> ## 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.

# Clearinghouse integration

> Add knowledge-based claim scrubbing and enrichment to your clearinghouse pipeline

RCI plugs into your clearinghouse pipeline to validate and enrich claims before they reach payers. This reduces rejection rates, speeds up payment, and gives your customers a better experience.

## Integration architecture

```
Provider submits claim (837P / 837I)
         │
    ┌────▼──────────────────────────────────┐
    │   Your Clearinghouse Pipeline         │
    │                                       │
    │   ┌───────────────────────────────┐   │
    │   │   RCI Knowledge Validation    │   │
    │   │                               │   │
    │   │   L2: Correct billing form?   │   │
    │   │   L3: Correct POS code?       │   │
    │   │   L4: Filing deadline ok?     │   │
    │   │   L5: Valid code + modifiers? │   │
    │   │   L6: Payment in range?       │   │
    │   └───────────────────────────────┘   │
    │                                       │
    │   Pass → Route to payer               │
    │   Fail → Return to provider           │
    └───────────────────────────────────────┘
```

## What RCI validates

| Check                              | Knowledge Layer | Catches                                           |
| ---------------------------------- | --------------- | ------------------------------------------------- |
| Billing form matches facility type | L2              | CMS-1500 submitted for institutional facility     |
| POS code matches care setting      | L3              | Wrong place of service for the facility/setting   |
| TOB code matches facility          | L2              | Incorrect type of bill for facility type          |
| Modifiers appropriate for setting  | L3, L5          | Missing or incorrect modifiers                    |
| Filing deadline not expired        | L4              | Claims submitted past timely filing limit         |
| Prior auth indicated               | L4              | Services that typically require prior auth        |
| Payment in expected range          | L6              | Billed amount wildly different from MPFS expected |

## Per-claim validation call

For each claim, resolve the knowledge and validate:

```bash theme={null}
curl -X POST https://api-dev.rcintell.com/v1/knowledge/resolve \
  -H "X-API-Key: kp_test_..." \
  -H "Content-Type: application/json" \
  -d '{
    "ccn": "170001",
    "cpt": "99213",
    "payer": "Medicare",
    "care_setting": "outpatient"
  }'
```

## Facility-level caching

L1-L4 data is the same for all claims from a given facility + payer. Cache at the facility level and only call L5-L6 (which require CPT) per claim line:

```bash theme={null}
# Cache once per facility
curl https://api-dev.rcintell.com/v1/knowledge/layers/170001 \
  -H "X-API-Key: kp_test_..."

# Per claim line — add CPT for L5-L6
curl https://api-dev.rcintell.com/v1/knowledge/layers/170001/l6?cpt=99213 \
  -H "X-API-Key: kp_test_..."
```

## Connecting to eligibility and claims APIs

RCI provides the knowledge — your clearinghouse provides the connectivity. Use RCI alongside your existing connections to payer eligibility (270/271) and claims (837) systems:

1. **Before submission**: RCI validates the claim against billing rules
2. **Your pipeline**: Routes the validated claim to the payer
3. **After denial**: RCI's denial resolution agent generates appeal strategies
4. **ERA processing**: When 835 ERAs return, use RCI to interpret CARC/RARC codes

## Pricing for clearinghouses

Enterprise plans include volume-based pricing optimized for high-throughput processing. Contact [sales@rcintell.com](mailto:sales@rcintell.com) for clearinghouse-specific terms.