n8n-nodes-r1rcm

[Velocity BPA Licensing Notice]

This n8n node is licensed under the Business Source License 1.1 (BSL 1.1).

Use of this node by for-profit organizations in production environments requires a commercial license from Velocity BPA.

For licensing information, visit https://velobpa.com/licensing or contact [email protected].

A comprehensive n8n community node for R1 RCM revenue cycle management platform, providing 22 resources and 200+ operations for healthcare revenue cycle automation. Includes patient access, eligibility verification, prior authorization, claim lifecycle management, denial management, payment posting, Epic EHR integration, and intelligent automation.

Features

• Patient Access & Registration - Patient search, demographics, financial clearance, coverage discovery
• Eligibility Verification (270/271) - Real-time and batch eligibility checking, benefits lookup
• Prior Authorization (278) - Submit, track, and manage prior authorizations
• Charge Capture & Coding - Charge creation, coding workflows, code validation, CCI edits
• Claim Lifecycle (837P/I/D) - Create, submit, track, correct, and void claims
• Claim Status (276/277) - Real-time claim status inquiries
• Denial Management - Denial analysis, root cause, appeals, prevention recommendations
• Payment Posting (835) - ERA processing, payment reconciliation, variance detection
• A/R Management - Aging analysis, follow-up queues, collection workflows
• Epic Integration - HL7/FHIR data synchronization with Epic EHR
• Work Queue Management - Task assignment, SLA tracking, productivity metrics
• Analytics & Reporting - KPIs, dashboards, trend analysis, scheduled reports
• Intelligent Automation - AI/ML-powered automation rules and predictions
• SFTP File Transfer - Secure EDI file upload/download with validation
• Webhooks - Real-time event subscriptions for RCM events

Installation

Community Nodes (Recommended)

1. Open n8n
2. Go to Settings > Community Nodes
3. Click Install
4. Enter n8n-nodes-r1rcm
5. Click Install

Manual Installation

# Navigate to your n8n installation directory
cd ~/.n8n

# Install the package
npm install n8n-nodes-r1rcm

Development Installation

# 1. Extract the zip file
unzip n8n-nodes-r1rcm.zip
cd n8n-nodes-r1rcm

# 2. Install dependencies
npm install

# 3. Build the project
npm run build

# 4. Create symlink to n8n custom nodes directory
# For Linux/macOS:
mkdir -p ~/.n8n/custom
ln -s $(pwd) ~/.n8n/custom/n8n-nodes-r1rcm

# For Windows (run as Administrator):
# mklink /D %USERPROFILE%\.n8n\custom\n8n-nodes-r1rcm %CD%

# 5. Restart n8n
n8n start

Credentials Setup

R1 RCM API Credentials

| Field | Description | |-------|-------------| | Environment | Production, Test/UAT, or Custom | | Client ID | OAuth 2.0 client identifier | | Client Secret | OAuth 2.0 client secret | | API Key | API key for additional authentication | | Organization ID | Your R1 RCM organization identifier | | Facility ID | Default facility identifier |

R1 RCM Integration Credentials (Epic)

| Field | Description | |-------|-------------| | Integration Endpoint | Epic integration endpoint URL | | Certificate | mTLS certificate (PEM format) | | Private Key | mTLS private key (PEM format) | | Partner ID | R1 RCM partner identifier |

R1 RCM SFTP Credentials

| Field | Description | |-------|-------------| | Host | SFTP server hostname | | Port | SFTP port (default: 22) | | Username | SFTP username | | Password/SSH Key | Authentication method | | Directory Path | Default directory for operations |

Resources & Operations

Patient Access (11 operations)

• Get Patient Info, Search Patients, Create/Update Patient
• Get Demographics, Verify Identity
• Get Insurance Coverage, Financial Clearance
• Patient Responsibility Estimate, Coverage Discovery
• Propensity to Pay

Registration (8 operations)

• Create/Get/Update Registration
• Get Status, Complete, Cancel
• Pre-Registration Info, Registration Queue

Eligibility (9 operations)

• Check Eligibility (270/271), Real-Time Eligibility
• Batch Check, Benefits Summary
• Coverage Details, Deductible Info, Copay Info
• Prior Auth Requirements, Eligibility History

Prior Authorization (9 operations)

• Submit/Get/Update/Cancel Prior Auth
• Auth Reference, Requirements
• Track Request, Auth Queue, Auth History

Charge Capture (10 operations)

• Create/Get/Update/Delete Charge
• Charges by Encounter/Patient
• Unbilled Charges, Charge Lag
• Review Charge, Coding Queue

Coding (10 operations)

• Get Encounter for Coding, Submit Codes
• Coding Status, Query Codes
• Code Suggestions, Validate Codes
• CCI Edits, LCD/NCD
• Coding Queue, Productivity

Claim (12 operations)

