Rivet Health

Supergood | Rivet API

Alex Klarfeld

Alex Klarfeld

— 7 min read
Supergood | Rivet API

Programmatically access payer contract models, prior authorization tracking, estimates, and reimbursement analytics in Rivet with a stable REST API. Supergood builds and operates production-grade, unofficial Rivet integrations so your team can automate critical billing and revenue cycle workflows without heavy custom engineering.

Rivet is software used by healthcare provider groups, clinics, and revenue cycle teams to model payer contracts, track prior authorizations, generate compliant patient estimates, identify underpayments, and manage denials and reimbursement. With an unofficial API, you could calculate allowed amounts by payer and CPT code, synchronize authorizations from your scheduling/EHR, generate patient estimates tied to coverage and benefits, pull claims and remittance variance, and route underpayment/denial worklists—end to end.

If you’re a healthcare tech startup focused on billing, practice management, or provider services, an unofficial Rivet API gives you clean programmatic access to:

  • Pull: Payer contracts and fee schedules, negotiated rates, prior authorization statuses, claim line items, CARC/RARC codes, remittance details (835), underpayment flags, denials queues, patient estimates and cost breakdowns
  • Push: Authorization requests and updates, scheduled procedures for estimate generation, claim notes and appeal documentation, worklist assignments and resolution outcomes, contract amendments for modeling and comparison
  • Build: Authorization-aware scheduling, instant estimates in pre-service workflows, automated underpayment detection against contract terms, denials routing with CARC/RARC insights, reconciliation dashboards combining charges, allowed, paid, and patient responsibility

What is Rivet?

Rivet provides revenue acceleration and contract intelligence for healthcare organizations. Its products help provider groups understand and operationalize payer contracts, detect and resolve underpayments, manage prior authorizations, produce No Surprises Act-compliant patient estimates, and streamline claims and remittance workflows.

Core product areas include:

  • Payer contract modeling and fee schedules (CPT/HCPCS, modifiers, POS)
  • Underpayment detection and payment variance analysis
  • Prior authorization tracking for procedures and services
  • Patient estimates and price transparency (Good Faith Estimates)
  • Claims worklists and denials management with CARC/RARC codes
  • Remittance (835) reconciliation and audit trails
  • Revenue analytics and payer performance insights

Common data entities:

  • Payers and Plans
  • Contracts and Fee Schedules (allowed amounts, effective dates, terms)
  • Procedures (CPT/HCPCS), Modifiers, Place of Service, Diagnosis Codes
  • Patients/Guarantors and Coverage
  • Authorizations (service, units, dates, status)
  • Claims and Claim Line Items (charges, allowed, paid, adjustments)
  • Remittances (835), EOBs, CARC/RARC codes
  • Estimates/Quotes (patient responsibility breakdowns)
  • Worklists, Tasks, Notes, Attachments

The Rivet Integration Challenge

Healthcare organizations rely on Rivet daily, but turning portal-based contract math and reimbursement workflows into automated pipelines is hard:

  • Complex contract math: Allowed amounts vary by payer, plan, CPT, modifiers, POS, and effective dates; multiple procedure reduction and bundling rules apply
  • Claims nuance: CARC/RARC adjustment codes must be mapped to denial/variance reasons, and line-level math needs normalization across payers
  • Portal-first delivery: Key contract, authorization, estimate, and worklist features live in web applications; public APIs are limited or non-unified
  • Strong enterprise security: SSO/MFA and network controls complicate headless automation for revenue cycle teams
  • File interfaces and timing windows: 835 remittance and 837 claim artifacts may be batched via SFTP/EDI, with submission and retrieval windows
  • Compliance requirements: No Surprises Act estimates, audit trails for appeals, and data retention policies demand careful handling

How Supergood Creates Rivet APIs

Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.

  • Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
  • Maintains session continuity with automated refresh and change detection
  • Normalizes contract, authorization, estimate, claim, and remittance objects across payers
  • Aligns with customer entitlements and licensing constraints to ensure compliant access
  • Bridges batch exports and SFTP/EDI flows with signed URL retrieval and delivery where applicable

Use Cases

EHR-to-RCM Synchronization

  • Push scheduled procedures and demographics to generate estimates pre-service
  • Sync authorizations from your scheduling system to Rivet with statuses and units
  • Maintain a single source of truth for payer, plan, and coverage data

Authorization-Aware Scheduling and Eligibility

  • Validate authorizations before scheduling or claim creation
  • Track remaining authorized units and prevent over-utilization
  • Surface payer-specific rules and required documentation to care coordinators

Price Transparency and Good Faith Estimates

  • Generate No Surprises Act-compliant estimates with contract-aware allowed amounts
  • Incorporate coverage, deductible, copay, and coinsurance to show patient responsibility
  • Attach printable estimate packets to encounters and share via patient workflows

Underpayment Detection, Denials, and Appeals

  • Compare paid amounts to contract rates and flag variances automatically
  • Pull CARC/RARC details and route denials to the right worklists n- Attach appeal letters and documentation programmatically and track outcomes

Remittance Reconciliation and Analytics

  • Consolidate 835 payments, adjustments, and variances into dashboards
  • Tie estimates, authorizations, and claims to reimbursement outcomes
  • Monitor payer performance and contract effectiveness over time

Audit and Compliance

  • Export machine-readable artifacts for estimates, authorizations, and claims
  • Maintain audit trails with timestamps, user actions, and attached documents
  • Prove patient estimate compliance and claim provenance during reviews

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_92ba41",
    "name": "RCM Admin",
    "entitlements": ["contracts", "authorizations", "estimates", "claims"]
  }
}

Contract Rates

GET /contracts/rates: Retrieve negotiated/allowed amounts for a service under a payer contract. Use this to validate estimates, detect underpayments, and price services pre-visit.

Query parameters

  • payerId: string
  • planId: string
  • providerNpi: string
  • serviceCode: string (CPT/HCPCS)
  • modifiers: array
  • placeOfService: string (e.g., "11", "22")
  • effectiveOn: ISO 8601 date
  • units: number

Example response

{
  "items": [
    {
      "rateId": "rate_7c312a",
      "payerId": "payer_bcbs-ut",
      "planId": "plan_ppo_001",
      "feeScheduleVersion": "2026-Q1",
      "serviceCode": "99213",
      "modifiers": ["25"],
      "placeOfService": "11",
      "unitType": "procedure",
      "allowedAmount": 92.50,
      "multipleProcedureReduction": false,
      "effectiveStart": "2026-01-01",
      "effectiveEnd": "2026-03-31",
      "notes": "Outpatient office visit established patient"
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Authorizations

GET /authorizations: Retrieve prior authorization records with service details, units, date ranges, and statuses. Use this to confirm eligibility and prevent claim denials.

Query parameters

  • patientId: string
  • payerId: string
  • serviceCode: string (CPT/HCPCS)
  • activeOn: ISO 8601 date
  • status: string (e.g., "pending", "approved", "denied")

Example response

{
  "items": [
    {
      "authorizationId": "auth_1a9f30",
      "authorizationNumber": "AUTH-2026-11872",
      "patientId": "pat_9b42f0",
      "patientName": "Jordan Patel",
      "payerId": "payer_bcbs-ut",
      "planId": "plan_ppo_001",
      "serviceCode": "64615",
      "diagnosisCodes": ["G43.709"],
      "unitsAuthorized": 2,
      "unitsRemaining": 1,
      "startDate": "2026-01-01",
      "endDate": "2026-04-30",
      "status": "approved",
      "attachments": [
        {"type": "clinical_notes", "url": "https://download.rivet.example/signed/notes-abc123"}
      ]
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Patient Estimates

POST /estimates: Generate a patient cost estimate using contract rates and coverage details. Supergood normalizes payer math (deductible, copay, coinsurance) to produce No Surprises Act-compliant outputs.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/estimates \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patientId": "pat_9b42f0",
    "payerId": "payer_bcbs-ut",
    "planId": "plan_ppo_001",
    "providerNpi": "1234567890",
    "placeOfService": "11",
    "scheduledDate": "2026-01-25",
    "services": [
      {"serviceCode": "99213", "modifiers": ["25"], "units": 1},
      {"serviceCode": "J1885", "units": 2}
    ],
    "coverage": {
      "deductibleRemaining": 500.00,
      "oopRemaining": 1500.00,
      "coinsurance": 0.2,
      "copays": {"99213": 30.00}
    },
    "referenceId": "sched-42391"
  }'

