R1 RCM

Supergood | R1 RCM API

Alex Klarfeld

Alex Klarfeld

— 7 min read
Supergood | R1 RCM API

Automate patient access, billing, claims, denials, and payment reconciliation in R1 RCM with a stable REST API. Supergood builds and operates production-grade, unofficial R1 RCM integrations so your team can orchestrate revenue cycle workflows without heavy custom engineering.

In plain English: R1 RCM is software that hospitals and provider groups use to register patients, verify eligibility, capture charges, submit claims, manage denials, and collect patient balances. With an unofficial API, you could sync patients and insurance, run real-time eligibility checks, generate and route 837 claims, and reconcile ERA/835 remittances to close the loop.

If you’re a healthcare tech startup in billing, practice management, or provider services, integrating with R1 RCM unlocks concrete data flows and features for your product:

  • Pull: Patient demographics, insurance coverages, eligibility responses, encounters/accounts, charges, claim status, remittances/835, denial codes, underpayment findings
  • Push: New/updated patients and policies from your app, eligibility requests, price estimates and prior auth references, clean claims, payment postings
  • Build: Authorization-aware scheduling, upfront eligibility and copay estimation, clean claim generation for 837P/I, denial triage and appeals automation, reconciliation dashboards driven by ERAs

What is R1 RCM?

R1 RCM is a leading revenue cycle management platform and services partner for hospitals, health systems, and physician groups. Its technology and operational stack spans patient access (scheduling, registration, insurance capture, eligibility, estimates), mid-cycle (clinical documentation integrity, coding, charge integrity), and back-office (claims, denials, underpayments, AR follow-up, patient financial experience, and remittances). R1’s broader portfolio includes patient financial tools (e.g., VisitPay) and revenue intelligence and recovery capabilities (e.g., Cloudmed).

Core product areas include:

  • Patient access and registration (insurance capture, eligibility, price estimates)
  • Prior authorization and utilization management references
  • Charge capture, coding, and clinical documentation integrity
  • Claims generation and submission (837P/I) with clearinghouse and payer channels
  • Denials, underpayments, and AR workqueues with appeal workflows
  • Patient payments, statements, and payment plans
  • Remittance (835) ingestion and automated posting
  • Analytics, worklists, and revenue integrity monitors

Common data entities:

  • Patients, guarantors, and contact details
  • Encounters/Accounts and service locations
  • Insurance coverages, payers, and plans
  • Eligibility checks (270/271 artifacts)
  • Authorizations and reference numbers
  • Charges, diagnosis and procedure codes
  • Claims (837P/I) and submission statuses
  • Remittances (835), adjustments (CARC/RARC), and patient responsibility
  • Denials, underpayments, appeals, and workqueue tasks
  • Providers, NPIs, facilities, and taxonomy codes

The R1 RCM Integration Challenge

Turning portal- and batch-driven RCM workflows into automated pipelines is non-trivial:

  • Complex payer rules: Benefits, service type nuances, modifiers, and plan-specific edits vary widely
  • Enterprise auth: SSO/MFA and network controls complicate headless automation
  • Portal-first delivery: Key workqueues and status artifacts often live behind web apps or file exports
  • EDI orchestration: 837/835/270/271/277 windows, clearinghouse channels, and timing constraints must be respected
  • Audit and compliance: PHI handling, audit trails for edits and appeals, and retention requirements are strict

How Supergood Creates R1 RCM APIs

Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to present a resilient API layer for your integration.

  • Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
  • Maintains session continuity with automatic refresh and change detection
  • Normalizes patients, coverages, eligibility, claims, and remittance data into consistent JSON
  • Aligns with entitlements and licensing constraints to ensure compliant access
  • Bridges batch and EDI flows where applicable, with signed URL retrieval and delivery

Use Cases

Patient Access & Eligibility Synchronization

  • Push patients and insurance coverage from your app into R1 RCM
  • Run real-time eligibility (270/271) to validate active coverage and financial responsibility
  • Use payer responses to drive upfront estimates and reduce back-end rework

Price Estimates & Prior Authorization

  • Create estimate requests aligned to payer policies and service types
  • Attach prior authorization references to encounters to prevent downstream denials
  • Present patient-friendly estimates and payment options at scheduling or check-in

Clean Claims & Submission Automation

  • Assemble compliant 837P/I claims from charges, diagnoses, and coverage data
  • Route claims via clearinghouse or payer portal channels
  • Track submission acknowledgments and status updates programmatically

