Medigami patient tools: rates, markups, denial codes, deadlines, overturn rates, procedure codes
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Compares one billed line to the hospital's own published negotiated rate for that code and returns the multiple. You type the code and amount; no bill upload. Educational, not billing advice.
CPT/HCPCS procedure code.
Hospital / facility name.
Amount billed, USD.
Compares one billed line to the hospital's own published negotiated rate for that code and returns the multiple. You type the code and amount; no bill upload. Educational, not billing advice.
| Argument | Type | Description |
|---|---|---|
| cpt* | string | CPT/HCPCS procedure code. |
| hospital* | string | Hospital / facility name. |
| billed_amount* | number | Amount billed, USD. |
{
"type": "object",
"required": [
"hospital",
"cpt",
"billed_amount"
],
"properties": {
"cpt": {
"type": "string",
"maxLength": 10,
"description": "CPT/HCPCS procedure code."
},
"hospital": {
"type": "string",
"maxLength": 200,
"description": "Hospital / facility name."
},
"billed_amount": {
"type": "number",
"minimum": 0,
"description": "Amount billed, USD."
}
}
}Explains a CARC claim-adjustment reason code from the public X12 code list: what it means, whether it is typically appealable, and the general appeal path. Not legal advice.
| Argument | Type | Description |
|---|---|---|
| carc_code* | string | CARC/RARC code, e.g. 'CO-16', '16', 'CO-50'. |
{
"type": "object",
"required": [
"carc_code"
],
"properties": {
"carc_code": {
"type": "string",
"maxLength": 20,
"description": "CARC/RARC code, e.g. 'CO-16', '16', 'CO-50'."
}
}
}Returns the appeal window that applies to a plan type (employer ERISA plan, marketplace/individual, Medicare Advantage, Medicaid) with the federal citation and how the clock is counted. Cites the rule; does not tell you whether to file.
| Argument | Type | Description |
|---|---|---|
| state* | string | 2-letter US state (echoed on the row; the window itself is federal). |
| plan_type* | string | e.g. 'self_funded', 'aca_marketplace', 'medicare', 'medicaid'. |
{
"type": "object",
"required": [
"state",
"plan_type"
],
"properties": {
"state": {
"type": "string",
"maxLength": 32,
"description": "2-letter US state (echoed on the row; the window itself is federal)."
},
"plan_type": {
"type": "string",
"maxLength": 40,
"description": "e.g. 'self_funded', 'aca_marketplace', 'medicare', 'medicaid'."
}
}
}Returns the negotiated rate a named hospital publishes in its federally required machine-readable file for a CPT/HCPCS code, with the file's as-of date. Public hospital-transparency data; educational, not billing advice.
| Argument | Type | Description |
|---|---|---|
| cpt* | string | CPT/HCPCS procedure code. |
| hospital* | string | Hospital / facility name. |
{
"type": "object",
"required": [
"hospital",
"cpt"
],
"properties": {
"cpt": {
"type": "string",
"maxLength": 10,
"description": "CPT/HCPCS procedure code."
},
"hospital": {
"type": "string",
"maxLength": 200,
"description": "Hospital / facility name."
}
}
}Returns, for one insurer in one state, the share of external-review appeals the state regulator reports as overturned, with the sample size, the regulator's report as the source, and the as-of date. Available for CA, NY, MD, NJ, MI, OH, NC. This is one insurer's own historical rate — not a ranking or comparison against other insurers, and not a prediction for your case.
| Argument | Type | Description |
|---|---|---|
| state* | string | Venue state: CA, NY, MD, NJ, MI, OH, or NC. |
| insurer* | string | Insurer / payer name. |
{
"type": "object",
"required": [
"insurer",
"state"
],
"properties": {
"state": {
"type": "string",
"maxLength": 32,
"description": "Venue state: CA, NY, MD, NJ, MI, OH, or NC."
},
"insurer": {
"type": "string",
"maxLength": 100,
"description": "Insurer / payer name."
}
}
}Plain-English description of a CPT/HCPCS procedure code and its category, from public code references.
| Argument | Type | Description |
|---|---|---|
| cpt_code* | string | CPT / HCPCS-J code ('99213', 'J1885') or keyword ('knee MRI', 'colonoscopy'). |
{
"type": "object",
"required": [
"cpt_code"
],
"properties": {
"cpt_code": {
"type": "string",
"maxLength": 200,
"description": "CPT / HCPCS-J code ('99213', 'J1885') or keyword ('knee MRI', 'colonoscopy')."
}
}
}