DRG Integrations Integration-ready API

Connect the MS-DRG / IPPS pricing engine to core claim-admin, contract-modeling, and clearinghouse systems.

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Integration-ready

A pluggable connector framework for the systems that consume MS-DRG grouping and IPPS pricing — core claim-administration platforms (Facets, QNXT, HealthRules, Plexis, Tapestry), contract pricing & modeling engines (NetworX Pricer, NetworX Modeler, Optum CES), and clearinghouses. Each connector advertises the capabilities it can source from this service: DRG pricing, contract modeling, adjudication feed, eligibility (270/271), and remittance (835).

Sandbox by default. A connector goes live only when both its endpoint URL and credential env vars are set (e.g. NETWORX_PRICER_URL + NETWORX_PRICER_API_KEY) — never through this UI. When live, the claim (plus our reference DRG & IPPS pricing) is POSTed to the vendor's real API and its response is returned alongside ours. Until then the connector runs in deterministic sandbox mode, with DRG pricing still computed for real by this service's grouper + IPPS calculator.

Try it — price the sample claim through a connector

Groups the sepsis sample (A41.9 + R65.21) and returns the normalized DRG-pricing envelope the selected system would receive.

Connectors

API reference

Server-side endpoints under /api/v1. Live connectivity is gated on the per-connector credential env var; grouping + pricing always run for real.

GET /integrations — list connectors (filter: ?capability=drg_pricing&type=pricing)
GET /integrations/{id} — one connector's capabilities + mode
POST /integrations/{id}/price — { diagnoses, procedures, ccn, los, coveredCharges } → DRG-pricing envelope

The same grouping + pricing is available directly via POST /drg/group and GET /drg/calculate.