Denial Triage & Reconciliation

  • Pull ERAs (835), adjustments, and denial reason codes
  • Auto-post remittances, surface underpayments, and route denials to the right teams
  • Manage appeals with due dates and supporting documentation

Patient Payments & Balance Management

  • Reflect patient payments and plans alongside payer remits
  • Reconcile balances across encounters and statements
  • Trigger outreach and digital payment flows via your product

Available Endpoints

Authentication

POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {
      "type": "totp",
      "code": "123456"
    }
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_91fd0a",
    "name": "RCM Admin",
    "entitlements": ["patients", "eligibility", "claims", "remittances"]
  }
}

Patients & Coverage

GET /patients: Retrieve patient demographics with linked insurance coverages. Use to sync your EHR/practice app with R1 RCM and keep policies current.

Query parameters

  • mrn: string
  • lastName: string
  • dob: ISO 8601 date
  • coverageActiveOn: ISO 8601 date
  • page, pageSize: integers

Example response

{
  "items": [
    {
      "patientId": "pat_9c21f3",
      "mrn": "MRN123456",
      "name": {"first": "Avery", "last": "Nguyen"},
      "dob": "1988-04-12",
      "sex": "F",
      "contact": {"phone": "+1-555-201-8844", "email": "[email protected]"},
      "addresses": [
        {"type": "home", "line1": "14 Cedar St", "city": "Denver", "region": "CO", "postalCode": "80203"}
      ],
      "coverages": [
        {
          "coverageId": "cov_3b7a2d",
          "payerId": "payer_bcbs_co",
          "payerName": "BCBS of Colorado",
          "planName": "PPO",
          "memberId": "Z12345678",
          "groupNumber": "G78901",
          "sequence": "primary",
          "startDate": "2025-01-01",
          "endDate": null,
          "eligibilityStatus": "active"
        }
      ],
      "guarantor": {"name": "Avery Nguyen", "relation": "self"}
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

POST /patients: Create or update a patient and insurance coverage. Idempotent by MRN + coverage memberId.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/patients \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "mrn": "MRN123456",
    "name": {"first": "Avery", "last": "Nguyen"},
    "dob": "1988-04-12",
    "sex": "F",
    "contact": {"phone": "+1-555-201-8844", "email": "[email protected]"},
    "addresses": [{"type": "home", "line1": "14 Cedar St", "city": "Denver", "region": "CO", "postalCode": "80203"}],
    "coverages": [
      {
        "payerId": "payer_bcbs_co",
        "planName": "PPO",
        "memberId": "Z12345678",
        "groupNumber": "G78901",
        "sequence": "primary",
        "startDate": "2025-01-01"
      }
    ]
  }'

Example response

{
  "patientId": "pat_9c21f3",
  "created": false,
  "updatedFields": ["contact.email"],
  "coverageIds": ["cov_3b7a2d"]
}

Eligibility (270/271)

POST /eligibility/checks: Initiate a real-time eligibility inquiry for a patient/coverage, returning normalized benefits with a downloadable 271 artifact.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/eligibility/checks \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patientId": "pat_9c21f3",
    "coverageId": "cov_3b7a2d",
    "provider": {"npi": "1234567890", "taxId": "12-3456789"},
    "serviceTypes": ["30", "98"],
    "dateOfService": "2026-01-19",
    "placeOfService": "11"
  }'

Example response

{
  "eligibilityId": "elig_101ab0",
  "status": "eligible",
  "asOf": "2026-01-19T14:01:00Z",
  "coverage": {
    "payerName": "BCBS of Colorado",
    "planType": "PPO",
    "active": true
  },
  "financials": {
    "copay": {"officeVisit": 25.0},
    "deductible": {"individual": {"remaining": 350.0, "total": 1500.0}},
    "coinsurance": {"officeVisit": 0.2}
  },
  "limitations": [
    {"serviceType": "98", "notes": "Prior authorization required for advanced imaging"}
  ],
  "raw271": {"format": "X12-271", "size": 20480, "downloadUrl": "https://download.r1.example/signed/abc123..."}
}

Claims (837P/I)

