The knowledge layer that powers healthcare software
Every EHR, RCM platform, and AI billing company needs coding rules, payment calculations, and payer policies. Stop building your own rules engine. Call our API.
curl -X POST https://api.rci.health/v1/knowledge/resolve
-H "X-API-Key: YOUR_KEY"
-d '{"ccn":"170001","cpt":"99213","payer":"Medicare"}'One call. Six layers. The complete billing context.
Built for the companies building healthcare software
One API. Every billing rule.
Replace your internal rules engine, fee schedule lookups, and scattered CMS data with a single API that resolves the complete billing context from a facility identifier.
// From a single CCN, resolve six layers:
CCN "170001"
L1 Location → Kansas • GPCI values • MAC jurisdiction • Medicaid program
L2 Facility → Short-term Hospital • MPFS payment system • CMS-1500
L3 Setting → Outpatient • POS 22 • Facility rate • Modifiers
L4 Payer → Medicare • 12-month filing • 5 appeal levels • Prior auth
L5 Service Group → E/M rules • Documentation requirements
L6 Service → 99213 • RVU 2.22 • GPCI-adjusted • $80.78
Knowledge Resolution
Full L1–L6 billing context from a CCN + CPT. GPCI values, payment system, billing form, payer rules, and expected payment in one call.
POST /v1/knowledge/resolvePayment Calculation
Expected Medicare reimbursement using MPFS methodology. RVU components, GPCI adjustments, and conversion factor — calculated, not guessed.
POST /v1/knowledge/payment-calcAI Code Research
Describe a procedure in plain English — get the right CPT/HCPCS with modifiers, documentation requirements, and NCCI edit checks.
POST /v1/agents/code-researchDenial Resolution
Interpret CARC/RARC codes, get appeal strategies, required documentation, and payer-specific filing deadlines. AI-powered with audit trail.
POST /v1/agents/denial-resolutionPayer Rules
3,400+ payer rule sets. Timely filing limits, appeal deadlines, prior auth rules, and policy changes — structured and searchable via API.
GET /v1/knowledge/layers/{ccn}/l4Medical Necessity
Validate procedures against NCD and LCD criteria before submission. Returns coverage assessment, supporting criteria, and documentation checklist.
POST /v1/agents/medical-necessityBilling Guide
Facility-specific billing guidance. Correct form (CMS-1500 vs UB-04), TOB codes, revenue codes, modifier requirements, and exceptions.
POST /v1/knowledge/billing-guideMCP Server
Connect AI agents directly to the knowledge layer. Claude, Cursor, and custom agents can call resolve, calculate, and research as tools.
mcp.rci.health/v1/mcpBuilding it yourself
- —Parse CMS fee schedule files quarterly
- —Build internal rules engine from scattered sources
- —Maintain payer-specific filing and appeal logic
- —Hand-code CCN to facility type mapping
- —Stitch together GPCI, RVU, and conversion factor data
- —Hire domain experts to interpret billing rules
Using RCI
- One API call returns complete billing context
- CMS data updated as it changes — you stay current
- 3,400+ payer rules structured and searchable
- CCN → facility type → payment system → billing form
- GPCI-adjusted payment calculation built in
- AI agents for code research and denial resolution
Before a claim is submitted, call RCI to validate the code, check modifiers, verify the billing form, and estimate payment. Prevent denials before they happen.
Your platform → RCI API → Submit claim
After a denial comes back, call RCI to interpret the CARC/RARC codes, get an appeal strategy, and understand the root cause.
ERA received → RCI API → Appeal strategy
Connect your AI agents to RCI via MCP server or REST API. Ground billing decisions in authoritative knowledge instead of hallucinated rules.
AI agent → RCI MCP → Sourced answers
Who builds on RCI?
Every company that handles healthcare billing needs the same knowledge. RCI makes it a single API call instead of an internal engineering project.
Ground your agents in authoritative billing knowledge
AI RCM Platforms
Code validation, billing rules, denial logic, and payment expectations to train and ground your AI. MCP server for direct agent integration.
Embed billing intelligence in your product
EHR & PM Systems
Coding suggestions, form selection, modifier logic, and payment estimates at point of care. Replace your internal rules engine with one API.
Knowledge-enriched claim scrubbing at scale
Clearinghouses
Validate billing form, POS code, modifiers, and filing deadlines before claims reach payers. Batch API for high-volume processing.
Interpret denials and generate appeal strategies
Denial Management
CARC/RARC interpretation, payer-specific appeal deadlines, root cause resolution, and recommended documentation — all via API.
Validate necessity and prior auth requirements
Eligibility & Auth
Medical necessity validation against NCD/LCD criteria, prior auth rules by payer and procedure, and coverage criteria — before the service is performed.
Fewer denials, faster reimbursement for every client
Billing Companies
Right code, right form, right modifier, right deadline. Payment expectations and denial resolution across all your facilities and payers.
Try the API behind the tools
Every free tool is powered by the same API you integrate with. Use them to explore what RCI can do — then call the endpoint directly from your code.
Payment Calculator
Enter a procedure and facility — see exactly what Medicare will pay, broken down by component.
Powered by POST /v1/knowledge/payment-calc
Denial Inspector
Paste a denial code — get a plain-English explanation and a step-by-step appeal strategy.
Powered by POST /v1/agents/denial-resolution
Billing Rules Network
Search payer rules, filing deadlines, modifier requirements, and revenue codes — all cross-referenced.
Powered by GET /v1/knowledge/billing-rules/*
CCN Resolver
Paste any CCN — see the complete L1–L6 billing context for that facility. Location, type, payment system, and more.
Powered by GET /v1/knowledge/layers/{ccn}
Code Crosswalk
Map between code systems — CPT to ICD-10, HCPCS to CPT, and reverse lookups.
Powered by GET /v1/knowledge/crosswalk
Rule Change Feed
Track payer rule changes, CMS fee schedule updates, and NCCI edit changes in real time.
Powered by GET /v1/knowledge/changes
Built for healthcare
Healthcare billing data demands the highest standards. RCI is designed for security, reliability, and compliance from the ground up.
Security & Compliance
- HIPAA compliant infrastructure
- Multi-tenant data isolation
- API key authentication on every request
- Full audit logging
- SOC 2 Type II (in progress)
Reliability & Scale
- Cloud-native architecture
- Rate limiting and abuse protection
- Real-time monitoring and alerting
- CMS data updated as it changes
- Dedicated support for enterprise
HIPAA
Compliant
SOC 2
In progress
99.9%
Uptime target
<10 min
Support response
Stop building billing rules engines.
Get your API key, make your first call, and resolve the complete billing context for any facility in under 5 minutes. Free to start. Pay as you scale.
1,000 API calls/month free. No credit card required.