Full knowledge resolution

The /v1/knowledge/resolve endpoint chains all six knowledge layers to return a complete billing context — geographic adjustments, payment system, billing form, payer rules, service classification, and an expected payment estimate.

Request

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

Parameters

Field	Type	Required	Description
`ccn`	string	Yes	6-digit Medicare Provider Number
`lines`	object[]	No	Claim procedure lines (max 25). Same shape as `POST /v1/knowledge/payment-calc/claim`. Authoritative when present.
`dx`	string[]	No	ICD-10-CM diagnosis codes (preferred)
`cpt`	string	No	Single CPT/HCPCS (legacy). Ignored when `lines` is sent. Enables L5/L6 for one code.
`dx_codes`	string[]	No	Legacy DX alias. Ignored when `dx` is sent.
`payer`	string	No	Payer name — defaults to Medicare
`care_setting`	string	No	`inpatient`, `outpatient`, `office`, `home_health`, `snf`
`place_of_service`	string	No	Claim-level POS default (e.g. `11`, `22`)
`date_of_service`	string	No	`YYYY-MM-DD` for NCCI versioning

Locked claim-shaped example:

curl -X POST https://api-dev.rcintell.com/v1/knowledge/resolve \
  -H "X-API-Key: $RCI_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{
    "ccn": "170001",
    "payer": "Medicare",
    "dx": ["M17.11", "E11.9"],
    "lines": [
      {"code": "99213", "units": 1},
      {"code": "36415", "units": 1}
    ]
  }'

If you omit both cpt and lines, layers L5 (Service Group) and L6 (Service) are skipped. You still get L1 through L4 — useful when you need facility context without a specific procedure. layers and payment_estimate remain the first-line view for existing clients; dx / lines / ncci_* are the claim-shaped fields.

Response structure

{
  "ccn": "170001",
  "facility_name": "Sunflower Medical Center",
  "layers": [
    { "layer": "l1_location", "data": { "state": "KS", "gpci": { "pw_gpci": 1.0, "pe_gpci": 0.904, "mp_gpci": 0.504 } } },
    { "layer": "l2_facility_type", "data": { "payment_system": "IPPS / OPPS", "billing_form": "UB-04 (CMS-1450) / 837I" } },
    { "layer": "l3_care_setting", "data": { "care_setting": "outpatient" } },
    { "layer": "l4_payer", "data": { "payer_name": "Medicare" } },
    { "layer": "l5_service_group", "data": { "name": "Evaluation & Management" } },
    { "layer": "l6_service", "data": { "cpt": "99213" } }
  ],
  "payment_estimate": {
    "estimated_payment": 75.0,
    "methodology": "MPFS"
  },
  "dx": ["M17.11", "E11.9"],
  "lines": [
    {
      "line_id": "1",
      "code": "99213",
      "units": 1,
      "l5": { "layer": "l5_service_group" },
      "l6": { "layer": "l6_service", "cpt": "99213" },
      "coverage": null
    },
    {
      "line_id": "2",
      "code": "36415",
      "units": 1,
      "l5": { "layer": "l5_service_group" },
      "l6": { "layer": "l6_service", "cpt": "36415" },
      "coverage": null
    }
  ],
  "ncci_conflicts": [],
  "ncci_clean": true
}

Response fields

Field	Description
`layers`	L1–L4 always; L5/L6 for the first line only (legacy clients)
`payment_estimate`	Physician RVU estimate for the first line
`facility_name`	Facility name if registered in your tenant
`dx`	Normalized unique ICD-10-CM from `dx` (or legacy `dx_codes`)
`lines`	Per-line `l5` / `l6` / LCD `coverage`. Empty when no `cpt`/`lines` were sent
`ncci_conflicts`	PTP conflicts across unique codes on the claim
`ncci_clean`	`true` when there are no PTP conflicts (or fewer than two codes)

Claim dollars (four-block MPFS/OPPS/CLFS/DME, packaging) stay on POST /v1/knowledge/payment-calc/claim. Resolve is knowledge, not payment composition.

Partial resolution

The resolver adapts to whatever inputs you provide:

Inputs provided	Layers returned
`ccn` only	L1, L2, L3 (inferred), L4 (Medicare default)
`ccn` + `payer`	L1, L2, L3, L4 (payer-specific)
`ccn` + `cpt`	L1–L6; `lines` has one row; `payment_estimate` for that code
`ccn` + `lines[]` + `dx[]`	L1–L4 plus per-line L5/L6, LCD DX match, NCCI PTP
`ccn` + `cpt` + `payer` + `care_setting`	All six layers, fully contextualized

The ccn field must be exactly 6 digits. Providing an invalid CCN returns a structured error with is_valid: false and validation_errors explaining what went wrong.

Single-layer access

If you only need one layer, use the single-layer endpoint instead:

curl https://api-dev.rcintell.com/v1/knowledge/layers/170001/l1 \
  -H "X-API-Key: $RCI_API_KEY"

Dependencies are resolved automatically — requesting L6 still runs L1 internally to get GPCI values.

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Single-layer access

​Request

​Parameters

​Response structure

​Response fields

​Partial resolution

​Single-layer access

Request

Parameters

Response structure

Response fields

Partial resolution

Single-layer access