• Create/Get/Submit Claim (837P/I/D)
• Get Status (276/277), Update/Void
• Resubmit, Correct
• Claim History, Lifecycle
• Claims by Patient, Claim Errors

Denial (11 operations)

• Get Denial/Denials, Analyze
• Denial Reason, Root Cause
• Create/Get/Track Appeal
• Denial Trends, Prevention Recommendations
• Denial Queue

Payment (11 operations)

• Get/Post/Apply Payment
• Get ERA (835)
• Payment by Check/Payer
• Unapplied Payments
• Reconcile, Payment Variance
• Contract Variance, Underpayments

A/R Management (10 operations)

• A/R Aging, A/R by Payer/Facility
• High Balance Accounts
• Follow-Up/Collection/Bad Debt Queue
• Assign Work, Work Status
• Update A/R Status

Work Queue (9 operations)

• Get Work Queues, Queue Items
• Assign/Complete/Transfer Work Item
• Queue Metrics, Queue by Type
• User Work, Queue SLA

Analytics (13 operations)

• Revenue/KPI Dashboard
• A/R Metrics, Days in A/R
• Collection Rate, Clean Claim Rate
• Denial Rate, Net Collection Rate
• Revenue Trends
• Payer/Provider/Facility Performance
• Export Analytics

Reporting (11 operations)

• Generate/Get/List Reports
• Schedule Report
• A/R/Production/Denial/Payment Report
• Executive Summary
• Custom Report, Export Report

Epic Integration (8 operations)

• Get Epic Patient/Encounter/Charges
• Sync Patient Data (bidirectional)
• Send to Epic (FHIR)
• Get Epic Status
• Reconcile Data, Epic Queue

Contract (8 operations)

• Get Contract/Contracts
• Fee Schedule, Expected Payment
• Compare to Contract
• Contract Variance, Underpayment Analysis
• Contract Terms

Provider (7 operations)

• Get/Search Providers
• Provider Credentials, Performance, Productivity
• Validate NPI, Enrolled Providers

Facility (5 operations)

• Get Facility/Facilities
• Facility Performance, Metrics, A/R

Payer (7 operations)

• Get Payer/Payers
• Payer Rules, Performance, Trends
• Payer Contacts, Check Status

Automation (7 operations)

• Get/Create/Update Automation Rules
• Automation Status, Bot Performance
• Automation Queue, Intelligent Automation

SFTP (5 operations)

• Upload/Download File
• List Files, Get Status, Delete File

Webhook (7 operations)

• Create/Get/Update/Delete Webhook
• List Webhooks, Test Webhook
• Get Webhook Events

Utility (7 operations)

• Validate NPI, Validate Tax ID
• Code Lookup, CARC/RARC Codes
• Place of Service Codes
• Test Connection, API Status

Trigger Node

The R1 RCM Trigger node enables real-time event-driven workflows:

Event Categories

• Patient Events - Registered, Updated, Merged, Coverage Verified, Financial Clearance
• Registration Events - Created, Completed, Pre-Registration Done
• Eligibility Events - Verified, Failed, Benefits Updated
• Authorization Events - Submitted, Approved, Denied, Pending, Expiring, Expired
• Charge Events - Created, Updated, Review Required, Lag Alert
• Coding Events - Complete, Review Required, Validation Error, DRG Assigned
• Claim Events - Created, Submitted, Accepted, Rejected, Paid, Denied, Status Changed
• Denial Events - Received, Appeal Due, Appeal Submitted, Appeal Decision, Overturned
• Payment Events - Received, Posted, Underpayment, Variance, ERA Received
• Work Queue Events - Assigned, Due, SLA Warning, SLA Breach, Threshold
• Analytics Events - KPI Alert, Threshold Exceeded, Trend Alert, Report Ready
• Epic Events - Sync Complete, Sync Error, Message Received

Usage Examples

Patient Registration Workflow

{
  "nodes": [
    {
      "name": "Create Patient",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "patientAccess",
        "operation": "createPatient",
        "firstName": "John",
        "lastName": "Doe",
        "dateOfBirth": "1980-01-15",
        "gender": "male",
        "ssn": "123-45-6789"
      }
    }
  ]
}

Eligibility Verification

{
  "nodes": [
    {
      "name": "Check Eligibility",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "eligibility",
        "operation": "checkEligibility",
        "patientId": "{{ $json.patientId }}",
        "payerId": "BCBS",
        "serviceType": "professional",
        "dateOfService": "2024-01-15"
      }
    }
  ]
}

Prior Authorization Submission

{
  "nodes": [
    {
      "name": "Submit Prior Auth",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "priorAuth",
        "operation": "submitPriorAuth",
        "patientId": "{{ $json.patientId }}",
        "payerId": "AETNA",
        "serviceType": "MRI",
        "diagnosisCodes": "M54.5",
        "procedureCodes": "72148",
        "requestedUnits": 1,
        "urgency": "routine"
      }
    }
  ]
}

