Integration Pattern

EHR-Embedded Knowledge

Your users make billing decisions inside your EHR every day — ordering procedures, documenting visits, capturing charges. Embed RCI so they get the right guidance at every step without leaving your product.

For: EHR vendors, practice management systems, charge capture apps

Integration points

EHR workflow

Patient arrives
  │
  ├─ Check-in
  │   └─ RCI: Payer rules (L4) → Prior auth required?
  │
  ├─ Provider orders procedure
  │   ├─ RCI: Medical necessity (agent) → NCD/LCD validation
  │   └─ RCI: Payment calc (L6) → Estimated reimbursement
  │
  ├─ Visit documented
  │   └─ RCI: Code research (agent) → Correct CPT + modifiers
  │
  ├─ Charge captured
  │   ├─ RCI: Billing guide → CMS-1500 vs UB-04
  │   ├─ RCI: Resolve (L1-L6) → Full validation
  │   └─ RCI: Payment calc → Expected payment for patient
  │
  └─ Claim submitted
      └─ RCI: Pre-submission enrichment → Final check

What RCI replaces in your product

You currently maintain	RCI API path
Fee schedule lookup tables	Payment Intelligence capability
Payer rules database	Payer Intelligence capability
Billing form determination	Billing Guidance capability
POS code mapping	Knowledge Resolution capability (L3)
Coding guidance features	Code Research capability
Denial management rules	Denial Resolution capability
Medical necessity checks	Medical Necessity capability

Code example

A React hook for embedding payment estimates in your charge capture UI:

typescript — React hook

import { useState, useEffect } from "react";

interface PaymentEstimate {
  estimated_payment: number;
  methodology: string;
  components: {
    work_rvu_adjusted: number;
    pe_rvu_adjusted: number;
    mp_rvu_adjusted: number;
    conversion_factor: number;
  };
}

export function usePaymentEstimate(ccn: string, cpt: string) {
  const [estimate, setEstimate] = useState<PaymentEstimate | null>(null);
  const [loading, setLoading] = useState(false);

  useEffect(() => {
    if (!ccn || !cpt) return;
    setLoading(true);

    fetch("https://api.your-domain.com/<payment-capability>", {
      method: "POST",
      headers: {
        "Authorization": process.env.NEXT_PUBLIC_RCI_KEY!,
        "Content-Type": "application/json",
      },
      body: JSON.stringify({ ccn, cpt }),
    })
      .then((r) => r.json())
      .then(setEstimate)
      .finally(() => setLoading(false));
  }, [ccn, cpt]);

  return { estimate, loading };
}

Embed billing knowledge in your EHR

Replace your internal rules engine with one API. Python and TypeScript SDKs coming soon.

Get your API key Discuss your project