Billing External API Specifications


To list the capabilities of the RXNT External APIs that are used to load external data
into the RXNT database (DB). In addition, list the data that can be loaded as scripts
without using the APIs.

External API Modules

The following modules can be pushed over to RXNT DB through the APIs.
All RXNT solutions have APIs to do the below functionalities:

  • Search
  • Get
  • Delete
  • Save

The information that RXNT can receive via APIs to Search / Save / Delete on
all the modules including:

  • Payer
  • Referring Provider
  • Patient
  • People
  • Case
  • Encounters / Charges

The below modules have only SaveandPost implemented as of now.

  • Patient Payments
  • Insurance Payments

Find attached the excel file which explains each API in detail:

RXNT External API Details


All Payers that have an ‘ExternalReferencePayerId’ (Unique Payer ID) can be uploaded through the API. The electronic ID is mandatory if the payer’s claim filing is Electronic.
Referring Provider
Referring Providers from the external system can be loaded to RXNT with an ‘ExternalReferringProviderId’ mapped to each record.
Demographic Information (Patient / Case / People)
Patient / Cases / People (relation) information can be uploaded through the API. All the data needs an ‘External_Id’ (Unique ID) to reference.
Encounters / Charges
*Only Unbilled encounters (charges) can be uploaded through the APIs. An Unbilled encounter is described as NO Claims or Payments created for that encounter (charge).
The API will load all the charge information like Patient, Case, Providers, Locations, Procedure Codes, Diagnosis Codes, Amounts, and Units that are required for that encounter.
Patient Payments
Patient payments from the external system can be loaded to RXNT by providing an ‘ExternalReferencePatientPaymentId’ which is unique. ExternalReferencePatientId, ExternalReferenceEncounterId, ExternalReferenceEncounterDetailId (in case the payment is at line item level) and ExternalReferenceEncounterChargeId (in case the payment is at miscellaneous charge level) also needs to be provided to identify the encounter and line item. The patient payment API can be invoked only once the encounters which are part of the payment is imported into RXNT unless the payment is at the patient level.
This API will import all patient level, line items level, and miscellaneous charges level payments into RXNT.
Insurance Payments
Insurance payments from the external system can be loaded into RXNT by providing an ExternalReferenceInsurancePaymentId which is unique. ExternalReferencePatientId, ExternalReferenceEncounterId and ExternalReferenceEncounterDetailId also need to be provided to identify the encounter and line item.
The insurance payment API can be invoked only once the encounters which are part of the payment are imported into RXNT.
This API will import all line item level payments as well as any miscellaneous insurance payments into RXNT.

*Reason for not loading billed encounters:
When a claim is sent for an encounter, the clearinghouse will be sending back the status of the claim
and the payment associated with it only to the Submitter of the Claim. So, we cannot track that
encounter in RXNT as it will not show up in any of the Revenue / Transaction reports.

Sequence to call the External APIs

The external APIs should be called in the following sequence:

  1. Authenticate - Authenticates the user/company and provides a Signature and Token that can be used in the following API’s
  2. Payer - Payer API will load the complete list of payers for company
  3. Referring Provider – Loads the list of Referring Providers
  4. Patient – Loads the patient Information
  5. Cases - Loads the Cases information related to each patient
  6. People – Loads the relationships in the cases
  7. Encounters - Load the Charges for that patient 
  8. Patient Payments* - Loads the payments made by the patient
  9. Insurance Payments* - Loads the payments made by the insurance

*The order of Insurance Payments and Patient Payments should be in the same order in which they were added to the existing system.

We typically propose that high-volume clients set up 7 threads. Each thread will handle 1 API sequence at a time (a sequence is representative of 1 claim), and each sequence will take up to 15 seconds to complete.

A sequence is defined as: (1) authenticate, (2) payer, (3) referring provider - if applicable, (4) patient, (5) cases, (6) people - guarantors, (7) encounters - charge. 

Each thread can process 4-6 sequences/minute. With 7 threads, the throughput will be 28-42 sequences/minute OR 1,680-2,520 sequences/hour. Another way to say this is that the throughput will be 28-42 claims/minute OR 1,680-2,520 claims/hour.

If they're sending 4,800 claims, it will take 2 hours. 7,200 claims, it will take 3 hours. And so on.

RXNT Scripts

Financial history for a patient

There is no API to upload the financial history for a patient. Instead, we accept CSV or PDF files drafted for each patient that can contain the financial history for the patient. Below are the fields that can be included:

  • Total Adjustments on account
  • Total Charges on account
  • Total Insurance Payments to the account
  • Total Patient Payments to the account
  • Insurance Balance
  • Patient Balance
  • Total Balance

The CSV or PDF with the financial history will be uploaded as an attachment to the respective patient and the user can view it from Patient Dashboard, Profile, Encounter screen, etc.

The financial data will not be reported in any of the Revenue / Transaction reports and they are accessible as a view-only PDF.

Additional Scripts that can be uploaded without API

The following are the data uploads that can be done without APIs. This data should be provided in an excel sheet along with their External IDs and we will run scripts to insert them into the RXNT database.

  • Service Facility Locations
  • Procedure Codes
  • Diagnosis Codes
  • Fee Schedule
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