponse'
          title: X12 Master
          type: array
      required:
        - denial_code
      title: DenialCodeLookupResponse
      type: object
    HTTPValidationError:
      properties:
        detail:
          items:
            $ref: '#/components/schemas/ValidationError'
          title: Detail
          type: array
      title: HTTPValidationError
      type: object
    ReliabilityMetadata:
      description: User-visible reliability metadata attached to API responses.
      properties:
        data_sources:
          additionalProperties:
            type: string
          description: Data-source backends used to build this response.
          title: Data Sources
          type: object
        dataset_versions:
          additionalProperties:
            type: string
          description: >-
            CMS/DHCS/NLM/FDA named versions used to compose this response (e.g.
            mpfs=CY2026, ipps=FY2026). See GET /v1/data/changes.
          title: Dataset Versions
          type: object
        degraded:
          default: false
          description: True when a fallback or non-primary source path was used.
          title: Degraded
          type: boolean
        generated_at:
          description: UTC timestamp when the response payload was composed.
          title: Generated At
          type: string
        warnings:
          description: Human-readable caveats relevant to downstream consumers.
          items:
            type: string
          title: Warnings
          type: array
      required:
        - generated_at
      title: ReliabilityMetadata
      type: object
    DenialPatternResponse:
      properties:
        auto_appealable:
          default: false
          title: Auto Appealable
          type: boolean
        avg_resolution_days:
          anyOf:
            - type: integer
            - type: 'null'
          title: Avg Resolution Days
        denial_category:
          anyOf:
            - type: string
            - type: 'null'
          title: Denial Category
        denial_code:
          anyOf:
            - type: string
            - type: 'null'
          title: Denial Code
        documentation_needed:
          items:
            type: string
          title: Documentation Needed
          type: array
        frequency_rank:
          anyOf:
            - type: integer
            - type: 'null'
          title: Frequency Rank
        remark_code:
          anyOf:
            - type: string
            - type: 'null'
          title: Remark Code
        resolution_steps:
          items:
            type: string
          title: Resolution Steps
          type: array
        root_cause:
          anyOf:
            - type: string
            - type: 'null'
          title: Root Cause
        success_rate:
          anyOf:
            - type: number
            - type: 'null'
          title: Success Rate
      title: DenialPatternResponse
      type: object
    X12MasterDenialResponse:
      description: X12 master catalog row for a CARC denial code.
      properties:
        carc_code:
          title: Carc Code
          type: string
        carc_description:
          title: Carc Description
          type: string
        effective_date:
          anyOf:
            - type: string
            - type: 'null'
          title: Effective Date
        group_code:
          anyOf:
            - type: string
            - type: 'null'
          title: Group Code
        group_description:
          anyOf:
            - type: string
            - type: 'null'
          title: Group Description
        last_modified:
          anyOf:
            - type: string
            - type: 'null'
          title: Last Modified
        notes:
          anyOf:
            - type: string
            - type: 'null'
          title: Notes
      required:
        - carc_code
        - carc_description
      title: X12MasterDenialResponse
      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

````