Now in early access

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.

Discuss your project Generate API key

Tell us about your workflow, or generate an API key when you are ready to build.

resolve billing context

curl -X POST https://api.your-domain.com/<capability-path>/knowledge/resolve
  -H "Authorization: YOUR_KEY"
  -d '{"ccn":"170001","cpt":"99213","payer":"Medicare"}'

One call. Six layers. The complete billing context.

Built for the companies building healthcare software

AI RCM platformsEHR & PM systemsClearinghousesDenial managementVoice AIBilling companies

knowledge layers resolved per call

3,400+

payer rule sets tracked

<50ms

median resolution latency

documented API paths

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 across 88 documented API paths.

L1–L6 knowledge resolution

// 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.

Capability: Knowledge Resolution

Payment Calculation

Expected Medicare reimbursement using MPFS methodology. RVU components, GPCI adjustments, and conversion factor — calculated, not guessed.

Capability: Payment Intelligence

AI Code Research

Describe a procedure in plain English — get the right CPT/HCPCS with modifiers, documentation requirements, and NCCI edit checks.

Capability: AI Code Research

Denial Resolution

Interpret CARC/RARC codes, get appeal strategies, required documentation, and payer-specific filing deadlines. AI-powered with audit trail.

Capability: Denial Support

Payer Rules

3,400+ payer rule sets. Timely filing limits, appeal deadlines, prior auth rules, and policy changes — structured and searchable via API.

Capability: Payer Policy Lookup

Medical Necessity

Validate procedures against NCD and LCD criteria before submission. Returns coverage assessment, supporting criteria, and documentation checklist.

Capability: Medical Necessity Review

Billing Guide

Facility-specific billing guidance. Correct form (CMS-1500 vs UB-04), TOB codes, revenue codes, modifier requirements, and exceptions.

Capability: Billing Guidance

MCP Server

Connect AI agents directly to the knowledge layer. Claude, Cursor, and custom agents can call resolve, calculate, and research as tools.

Capability: MCP Integration

Building 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

Pre-Submission Enrichment

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

Post-Denial Resolution

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

AI Agent Grounding

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.

See integration guide

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.

See integration guide

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.

See integration guide

Interpret denials and generate appeal strategies

Denial Management

CARC/RARC interpretation, payer-specific appeal deadlines, root cause resolution, and recommended documentation — all via API.

See integration guide

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.

See integration guide

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.

See integration guide

Free — no account required

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 same API path directly from your code.

Payment Calculator

Enter a procedure and facility — see exactly what Medicare will pay, broken down by component.

Denial Inspector

Paste a denial code — get a plain-English explanation and a step-by-step appeal strategy.

Billing Rules Network

Search payer rules, filing deadlines, modifier requirements, and revenue codes — all cross-referenced.

CCN Resolver

Paste any CCN — see the complete L1–L6 billing context for that facility. Location, type, payment system, and more.

Code Crosswalk

Map between code systems — CPT to ICD-10, HCPCS to CPT, and reverse lookups.

Audit & Compliance Feed

Track payer rule changes, CMS fee schedule updates, and NCCI edit changes in real time.

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.

Tell us about the billing workflow you want to power with RCI. We can help map the right knowledge, API, and integration path for your project.

Discuss your project Generate API key

88 documented API paths across knowledge, agents, payer intelligence, and compliance workflows.