Endpoints

All endpoints require both auth headers (Authorization and x-api-key). Most accept a gzip-compressed POST body — see per-endpoint notes below for exceptions.

POST /v1/review

Primary endpoint. Submit a bill and receive a full pricing decision with RuleTrace™ calculation detail. Body: gzip JSON.

POST /v1/validate

Validate codes and determine the review jurisdiction before submitting for full review. Same request body as /v1/review. Body: gzip JSON.

POST /v1/facility

Return a list of hospitals or outpatient/surgery centers for accurate institutional pricing. Body: plain JSON (not gzip).

POST /v1/duplicates

Identify duplicate or potential duplicate service lines. Same request body as /v1/review. Body: gzip JSON.

POST /v1/customcodes

Retrieve tenant-specific procedure codes not in the standard CPT®/HCPCS list. No request body required.

All paths are appended to your API Endpoint URL — e.g. {your_api_endpoint}/v1/review.

Key naming convention: Request body fields use PascalCase (e.g. Bill, ProviderTaxID, CPT1). The API is case-insensitive for inbound requests. Response fields are returned in camelCase.

Request Body — `/v1/review`, `/v1/validate`, `/v1/duplicates`

The request is a JSON object. Bill, Services, Claim, and Provider are required. BillOptions and BillHistory are optional.

{
  "Bill": {
    "UniqueID": "1001",
    "ControlNumber": 1001,
    "ProviderTaxID": "123456789",
    "TypeOfBill": 0,
    "ProviderType": 1,
    "ZipCode": "90210",
    "JurisdictionState": "CA",
    "BillReviewState": "CA",
    "BucketList": []
  },
  "BillOptions": {
    "IsLateFee": true,
    "IsNCCI": true,
    "IsMUE": true,
    "IsIgnoreTimelyFiling": false
  },
  "Services": [
    {
      "Line": 1,
      "CPT1": "99213",
      "CPT2": "",
      "ServiceDate": "2025-07-15T00:00:00",
      "QuantityBilled": 1.0,
      "POS": "11",
      "ModifierList": "25",
      "Charge": 175.00,
      "BucketList": [],
      "ControlNumber": 1001
    }
  ],
  "Claim": {
    "DisplayID": "CLM-001",
    "State": "CA",
    "ZipCode": "90210",
    "StateOfJurisdiction": "CA",
    "DateOfInjury": "2024-06-01T00:00:00"
  },
  "Provider": {
    "TaxID": "123456789",
    "NPI": "1234567890",
    "PracticeState": "CA",
    "PracticeZipCode": "90210"
  },
  "BillHistory": []
}

{
  "Bill": {
    "UniqueID": "3",
    "ControlNumber": 2080,
    "ProviderTaxID": "123456789",
    "TypeOfBill": 0,
    "ProviderType": 2,
    "ZipCode": "93291",
    "JurisdictionState": "CA",
    "BillReviewState": "CA",
    "MedicareNumber": "050057",
    "DRG": "473",
    "AdmitDate": "2025-07-15T00:00:00",
    "DischargeDate": "2025-07-15T00:00:00",
    "BucketList": []
  },
  "BillOptions": {
    "IsLateFee": true,
    "IsMedicareTreatment": true,
    "IsIgnoreTimelyFiling": true
  },
  "Services": [
    {
      "Line": 1,
      "CPT1": "120",
      "ServiceDate": "2025-07-15T00:00:00",
      "QuantityBilled": 1.0,
      "POS": "21",
      "Charge": 2316.25,
      "BucketList": [],
      "ControlNumber": 2080
    }
  ],
  "Claim": {
    "DisplayID": "123-123",
    "State": "CA",
    "ZipCode": "92882",
    "StateOfJurisdiction": ""
  },
  "Provider": {
    "TaxID": "123456789",
    "PracticeState": "CA",
    "PracticeZipCode": "93291",
    "BillingZipCode": ""
  },
  "BillHistory": []
}

