Send a claim line. Get back the payer's own benchmark contracted rate, the underpayment gap, and a ready-to-send leverage memo — under your brand.
Built on federal Transparency in Coverage machine-readable files, including payer-published in-network negotiated rate data under 45 CFR § 147.212 and related implementing rules. Aggregates only — no PHI, no patient data, ever. REST/JSON, key-authenticated, metered.
Illustrative sample. Live responses are computed from the current federal rate index per call.
Your middleware extracts claim lines (CPT/HCPCS, payer, state, paid amount) from any source or BPO queue.
Call /rate-benchmark with up to 100 lines. We return the peer-median contracted rate, distribution, and the gap per line.
Call /leverage-memo for the flagged lines. We return a white-label, payer-ready leverage memo your team routes and works.
Every request carries your partner key in the X-Api-Key header. Keys are per-partner, metered, and rate-limited by tier. We issue a capped pilot key first.
| Tier | Rate limit | Batch | Monthly fair-use ceiling |
|---|---|---|---|
| Pilot | 60 req / min | 100 claims / call | 5,000 calls |
| Growth | 240 req / min | 100 claims / call | 50,000 calls |
| Scale | 600 req / min | 100 claims / call | Custom |
Batch, claim-aware. Returns one benchmark per line, with gap analysis when you pass paid_amount.
{
"claims": [
{ "id": "clm_8841", "cpt": "97110", "payer": "aetna", "state": "CA", "paid_amount": 29.70 },
{ "id": "clm_8842", "cpt": "99214", "payer": "uhc", "state": "CA" }
]
}
{
"ok": true,
"summary": { "claims": 2, "matched": 2, "underpaid": 1, "documented_gap_per_unit": 8.30 },
"results": [
{
"id": "clm_8841", "ok": true, "cpt": "97110", "description": "Therapeutic exercises",
"payer_label": "Aetna of California", "benchmark": 38.00,
"percentiles": { "p25": 33.10, "p50": 38.00, "p75": 42.40, "p95": 49.00 },
"sample_count": 51, "confidence": "Medium",
"paid_amount": 29.70, "gap": 8.30, "paid_percentile": 12, "underpaid": true, "opportunity_flag": "high"
}
],
"source": "tic_mrf"
}
Sample payloads with illustrative values. Field names and shapes match the live contract exactly.
Generates a white-label, payer-ready leverage memo from claim lines. Your brand in the header and footer; zero Reddenda attribution in white-label mode.
{
"payer": "aetna", "state": "CA",
"practice_name": "Sample Physical Therapy Practice",
"claims": [ { "cpt": "97110", "paid_amount": 29.70 }, { "cpt": "97140", "paid_amount": 24.10 } ],
"brand": { "name": "Porto RCM Partner Solutions" }
}
→ { ok:true, memo:"…ready-to-send memo text…", summary:{…}, line_detail:[…], white_label:true }
Key self-service: send your key, get back plan, period usage, and limit. Powers usage meters inside partner consoles.
{ "key": "ros_live_…" }
→ { ok:true, found:true, company:"…", status:"active", plan:"api-platform",
calls_this_period:412, monthly_call_limit:5000, key_prefix:"ros_live_4f2…" }
Partners buy each covered NPI at a fixed monthly wholesale rate and resell under their own brand. The per-NPI rate steps down as your committed portfolio grows. Flat fees only: no percentage pricing on any module, ever. The numbers get structured on the walkthrough.
Pilot-size books. White-label deliverables, scoped NPI access, usage metering.
Growing portfolios. Same engine and deliverables at a deeper flat rate.
Scaled books. Deepest flat band, custom rate limits on request.
The pilot is designed to prove value fast: a capped, metered key, a signed one-page agreement, and a single success metric — the share of your claim sample we flag as documented reimbursement opportunity. Convert to a volume band on results.
Send us a structured, de-identified claim sample (CPT/HCPCS, payer, state, paid amount). We provision a capped pilot key and run your sample through both endpoints on a live call.
Request a pilot key →