API 

Introduction

About our Platform and API

Recondo is an intelligence platform that sits between providers and payers to help translate the many pieces of benefit and cost information in the healthcare revenue cycle. We generate content across the revenue cycle: Eligibility, Authorization Status, Patient Estimates, and more. We believe good content is key to winning in the revenue cycle. Even with standards like ASCI X12 EDI and related code sets, the resulting responses aren’t enough to tell patient access or back office staff what to do, in some cases don’t return what you need, and in many cases do not even have the information you are looking for. Often, payer websites have more up-to-date data and information than EDI. Our platform’s set of web-enhanced data, payer rules engines, and workflow actions create better content and more content for you to drive your revenue cycle. We also believe in treating the patient encounter in the revenue cycle holistically, and have combined the majority of our Revenue Cycle API functionality into as few endpoints as possible, while allowing you and your development team to only use what you need.

Because we are merging data across sources, different standards, and across different temporal events, our API was designed to behave asynchronously (not in real-time). As an example, you may find that for a particular patient encounter, an eligibility response for a payer with strong EDI may come in before you receive an authorization status response, but you do not want to wait for the authorization to get the information you need. We also understand that patient encounters change—eligibility changes, procedures change, locations of service change—so we’ve designed the API to always send you the most current account status across the entire revenue cycle. As the encounter changes, and as our platforms deliver the content, we will always update the entire Revenue Cycle API response with all of the patient-encounter content that was provisioned.

Provider environments are unique. The data (HL7 ADT and SIU) that drives the patient encounter varies. Some use coded data, others use mnemonics, some are standards-based, some are not. Some may call an Outpatient Surgery patient type and service “OP-Surgery,” while others may call it, “1.” As you get familiar with our Revenue Cycle documentation, please keep in mind that as we move to deploy a solution in a customer environment it will be important to synchronize the data models between your development environment, the customer’s environment, and the Recondo platform to correctly map the data models (payers, procedures, patient types and service, locations of service, and so on) to ensure that the production API works as intended with our platform.