`Bill` object

Field	Type	Required	Notes
`UniqueID`	string (100)	✓	Your internal bill identifier
`ControlNumber`	int		Numeric control number
`Sequence`	int		Sequence number for split bills
`ProviderTaxID`	string (50)	✓	Provider federal tax ID
`TypeOfBill`	int (enum)	✓	See `TypeOfBill` values
`ProviderType`	int (enum)	✓	See `ProviderType` values
`ZipCode`	string (5)	✓	Provider ZIP code
`ZipPlusFour`	string (10)		ZIP+4
`BillReviewState`	string (2)		2-letter state — overrides jurisdiction if set
`JurisdictionState`	string (2)		2-letter jurisdiction state
`NPI`	string (10)		Billing NPI
`ProviderSpecialty`	int (enum)		See `EProviderSpecialty`
`MedicareNumber`	string (6)		CMS certification number (institutional)
`OPCERT`	string (7)		Outpatient certification number
`DRG`	string (3)		DRG code (institutional inpatient)
`DRGLevelOfSeverity`	int		DRG severity level
`AdmitDate`	datetime		Admission date (institutional)
`DischargeDate`	datetime		Discharge date (institutional)
`DischargeStatus`	string (2)		UB-04 discharge status
`ClaimsOfficeReceivedDate`	datetime		Date claims office received the bill
`ProcessedDate`	datetime		Date bill was processed
`BillReviewReceivedDate`	datetime		Date bill review was received
`ModifyDate`	datetime		Last modified date
`FacilityName`	string (250)		Facility name
`UB92TypeOfBill`	string (3)		UB-04 type of bill code
`TypeOfAdmission`	int (enum)		UB-04 type of admission
`RateCode`	string (4)		Rate code
`ALCDays`	int		Alternate level of care days
`DeviceCredit`	decimal		Device credit amount
`BillFormType`	int (enum)		Form type override
`BillSource`	int (enum)		Source of the bill
`ICDDiagnosticCodes`	string (150)		Comma-separated ICD diagnostic codes
`ICDProcedureCodes`	string (150)		Comma-separated ICD procedure codes
`ScheduledSurgery`	int (enum)		Scheduled surgery flag
`NoticeNonPaymentDate`	datetime		Notice of non-payment date
`RenderingProviderNPI`	string (10)		Rendering provider NPI
`RenderingProviderRating`	string (10)		Rendering provider rating
`RenderingProviderTaxonomyCode`	string (20)		Rendering provider taxonomy
`RenderingPhysicianNPI`	string (10)		Rendering physician NPI
`RenderingPhysicianLicenseNumber`	string (20)		Rendering physician license
`RenderingPhysicianTaxonomyCode`	string (20)		Rendering physician taxonomy
`BillingProviderNPI`	string (10)		Billing provider NPI
`BillingProviderRating`	string (10)		Billing provider rating
`AttendingProviderRating`	string (10)		Attending provider rating
`AttendingPhysicianLicenseNumber`	string (20)		Attending physician license
`OperatingPhysicianLicenseNumber`	string (20)		Operating physician license
`OtherPhysicianLicenseNumber`	string (20)		Other physician license
`SupervisingProviderRating`	string (10)		Supervising provider rating
`BucketList`	array		Pass `[]` for standard review

`BillOptions` object

All fields are optional and override your tenant’s default configuration.

Field	Type	Default	Notes
`IsLateFee`	bool	`true`	Apply late fee rules
`IsNCCI`	bool	`true`	Apply NCCI edits
`IsMUE`	bool	`true`	Apply MUE limits
`IsDisallowBeforeDOI`	bool	`true`	Disallow services before date of injury
`IsDisallowAfterClosedClaim`	bool	`true`	Disallow services after claim closure
`IsPayAboveCharge`	bool	`true`	Cap allowance at billed charge
`IsIgnoreTimelyFiling`	bool	`false`	Bypass timely filing limits
`IsBoardCertified`	bool	`false`	Provider is board certified
`IsSeparateImplantReimbursement`	bool	`false`	Separately reimburse implants
`IsSelfInsured`	bool	`false`	Self-insured payer
`IsIgnoreClosedFormulary`	bool	`false`	Ignore closed formulary rules
`IsIgnoreLimitVisitRule`	bool	`false`	Ignore visit limit rules
`UseEAPGBaseRate`	bool	`false`	Use EAPG base rate for outpatient
`IsIgnoreHistory`	bool	`false`	Ignore bill history for duplicate check
`IsSurchargePaidDirectlyToPool`	bool	`false`	Surcharge paid directly to pool
`IsPriorAuthorization`	bool	`false`	Prior authorization obtained
`IsDocumentation`	bool	`false`	Required documentation provided

