Integrated Rules Professional V1 Getting Started
Integrated Rules Professional v1 API
The Integrated Rules Professional API enables you to perform claim scrubbing on a professional claim and fix any possible errors before sending it to the payer. It goes beyond the /professionalclaims/advanced/v1/validation endpoint for checking and validating claims before submission. The /validation endpoint is an enabling tool for making complex provider claims more accurate, and more likely to be accepted and adjudicated by the payer.
Using our Integrated Rules Knowledge Packs , our representatives can tailor your Professional Claims error checks and validations to the needs of your medical team. If you need a powerful General Billing capability, or if you specialize in Medicare, Ambulance Place of Service, Dialysis, Prior Authorization, and many other options, you can order a Knowledge Pack that matches your medical company's specific claims requirements.
NOTE
The Integrated Rules Professional v1 API is designed to work in complementary fashion with the standard Professional Claims API.
We designed the Integrated Rules Institutional API to be complementary to the Professional Claims v3 API, where you build and submit Professional Claims. The Integrated Rules API does not submit claims; it is a separate analysis tool. You must use the standard Professional Claims API for claims submission.
NOTE
For more sophisticated checking of Professional Claims, consider contracting for our Professional Claims Integrated Rules API
/professionalclaims/advanced/v1/validationendpoint, which applies intelligent rules evaluation to the actual contents of your claim with rules tailored to the specific needs of your practice.
Many claims get rejected by either the clearinghouses, which forward medical claims to the payer networks or by the payers themselves because of needless mistakes in formatting or syntax.
NOTE
- If you only plan to use a few daily transactions, you can use our ConnectCenter for your Medical Network transaction needs.
It provides most of the features supported by an API console but only allows manual entry for all data needed for a transaction. It contains Payer Lists, the Payer List Enrollments wizard, and other API customer resources.- For providers sending hundreds of daily requests, we recommend our APIs to be able to automate the submission processes and have a better fit for your business needs.
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Updated 7 months ago