> ## Documentation Index
> Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt
> Use this file to discover all available pages before exploring further.

# RCI for Billers & Coders

> Coding guidance, payment expectations, filing deadlines, and denial resolution

15-20% of claims are denied on first submission. 35% of providers say staffing is their top RCM problem. Experienced billers retire and the knowledge leaves with them. You spend your day making sure claims get paid — RCI gives you the billing knowledge you need before you submit, and the tools to fix it when something goes wrong.

## What RCI does for you

### Before you bill

| Task                         | How RCI helps                                                                                     | Endpoint                           |
| ---------------------------- | ------------------------------------------------------------------------------------------------- | ---------------------------------- |
| **Find the right code**      | AI agent researches CPT/HCPCS codes and tells you which one fits, with documentation requirements | `POST /v1/agents/code-research`    |
| **Know the billing form**    | CMS-1500 or UB-04? RCI determines this from the facility type                                     | `POST /v1/knowledge/billing-guide` |
| **Check modifiers**          | Which modifiers apply to this procedure at this facility in this setting?                         | `POST /v1/knowledge/resolve`       |
| **Estimate payment**         | Expected Medicare reimbursement based on RVU × GPCI × conversion factor                           | `POST /v1/knowledge/payment-calc`  |
| **Know the filing deadline** | Payer-specific timely filing limits so you never miss a window                                    | L4 payer rules                     |
| **Check prior auth**         | Does this payer require prior authorization for this service?                                     | L4 payer rules                     |

### When a claim is denied

| Task                        | How RCI helps                                                          | Endpoint                            |
| --------------------------- | ---------------------------------------------------------------------- | ----------------------------------- |
| **Understand the denial**   | AI agent interprets CARC/RARC codes and explains what went wrong       | `POST /v1/agents/denial-resolution` |
| **Get appeal deadlines**    | Payer-specific appeal levels with exact deadlines                      | L4 payer rules                      |
| **Build the appeal**        | AI generates an appeal strategy with recommended documentation         | Denial resolution agent             |
| **Check medical necessity** | If denied for medical necessity, AI validates against NCD/LCD criteria | `POST /v1/agents/medical-necessity` |

## Example: Complete billing workflow

### 1. You receive an order for CPT 99214 at facility 170001

```bash theme={null}
curl -X POST https://api-dev.rcintell.com/v1/knowledge/resolve \
  -H "X-API-Key: kp_test_..." \
  -H "Content-Type: application/json" \
  -d '{
    "ccn": "170001",
    "cpt": "99214",
    "payer": "Medicare",
    "care_setting": "outpatient"
  }'
```

RCI tells you:

* **Billing form**: CMS-1500 / 837P
* **Place of service**: 22 (Outpatient Hospital)
* **Expected payment**: \$107.42
* **Filing deadline**: 12 months from date of service
* **Modifier requirements**: Site-of-service differential applies

### 2. The claim is denied — CARC 197 (prior auth not obtained)

```bash theme={null}
curl -X POST https://api-dev.rcintell.com/v1/agents/denial-resolution \
  -H "X-API-Key: kp_test_..." \
  -H "Content-Type: application/json" \
  -d '{
    "query": "Claim denied for lack of prior authorization",
    "carc": "197",
    "rarc": "N479",
    "ccn": "170001"
  }'
```

RCI tells you:

* **CARC 197**: Precertification/authorization/notification absent
* **Recommended action**: Request retroactive authorization, then appeal
* **Appeal deadline**: 60 days (Medicare Redetermination)
* **Appeal level**: Redetermination → QIC → ALJ → Medicare Appeals Council

### 3. You're unsure about the correct code for a procedure

```bash theme={null}
curl -X POST https://api-dev.rcintell.com/v1/agents/code-research \
  -H "X-API-Key: kp_test_..." \
  -H "Content-Type: application/json" \
  -d '{
    "query": "Patient had a laparoscopic cholecystectomy with intraoperative cholangiography. What CPT codes?",
    "ccn": "170001"
  }'
```

RCI's AI agent researches the codes and returns the primary CPT, add-on codes, documentation requirements, and common modifiers.

## What you get from each knowledge layer

| Layer                | What it means for billing                                                         |
| -------------------- | --------------------------------------------------------------------------------- |
| **L1 Location**      | GPCI values determine how much payment is adjusted for your area                  |
| **L2 Facility**      | Tells you which claim form to use and which payment system applies                |
| **L3 Setting**       | Place of service code and whether facility or non-facility rates apply            |
| **L4 Payer**         | Filing deadlines, appeal windows, prior auth requirements — the rules you live by |
| **L5 Service Group** | Documentation requirements and coding rules for the procedure category            |
| **L6 Service**       | The actual dollar amount — RVU breakdown and expected reimbursement               |

## Related APIs

| Need                       | Guide                                   |
| -------------------------- | --------------------------------------- |
| Cited payer policy         | [Payer policies](/docs/policies)        |
| 340B manufacturer rules    | [340B](/docs/policy-340b)               |
| Prior auth before you bill | [Prior authorization](/docs/prior-auth) |
| Raw CMS fee schedule rows  | [Fee schedules](/docs/fee-schedules)    |
| Which endpoint to pick     | [Which API to use](/docs/api-map)       |