`Services` array — per service line

Field	Type	Required	Notes
`Line`	int	✓	Line number (1-based)
`CPT1`	string (20)	✓	CPT, HCPCS, or revenue code
`CPT2`	string (20)		Secondary / compound code
`ServiceDate`	datetime	✓	Date of service
`QuantityBilled`	decimal	✓	Units billed
`QuantityOverride`	decimal		Override calculated quantity — omit if not overriding
`Charge`	decimal	✓	Billed charge for this line
`POS`	string (2)		Place of service code
`TOS`	string (2)		Type of service code
`ModifierList`	string (20)		Comma-separated modifiers (e.g. `"25,59"`)
`PPOAllowance`	decimal		PPO contracted rate — caps allowance if provided; omit or `null` to skip PPO capping
`Allowance`	decimal		Prior allowance (for history/re-review)
`TaxCharge`	decimal		Tax amount billed
`TaxAllowance`	decimal		Tax allowance
`TaxRate`	decimal		Tax rate
`Duplicate`	int (enum)		Duplicate flag
`PriorAuthorization`	int (enum)		Prior auth status for this line
`Documentation`	int (enum)		Documentation status for this line
`InvoiceCost`	decimal		Invoice cost (implants/devices)
`ShippingAndHandling`	decimal		Shipping and handling charge
`NPI`	string (10)		Service-level NPI
`ChargemasterCode`	string (50)		Chargemaster code for outpatient
`IsCompoundSterile`	bool		Compound sterile flag (pharmacy)
`CompoundingTime`	int		Compounding time in minutes
`CompoundingFee`	decimal		Compounding fee
`CompoundUniqueID`	string (20)		Compound drug unique identifier
`SterilizationFee`	decimal		Sterilization fee
`ContainerCount`	int		Number of containers (pharmacy)
`DaysSupply`	int		Days supply (pharmacy)
`DispensedAsWritten`	int (enum)		DAW code (pharmacy)
`PrescriberLicense`	string (20)		Prescriber license number
`IsRefill`	bool		Refill prescription
`IsOTCDispensingFee`	bool		OTC dispensing fee applies
`ControlNumber`	int		Bill control number (required for history bills)
`Sequence`	int		Sequence (history bills)
`BucketList`	array		Pass `[]` for standard review

`Claim` object

Field	Type	Notes
`DisplayID`	string (50)	Your claim identifier
`State`	string (2)	Claimant state
`ZipCode`	string (5)	Claimant ZIP code
`StateOfJurisdiction`	string	Jurisdiction state override
`DateOfInjury`	datetime	Date of injury
`ClosedDate`	datetime	Claim closure date
`Age`	int	Claimant age

`Provider` object

Field	Type	Required	Notes
`TaxID`	string (50)	✓	Provider federal tax ID
`NPI`	string (10)		Provider NPI
`License`	string (15)		Provider license number
`Rating`	string (20)		Provider rating
`PracticeName`	string (500)		Practice name
`PracticeAddress1`	string (200)		Practice address line 1
`PracticeAddress2`	string (200)		Practice address line 2
`PracticeCity`	string (200)		Practice city
`PracticeState`	string (2)		Practice state
`PracticeZipCode`	string (5)		Practice ZIP
`BillingName`	string (500)		Billing name
`BillingAddress1`	string (200)		Billing address line 1
`BillingAddress2`	string (200)		Billing address line 2
`BillingCity`	string (200)		Billing city
`BillingState`	string (2)		Billing state
`BillingZipCode`	string (5)		Billing ZIP

`BillHistory` array

Pass prior bills from the same claim to enable duplicate detection and visit-limit enforcement. Each entry has the same structure as the top-level request (a Bill object + Services array).