POST /claims: Assemble a professional or institutional claim from charges and coverage. Supergood normalizes service lines and can route the generated EDI to your configured channel.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/claims \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "claimType": "837P",
    "payerId": "payer_bcbs_co",
    "billingProvider": {
      "npi": "1234567890",
      "taxId": "12-3456789",
      "name": "Downtown Family Medicine",
      "billingAddress": {"line1": "100 Clinic Way", "city": "Denver", "region": "CO", "postalCode": "80203"}
    },
    "renderingProvider": {"npi": "1098765432", "taxonomy": "207Q00000X"},
    "facility": {"npi": "1568473920", "placeOfService": "11"},
    "patientId": "pat_9c21f3",
    "coverageId": "cov_3b7a2d",
    "diagnosisCodes": ["J01.90", "R50.9"],
    "serviceLines": [
      {"procedureCode": "99213", "modifiers": ["25"], "units": 1, "chargeAmount": 145.00, "dosFrom": "2026-01-19", "dosTo": "2026-01-19", "placeOfService": "11", "diagnosisPointers": ["A", "B"]}
    ],
    "authorizationNumber": null,
    "submissionChannel": "clearinghouse",
    "referenceId": "batch-jan19-01"
  }'

Example response

{
  "claimId": "clm_82cb17",
  "status": "queued",
  "edi": {"format": "837P", "size": 53120},
  "submissionChannel": "clearinghouse",
  "createdAt": "2026-01-19T16:05:42Z",
  "reviewUrl": "https://download.r1.example/signed/def456...",
  "referenceId": "batch-jan19-01",
  "payerTraceId": null
}

Remittances & Denials (835)

GET /remittances: Retrieve ERA summaries with claim-level postings, adjustments (CARC/RARC), and patient responsibility. Use to auto-post payments and triage denials.

Query parameters

  • claimId: string
  • payerId: string
  • paymentDateFrom, paymentDateTo: ISO 8601 dates
  • page, pageSize: integers

Example response

{
  "items": [
    {
      "remitId": "era_4e1c0b",
      "paymentDate": "2026-01-24",
      "payer": {"id": "payer_bcbs_co", "name": "BCBS of Colorado"},
      "paymentMethod": "EFT",
      "checkOrTrace": "123456789",
      "amount": 120.35,
      "claims": [
        {
          "claimId": "clm_82cb17",
          "patientId": "pat_9c21f3",
          "paidAmount": 95.35,
          "patientResponsibility": 25.00,
          "adjustments": [
            {"group": "CO", "reasonCode": "45", "amount": 24.65, "description": "Charge exceeds fee schedule"},
            {"group": "PR", "reasonCode": "2", "amount": 25.00, "description": "Copay amount"}
          ],
          "denials": [],
          "balance": 0.00
        }
      ]
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Get full API Specs →

Technical Specifications

  • Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
  • Response format: JSON with consistent resource schemas and pagination
  • Rate limits: Tuned for enterprise throughput while honoring licensing and usage controls
  • Session management: Automatic reauth and cookie/session rotation with health checks
  • Data freshness: Near real-time retrieval of eligibility, claim, and remittance artifacts
  • Security: Encrypted transport, scoped tokens, audit logging; respects R1 entitlements and HIPAA requirements
  • Webhooks: Optional asynchronous delivery for eligibility responses, claim status updates, and ERA postings

Performance Characteristics

  • Latency: Sub-second responses for list/detail queries under normal load
  • Throughput: Designed for high-volume eligibility and claims pipelines
  • Reliability: Retry logic, backoff, and idempotency keys minimize duplicates and ensure safe replays
  • Adaptation: Continuous monitoring for UI/EDI changes with rapid adapter updates

Getting Started

  1. Schedule Integration Assessment

Book a 30-minute session to confirm your R1 product mix, licensing, and authentication model.

  1. Supergood Builds and Validates Your API

We deliver a hardened R1 adapter tailored to your workflows and entitlements.

  1. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as R1 evolves.

Schedule Integration Call →

Frequently Asked Questions

Q: Which R1 RCM products can this integration cover?

Supergood supports workflows across commonly used R1 patient access, mid-cycle, and back-office tools—subject to your licensing and entitlements. We scope coverage (e.g., registration, eligibility, claims, ERAs, denials/underpayments) during integration assessment.

Q: How do you handle SSO/MFA and clearinghouse or payer channel submissions?

We support username/password + MFA and can operate behind SSO/OAuth when enabled. For submissions, we can generate 837 files, respect batching/timing windows, and deliver via configured channels (clearinghouse or payer portal) while returning statuses and artifacts.

Q: Can I reconcile payments and denials automatically?

Yes. Pull ERAs (835), auto-post payments and adjustments, surface denials with CARC/RARC codes, and route unresolved items to workqueues or your ticketing system with due dates.

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Ready to automate your R1 RCM workflows?

Supergood can have your R1 RCM integration live in days with no ongoing engineering maintenance.

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