Example response

{
  "estimateId": "est_58d3e0",
  "patientResponsibility": 104.50,
  "insurancePortion": 78.00,
  "allowedTotal": 182.50,
  "breakdown": {
    "services": [
      {
        "serviceCode": "99213",
        "allowed": 92.50,
        "copay": 30.00,
        "coinsurance": 12.50,
        "deductibleApplied": 0.00
      },
      {
        "serviceCode": "J1885",
        "allowed": 90.00,
        "copay": 0.00,
        "coinsurance": 18.00,
        "deductibleApplied": 44.50
      }
    ],
    "totals": {"deductibleApplied": 44.50, "copay": 30.00, "coinsurance": 30.50}
  },
  "compliance": {"nsa": true, "printableUrl": "https://download.rivet.example/signed/gfe-abc123"},
  "referenceId": "sched-42391"
}

Claims

GET /claims: Retrieve claims and line items with statuses, denials, and payment variance against contract rates. Use this to feed underpayment detection and denials worklists.

Query parameters

  • patientId: string
  • payerId: string
  • dosStart: ISO 8601 date
  • dosEnd: ISO 8601 date
  • status: string (e.g., "submitted", "paid", "denied", "partial")
  • underpaid: boolean

Example response

{
  "items": [
    {
      "claimId": "clm_71af2b",
      "patientId": "pat_9b42f0",
      "payerId": "payer_bcbs-ut",
      "dosStart": "2026-01-19",
      "dosEnd": "2026-01-19",
      "status": "paid",
      "lines": [
        {
          "lineId": "ln_001",
          "serviceCode": "99213",
          "modifiers": ["25"],
          "units": 1,
          "billedAmount": 145.00,
          "allowedAmount": 92.50,
          "paidAmount": 82.50,
          "adjustments": [
            {"code": "CO-45", "amount": 52.50},
            {"code": "PR-2", "amount": 10.00}
          ],
          "denialCodes": [],
          "underpayment": {
            "flag": true,
            "variance": 10.00,
            "reason": "Paid below allowed; patient responsibility misapplied"
          }
        }
      ],
      "remittance": {
        "835Id": "rem_8a91c3",
        "postingDate": "2026-01-22",
        "paymentReference": "EFT-187223"
      }
    }
  ],
  "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 contracts, authorizations, estimates, claims, and remittance artifacts
  • Security: Encrypted transport, scoped tokens, and audit logging; respects Rivet entitlements and compliance requirements
  • Webhooks: Optional asynchronous delivery for authorization updates, estimate generation, and remittance postings

Performance Characteristics

  • Latency: Sub-second responses for list/detail queries under normal load
  • Throughput: Designed for high-volume estimate generation and reimbursement pipelines
  • Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
  • Adaptation: Continuous monitoring for UI/API changes with rapid adapter updates

Getting Started

  1. Schedule Integration Assessment

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

  1. Supergood Builds and Validates Your API

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

  1. Deploy with Monitoring

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

Schedule Integration Call →

Frequently Asked Questions

Q: Which Rivet products can this integration cover?

Supergood supports workflows across commonly used Rivet modules, subject to your licensing and entitlements. We scope coverage (e.g., contract modeling, prior auth tracking, patient estimates, underpayment detection, claims/denials worklists, remittance reconciliation) during integration assessment.

Q: How are MFA, SSO, and batch interfaces handled for automation?

We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For batch flows, we manage SFTP/EDI timing windows, generate/retrieve 835/837 artifacts, and return signed URLs or delivery confirmations programmatically.

Q: Can I detect underpayments and route denials automatically?

Yes. You can compare paid amounts against contract rates, flag variances, and route denials with CARC/RARC context to worklists. We can attach appeal documentation and track outcomes programmatically.

Waystar API - Programmatically access revenue cycle clearinghouse workflows with Supergood

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