"BillHistory": [
  {
    "Bill": { "ControlNumber": 999, "ProviderType": 1, ... },
    "Services": [ { "Line": 1, "CPT1": "99213", ... } ]
  }
]

`TypeOfBill` values

Value	Name
`0`	Workers Comp
`1`	UCR
`2`	OWCP
`4`	Auto

`ProviderType` values

Value	Name	Value	Name
`0`	Unknown	`29`	Nurse Practitioner
`1`	Physician	`30`	Nursing Facility
`2`	Inpatient	`31`	Occupational Therapist
`3`	Outpatient	`32`	Occupational Therapist Assistant
`4`	Surgery Center	`33`	Optometrist
`5`	Acupuncturist	`34`	Osteopath
`6`	Advanced Practice Registered Nurse	`35`	Other
`7`	Ambulance Transport Services	`36`	Pain Management
`8`	Anesthesiologist	`37`	Pathology Laboratory
`9`	Anesthesiologist Assistant	`38`	Pharmacy
`10`	Athletic Trainer	`39`	Physical Therapist
`11`	Audiologist	`40`	Physical Therapist Assistant
`12`	Behavioral Health Counselor	`41`	Physician Assistant
`13`	Certified Nurse Assistant	`42`	Podiatrist
`14`	Certified Registered Nurse Anesthetist	`43`	Professional Clinical Counselor
`15`	Certified Rehabilitation Counselor	`44`	Psychiatric Nurse Practitioner
`16`	Chiropractor	`45`	Psychiatrist
`17`	Clinical Nurse Specialist	`46`	Psychologist
`18`	Clinical Psychologist	`47`	Radiology Facility
`19`	Dentist	`48`	Registered Nurse
`20`	Dietitian	`49`	Registered Nurse First Assistant
`21`	Home Health	`50`	Rehab Nurse
`22`	Independent Social Worker	`51`	Respiratory Therapist
`23`	Licensed Massage Therapist	`52`	Skilled Nursing Facility
`24`	Licensed Surgical Assistant	`53`	Social Worker
`25`	Medical Clinic	`54`	Speech Therapist
`26`	Medical Supplies	`55`	Urgent Care Center
`27`	Mental Health Facility	`56`	Vocation Rehabilitation Case Management Intern
`28`	Mental Health Intern

Request Body — `/v1/facility`

This endpoint accepts plain JSON — do not gzip-compress the body or set Content-Encoding: gzip.

{
  "state": "CA",                   // 2-letter state code, required
  "providerType": 2,               // int enum — 2=Inpatient, 3=Outpatient, 4=Surgery Center
  "effectiveDate": "2025-07-15T00:00:00"
}

Request Body — `/v1/customcodes`

No request body. Send auth headers only (Authorization and x-api-key). The response returns the list of custom codes configured for your tenant.

Response Structure — `/v1/review`

A successful review returns HTTP 200 with a gzip-compressed JSON body (Content-Encoding: gzip). Most HTTP clients decompress this automatically — ensure your client sends Accept-Encoding: gzip or handles decompression explicitly.

Top-level response fields

Field	Type	Description
`error`	string	Non-null if the review failed — check this first
`qrCodeID`	string	Unique review identifier — use for audit trails and dispute tracking
`qrCodeURL`	string	Shareable link to the hosted RuleTrace™ report
`logHTML`	string	Self-contained HTML report showing full RuleTrace™ calculation logic
`bill`	object	Bill-level results — see `bill` fields below
`services`	array	Per-line results — see `services[]` fields below
`serviceReasonCodes`	object	Map of `lineNumber → [reason code]` for all lines
`logHeader`	object	Metadata about the review run
`logDetails`	array	Structured log entries for the review calculation

