R1 RCM API
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, generat
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
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your R1 product mix, licensing, and authentication model.
- Supergood Builds and Validates Your API
We deliver a hardened R1 adapter tailored to your workflows and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as R1 evolves.
API Endpoints
Authentication
/sessionsEstablish 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.
Patients & Coverage
/patientsRetrieve patient demographics with linked insurance coverages. Use to sync your EHR/practice app with R1 RCM and keep policies current.
Patients & Coverage
/patientsCreate or update a patient and insurance coverage. Idempotent by MRN + coverage memberId.
Eligibility (270/271)
/eligibility/checksInitiate a real-time eligibility inquiry for a patient/coverage, returning normalized benefits with a downloadable 271 artifact.
Claims (837P/I)
/claimsAssemble a professional or institutional claim from charges and coverage. Supergood normalizes service lines and can route the generated EDI to your configured channel.
Remittances & Denials (835)
/remittancesRetrieve ERA summaries with claim-level postings, adjustments (CARC/RARC), and patient responsibility. Use to auto-post payments and triage denials.
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
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
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
Frequently asked questions
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.
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.
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.