Revenue cycle API for fast automation

You have great ideas to improve outcomes and experiences for providers and patients. We’re excited to help!
It’s going to take a collaborative effort to solve challenges in the revenue cycle, so if you are a developer, provider organization, technology start-up or established vendor, or payer wanting to innovate — we’ll give you a jump start.

Create the experience you envision

Our API helps providers add richer, more accurate, and actionable content from payers to automate the revenue cycle and achieve better outcomes. Designed on REST architecture, so you load the details about the patient encounter, and we respond with account updates throughout the processing cycle. Code away!

Enriched Data

Get enhanced eligibility, authorization, medical necessity, and patient estimation content brought by EDI and Reconbot® technology.

Logic Engine

Leverage our content engines that resolve to correct benefits, normalize the variation of payer results, interpret the meaning of responses, find the best routes for information, and use rules for accurate content creation.

Next Best Actions

Our API tells you when authorization is needed, what benefits to use for an estimate, alerts to take preventative action for denials, and what work step is the next best step to take in your revenue cycle workflow.

Our Revenue Cycle API

Our API helps providers add richer, more accurate and actionable data from payers into the revenue cycle.

Eligibility Verification

Automate discovery of an individual’s current levels of coverage before and after services.

Patient Estimation

Determine patient financial responsibility, get detailed benefits, and leverage price transparency.

Prior Authorizations

Access our authorization suite, including initiation, submission, status, notification and rules.

Medical Necessity

Includes commercial and government plans, CCI edits, procedure modifiers, LCD & ABN.

Things to know

We’re glad you want to develop using our API. Before you start, there is critical information to keep in mind as you use the API documentation.

Data mapping is really important

This is the most critical part of deploying our API into a customer’s environment. While test messages and data will give you the appropriate details to build and test API functionality, making it work in a customer’s environment will take an extra step to align data models. As an example, relationships to subscribers, patient types and services, payer names/IDs, and so forth, will be different from site to site, and from third-party to third-party. This information needs to be aligned in a customer’s production environment. It’s critically important that you review the HIS to Recondo Data Mapping section in the documentation.

Our API is provider-centric

Most APIs give universal access to a dataset that was created to be as universal as possible and once you code to the test API, you can move into a production environment and go-live without changing the data used to call the API. Healthcare environments make it slightly more complex.

  • Not every Recondo customer has every application service in our platform.
  • Data is not consistent from site to site.
  • Providers have different contracts and rates that drive patient estimates.
  • Third parties, providers, and Recondo have different lists of payers with different payer IDs.

How data is mapped is critical. Once you’ve developed a working test application, the next step is to deploy to the customer’s environment, where we will align our data models. For more data-mapping information, see “HIS to Recondo Data Mapping” in the documentation.

Patient encounter API model

Our API model was designed around the patient encounter. We treat the patient’s revenue cycle encounter as holistically as possible. When there are changes to a patient’s location of service, procedures, or coverage, it effects the encounter. Rather than generate a large number of API endpoints, we’ve limited the endpoints to drive some simplicity in designing to our specification.

Asynchronous responses

Our API response is asynchronous, not real-time. Because of the nature of our platform, using our patented ReconBots® with EDI, and provider processes such as authorization, not all responses in the revenue cycle occur in real-time. When key encounter information changes it may cause services lines like eligibility to re-trigger. Rather than have your application continually poll our API for a response, we communicate proactively to your API endpoint every time the encounter is updated with new information from our platform.

Available endpoints

The following are the available endpoints for our API:

  • Load Account
  • Update Account
  • Cancel Account
  • Retrieve Account Status
  • Regenerate EligibilityPlus Alerts
  • Retrieve Image (for authorization substantiation images)
  • Retrieve 271 Response (for those wanting to consume raw EDI)
HIPAA compliance

As a Business Associate to our customers, we take Health Insurance Portability and Accountability Act (HIPAA) compliance very seriously. The patient’s Protected Health Information (PHI) used in our products must be treated in accordance with the HIPAA privacy and security regulations. Toward that end, developers working with the Revenue Cycle API must use standard security measures to ensure that PHI cannot be accessed by anyone other than authorized users. These measures include:

  • Protecting your login to prevent unauthorized use.
  • Using appropriately secured methods to communicate with us when PHI is involved.
    • Never send PHI in an unsecured email to us.
    • If you need to communicate with us about a particular transaction that requires a screen print, make sure to mask any PHI so no one can read it.

API integration process

No two revenue cycles are the same, and often the data behind the scenes is different across organizations. We’ve set up a process to ensure our mutual customers are set up for success.

1. Request API Key

Fill out the form below to request your API key. Provide key details about you and your organization and we’ll contact you to set up access to our test system and data.

2. Code!

Using our documentation and test data, start coding to our API. Send test accounts and get test responses. Show us what you made, or tell customers you’re coding to our API.

3. Plan go-live

No two providers are alike in the data they send to drive our platform. We can align implementation plans, data sets and API pricing for an integrated go-live for your organization.

4. Apply to be a partner

We believe in the “quintuple” win. A win for patients, providers, your company, your developers, and us. Apply to be a partner, and we’ll review the possibilities!

Request your API Key


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