`bill` response fields

Field	Type	Description
`uniqueID`	string	Echoed from request
`billReviewState`	string	State that was used for fee schedule lookup
`reviewedToState`	string	State actually reviewed under (may differ from submitted)
`isPriorAuthorizationRequired`	bool	True if any service line requires prior auth
`isDocumentationRequired`	bool	True if any service line requires documentation
`totalCharge`	decimal	Sum of all billed charges
`totalAllowance`	decimal	Total approved reimbursement (PPO-capped if applicable)
`totalUncappedAllowance`	decimal	Allowance before PPO cap
`totalReduction`	decimal	Total reduction from billed charges
`totalPrePPOAllowance`	decimal	Allowance before PPO adjustment
`totalUncappedPrePPOAllowance`	decimal	Pre-PPO allowance before any cap
`totalSurcharge`	decimal	Total surcharge amount
`totalTaxCharge`	decimal	Total tax charge
`totalTaxAllowance`	decimal	Total tax allowance
`totalTaxReduction`	decimal	Total tax reduction
`fromServiceDate`	datetime	Earliest service date on the bill
`toServiceDate`	datetime	Latest service date on the bill
`processedDate`	datetime	Date/time the review was processed
`facilityName`	string	Resolved facility name
`billReviewProcessingTime`	integer	Processing time in milliseconds
`isNYC81FormRequired`	bool	NYC C-81 form required
`isNYC84FormRequired`	bool	NYC C-84 form required
`nmLocationCode`	string	New Mexico location code
`reasonCodes`	array	Bill-level reason code IDs
`bucketList`	array	Bill-level RuleTrace™ rule trace entries — see Rule Trace Entry below
`bucketTotalList`	array	Bill-level bucket totals
`billState`	object	State-specific bill metadata

`services[]` response fields — per line

Field	Type	Description
`line`	int	Line number matching the submitted service
`cpt1`	string	Resolved CPT / revenue code used for pricing
`originalCPT1`	string	CPT1 as submitted (before any code substitution)
`description1`	string	Description of CPT1
`descriptionSource1`	int (enum)	Source of the CPT1 description
`cpt2`	string	Resolved secondary code
`originalCPT2`	string	CPT2 as submitted
`description2`	string	Description of CPT2
`quantityBilled`	decimal	Quantity as submitted
`quantityUsed`	decimal	Quantity used for pricing (may differ after MUE)
`charge`	decimal	Billed charge for this line
`allowance`	decimal	Approved reimbursement (PPO-capped if applicable)
`uncappedAllowance`	decimal	Allowance before PPO cap
`reduction`	decimal	Reduction amount for this line
`prePPOAllowance`	decimal	Allowance before PPO adjustment
`uncappedPrePPOAllowance`	decimal	Pre-PPO allowance before any cap
`taxCharge`	decimal	Tax charge for this line
`taxAllowance`	decimal	Tax allowance for this line
`taxReduction`	decimal	Tax reduction for this line
`taxRate`	decimal	Tax rate applied
`invoiceCost`	decimal	Invoice cost (implants/devices)
`isPriorAuthorizationRequired`	bool	Prior auth required for this line
`isDocumentationRequired`	bool	Documentation required for this line
`duplicate`	int (enum)	Duplicate status
`cptUsedForPayment`	int (enum)	Which CPT code was used for payment calculation
`chargemasterCode`	string	Resolved chargemaster code
`chargemasterDescription`	string	Chargemaster code description
`reasonCodes`	string	Comma-separated reason code IDs for this line
`carcReasonCodes`	string	Comma-separated CARC codes for this line
`stateReasonCodes`	string	Comma-separated state-specific reason codes
`reasonCodesDTO`	array	Full reason code objects — see Reason Code below
`bucketList`	array	Line-level RuleTrace™ rule trace entries — see Rule Trace Entry below
`bucketTotalList`	array	Line-level bucket totals
`serviceState`	object	State-specific service metadata

Reason Code fields

Field	Type	Description
`id`	int	Reason code ID (1000–4999 system; 5000–9999 custom)
`displayID`	string	Display identifier (may differ from `id`)
`shortDescription`	string	Human-readable summary
`longDescription`	string	Full explanation
`bucketHierarchyID`	int	Associated rule bucket
`cARC_ID`	string	Corresponding CARC code
`cARCDescription`	string	CARC code description
`cARCGroupCode`	string	CARC group code
`stateReasonCodes`	object	Map of `state → state-specific reason code`

Rule Trace Entry fields

Each entry in bucketList represents one step in the pricing calculation.