Claim Submission (837P)

{
  "nodes": [
    {
      "name": "Submit Claim",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "claim",
        "operation": "submitClaim",
        "claimType": "837P",
        "patientId": "{{ $json.patientId }}",
        "encounterId": "{{ $json.encounterId }}",
        "diagnosisCodes": "J06.9",
        "procedureCodes": "99213",
        "chargeAmount": 150.00
      }
    }
  ]
}

Denial Management

{
  "nodes": [
    {
      "name": "Analyze Denial",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "denial",
        "operation": "analyzeDenial",
        "denialId": "{{ $json.denialId }}",
        "includeRootCause": true,
        "includeAppealRecommendation": true
      }
    }
  ]
}

Payment Posting (835)

{
  "nodes": [
    {
      "name": "Process ERA",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "payment",
        "operation": "getEra",
        "eraId": "{{ $json.eraId }}",
        "autoReconcile": true,
        "flagVariances": true
      }
    }
  ]
}

Epic Integration

{
  "nodes": [
    {
      "name": "Sync Patient from Epic",
      "type": "n8n-nodes-r1rcm.r1Rcm",
      "parameters": {
        "resource": "epicIntegration",
        "operation": "syncPatientData",
        "epicPatientId": "E12345",
        "syncDirection": "epic_to_r1rcm",
        "dataTypes": ["demographics", "insurance", "encounters"]
      }
    }
  ]
}

Healthcare RCM Concepts

EDI Transaction Types

| Transaction | Purpose | |-------------|---------| | 270 | Eligibility Inquiry | | 271 | Eligibility Response | | 276 | Claim Status Inquiry | | 277 | Claim Status Response | | 278 | Prior Authorization | | 835 | Electronic Remittance Advice (ERA) | | 837P | Professional Claims | | 837I | Institutional Claims | | 837D | Dental Claims |

CARC/RARC Codes

• CARC - Claim Adjustment Reason Codes explain why a payment differs from the billed amount
• RARC - Remittance Advice Remark Codes provide additional explanation

Key Metrics

| Metric | Description | Benchmark | |--------|-------------|-----------| | Days in A/R | Average days to collect | < 40 days | | Clean Claim Rate | First-pass acceptance rate | > 95% | | Denial Rate | Percentage of claims denied | < 5% | | Net Collection Rate | Collected vs. allowed | > 95% |

Work Queue Types

• Eligibility Verification
• Prior Authorization
• Charge Review
• Coding Review
• Claim Edits
• Denial Follow-up
• Payment Posting
• A/R Follow-up
• Patient Collections
• Bad Debt

Error Handling

The node provides comprehensive error handling with healthcare-specific context:

try {
  // Operation execution
} catch (error) {
  // Error includes:
  // - errorCode: Healthcare-specific code
  // - errorMessage: Human-readable description
  // - resource: Resource being accessed
  // - operation: Operation attempted
  // - suggestions: Recommended resolution steps
}

Security Best Practices

1. HIPAA Compliance - All PHI is handled securely; sensitive data is not logged
2. Credential Security - Use n8n's credential management; never hardcode secrets
3. TLS/mTLS - All API communications use TLS; Epic integration supports mTLS
4. Audit Trail - All operations include request IDs for traceability
5. Data Minimization - Request only necessary data fields
6. Access Control - Use least-privilege API credentials

Development

# Install dependencies
npm install

# Build
npm run build

# Run tests
npm test

# Run tests with coverage
npm run test:coverage

# Lint
npm run lint

# Fix linting issues
npm run lint:fix

# Watch mode for development
npm run dev

Author

Velocity BPA

• Website: velobpa.com
• GitHub: Velocity-BPA

Licensing

This n8n community node is licensed under the Business Source License 1.1.

Free Use

Permitted for personal, educational, research, and internal business use.

Commercial Use

Use of this node within any SaaS, PaaS, hosted platform, managed service, or paid automation offering requires a commercial license.

For licensing inquiries: [email protected]

See LICENSE, COMMERCIAL_LICENSE.md, and LICENSING_FAQ.md for details.

Contributing

1. Fork the repository
2. Create a feature branch (git checkout -b feature/new-operation)
3. Commit your changes (git commit -am 'Add new operation')
4. Push to the branch (git push origin feature/new-operation)
5. Create a Pull Request

All contributions must comply with BSL 1.1 licensing.

Support

• Documentation: velobpa.com/docs/n8n-nodes-r1rcm
• Issues: GitHub Issues
• Email: [email protected]

Acknowledgments

• n8n - Workflow automation platform
• R1 RCM - Revenue cycle management platform
• Healthcare industry standards: HL7, FHIR, X12 EDI