RCM Service
The Revenue Cycle Management Service provides API endpoint for performing insurance eligibility checks and submitting claims.
- Eligibility — Submit patient insurance information and receive a response detailing the patient's coverage and benefits information.
- Claim Submission — Submit a claim stored in your FHIR database for adjudication by payers.
Production requirements & enrollment timelines
Using RCM services in a production environment requires business verification. Before getting started, every business entity should review its entry in the NPI Registry (opens in a new tab) and confirm that all information is accurate, especially the phone number. If anything is out of date, update your record in NPPES (opens in a new tab).
Eligibility and claim submission require payer enrollments. Most EDI enrollments complete within a day or two. Medicare and Medicaid enrollments can take somewhat longer, and are processed once your business has been verified and the correct PTAN information has been provided to the support team.