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 endpoint
Fee schedule lookup tables	POST /v1/knowledge/payment-calc
Payer rules database	GET /v1/knowledge/layers/{ccn}/l4
Billing form determination	POST /v1/knowledge/billing-guide
POS code mapping	POST /v1/knowledge/resolve (L3)
Coding guidance features	POST /v1/agents/code-research
Denial management rules	POST /v1/agents/denial-resolution
Medical necessity checks	POST /v1/agents/medical-necessity

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.rci.health/v1/knowledge/payment-calc", {
      method: "POST",
      headers: {
        "X-API-Key": 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.

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