HEALTHCARE’S FIRST PRICING PROTOCOL
Four engines and one gateway that turn an appointment into an accurate patient price before the visit. It runs our own products, and it is available as an API and as an SDK you configure into yours.
THE SDK
Our own products are configurations of the same modules. A different set gives you a different product, running in your workflow instead of ours. Try it below.
// nothing enabled // turn on a module and the call sequence, // the configuration and this surface // all change with it
{
"totals": {
"patient_responsibility": 31240,
"allowed": 156200
},
"benefits_summary": {
"narrative": "COINSURANCE",
"explanation": "20% coinsurance
across the encounter;
deductible met.",
"patient_owes": 31240
}
}
The response only, rendered in an interface you build.
Our price card, dropped into your interface.
Same-day imaging, radiologist read included.
We host it on your domain, in your brand.
20% coinsurance on your Aetna PPO plan. Your deductible is met.
Self-service check-in, priced before the visit starts.
Based on your live benefits and this facility’s negotiated rate, not a chargemaster range.
The estimator 45 CFR 180.60 asks for, running on our pricing.
Expected against paid, by payer and code.
Priced across the day’s schedule rather than per patient.
USE CASES
Platforms, MSOs, payers and surgery centers each sequence the same endpoints differently. Open one to see its call sequence and the API fields it uses.
THE COMPLEXITY NO ONE ELSE HAS SOLVED FOR
Patient responsibility depends on the payer, the plan package, the provider’s contracted rate and the codes the encounter actually generates. To get it right before the visit you have to know that provider’s contracted rate and where the patient’s accumulators stand on the day.
PAYER×PACKAGE×PROVIDER×TREATMENT
Deductible met, 20% coinsurance
$1,100.00 deductible remaining, then 20%
Flat advanced imaging copay
Deductible met, 20% coinsurance
Out-of-pocket maximum already reached
Practice cash price, no insurance applied
CPT 73721 + 73721-26, KNEE MRI WITHOUT CONTRAST, ONE PRACTICE, ONE WEEK. ALLOWED AMOUNTS ILLUSTRATIVE.
Four engines produce that number. We model the negotiated rate from adjudicated claims at the NPI level, read the encounter out of the EHR, run the patient’s live benefits through it in adjudication order, then check the 835 against what we predicted when the claim comes back. Three and a half years of R&D went into that loop before any of it was callable.
AUTO-LOAD FROM EHR
Pulls the practice’s schedule, providers, and codes nightly, so a price exists before the patient arrives.
ACCESSING INSURANCE RESOURCES
Real-time eligibility through the clearinghouse, parsed across EB segment hierarchies and free-text MSG fields when the response is ambiguous.
ALGORITHMIC BALANCING ENGINE
Predicts what this payer pays this provider for this code, modeled at the individual NPI rather than a market average. Over 1TB of claims ETL per practice.
ADJUDICATION RECONCILIATION
Reads every 835 and maps each pricing discrepancy. 8,700 weekly adjustments become labeled training examples, so the models self-correct without human annotation.
LIVE TODAY
The protocol runs in production and is reconciled against real claims every day. The API and the SDK open it to the rest of the market.
Patient cost share collected at MedRite, three urgent care sites
FEB–APR 2026 AGAINST THE SAME WINDOW IN 2025
Org-wide patient yield at Knownwell, a national virtual care group
LTM
Patient yield at Foothills Neurology after go-live
LTM
