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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.

FHIR → X12 837I mapping Loop 2300 · HI segment

The grouped claim's diagnoses, principal procedure and MS-DRG map to the X12 837I (institutional) HI segment your payer platform ingests — each field prefixed with its X12 qualifier. Edit the codes below (or load the sample) and toggle each path to see it light up in the diagram and the assembled segment. Codes are looked up against the real FY2026 ICD-10 files.

Assembled HI segment (Loop 2300)
Illustrative single HI segment — X12 strips the ICD-10 decimal (J18.9 → J189). Production 837I may split diagnoses across multiple HI segments (12 components each); qualifiers shown are BK principal Dx · BF secondary Dx · BBR principal procedure · DR diagnosis-related group.
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.