Field	Type	Description
`line`	int	Service line number
`bucketHierarchyID`	int	Rule hierarchy identifier
`bucketEntryPoint`	int (enum)	How this bucket was triggered
`bucketSource`	int (enum)	Source of the pricing value — see `BucketSource` values
`bucketSourceID`	string	Source identifier (fee schedule ID, rule ID, etc.)
`sourceDescription`	string	Human-readable source description
`sourceValue`	decimal	Raw source value
`sourcePercent`	decimal	Source percentage applied
`sourceAdditional`	decimal	Additional source value
`allowance`	decimal	Allowance from this bucket
`uncappedAllowance`	decimal	Uncapped allowance from this bucket
`percentApplied`	decimal	Percentage applied in this step
`reduction`	decimal	Reduction from this bucket
`bucketOverride`	int (enum)	Override type applied
`fullRuleName`	string	Full name of the pricing rule
`triggerCode`	string	Code that triggered this rule
`triggerDate`	datetime	Effective date for this rule
`percentOfCharge`	decimal	Allowance expressed as percent of charge
`requirementURL`	string	Link to the fee schedule or regulation source
`reasonCodes`	string	Comma-separated reason codes from this bucket
`reasonCodesResult`	array	Full reason code objects for this entry

Rule Trace — `bucketSource` values

Value	Name	Description
`0`	Unknown
`1`	Charge	Allowance equals the billed charge
`2`	Calculated	Fee schedule or rule-based calculation
`3`	User	Manual override
`4`	PPO	PPO contracted rate
`5`	OSR	Other source rate
`6`	Utilization Review	UR determination
`7`	Adjuster	Adjuster override
`8`	Customer Rule	Tenant-specific custom rule
`9`	External	External pricing source
`10`	Bill Level	Bill-level rule (not line-specific)
`11`	Modifier	Modifier-driven adjustment

CPT® © 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

Getting Started

API Reference

Production Guide

Resources

POST /v1/review

POST /v1/validate

POST /v1/facility

POST /v1/duplicates

POST /v1/customcodes

Request Body — `/v1/review`, `/v1/validate`, `/v1/duplicates`

`Bill` object

`BillOptions` object

`Services` array — per service line

`Claim` object

`Provider` object

`BillHistory` array

`TypeOfBill` values

`ProviderType` values

Request Body — `/v1/facility`

Request Body — `/v1/customcodes`

Response Structure — `/v1/review`

Top-level response fields

`bill` response fields

`services[]` response fields — per line

Reason Code fields

Rule Trace Entry fields

Rule Trace — `bucketSource` values

POST /v1/review

POST /v1/validate

POST /v1/facility

POST /v1/duplicates

POST /v1/customcodes

​Request Body — /v1/review, /v1/validate, /v1/duplicates

​Bill object

​BillOptions object

​Services array — per service line

​Claim object

​Provider object

​BillHistory array

​TypeOfBill values

​ProviderType values

​Request Body — /v1/facility

​Request Body — /v1/customcodes

​Response Structure — /v1/review

​Top-level response fields

​bill response fields

​services[] response fields — per line

​Reason Code fields

​Rule Trace Entry fields

​Rule Trace — bucketSource values

Request Body — `/v1/review`, `/v1/validate`, `/v1/duplicates`

`Bill` object

`BillOptions` object

`Services` array — per service line

`Claim` object

`Provider` object

`BillHistory` array

`TypeOfBill` values

`ProviderType` values

Request Body — `/v1/facility`

Request Body — `/v1/customcodes`

Response Structure — `/v1/review`

Top-level response fields

`bill` response fields

`services[]` response fields — per line

Reason Code fields

Rule Trace Entry fields

Rule Trace — `bucketSource` values