When to build vs. buy your RCM stack

AI coding agents, like Codex and Claude Code, have made software cheaper to build. That includes revenue cycle management (RCM) tools.

But the first build is only part of the cost. Someone still has to fix bugs, add new features, and manage the infrastructure. When you buy, the vendor does that work and spreads the cost across its customers.

For many providers, the question is no longer whether they can build. It's whether building is worth the long-term cost.

The right answer depends on your practice. This guide covers the factors to weigh.

What is an RCM stack?

A revenue cycle management (RCM) stack is the software a provider uses to get paid for care. For example:

• An EHR to record care
• A practice management system to schedule visits
• A patient intake tool to collect patient and insurance details
• A system to code claims
• RCM software to send claims and reconcile payments

These categories overlap. Many EHRs include RCM features, like eligibility checks and claim submissions. Other tools focus on one step of the revenue cycle, like patient intake or denial management. Because their focus is narrow, they often offer more advanced features for that step of the workflow.

How do I decide whether to build or buy my RCM stack?

The decision comes down to four factors: features, developer ownership, maintenance, and cost.

Ask yourself these questions:

• Do I need features that other software doesn't offer?
  Buying works when existing software already does what you need. Building makes sense when it doesn't.

  For example, your specialty practice might need a workflow that your RCM platform doesn't support.

• Do I have a developer who can own the code?
  Coding agents make software easier to build. But you still need an experienced developer who's responsible for the code. The developer can be an employee, a contractor, or an agency.

  RCM software handles regulated data, like protected health information (PHI) and banking information. HIPAA makes your practice responsible for protecting PHI, even when an AI agent writes the code. A developer who owns the code can make sure it keeps that data secure.

• Do I want to maintain the software?
  Most software costs come from maintenance, not the first build. Even the best software will contain bugs that need fixes. And you'll likely also want to make changes or add new features over time.

  Even with a developer, you may not want that work. When you buy, maintenance is the vendor's job. The vendor spreads that cost across many customers.

• Is it cheaper to build?
  Compare the full cost of each option. If you build, the cost is your developer's time to ship and maintain the software. If you buy, it's the vendor's fees.

  If existing software covers your needs, buying is usually cheaper. Then compare what each option gives back, like staff time saved or fewer denied claims.

Where does Stedi fit in?

Stedi is a headless healthcare clearinghouse and RCM engine.

As a clearinghouse, Stedi connects providers and their software to payers, like Aetna and Medicare. It sends and receives the transactions payers use, like eligibility checks, claims, and Electronic Remittance Advice (ERAs).

Most clearinghouses give you payer connections and handle transactions. As an RCM engine, Stedi also gives you the parts you need to build RCM software.

For example, building a claim processing system isn't about automating a single transaction. It's about automating several separate payer transactions: the claim submissions, claim acknowledgments, and ERAs – and reconciling all of it together.

To track a claim's status without Stedi, a developer would have to write code that stitches these transactions together. Stedi's claim lifecycle features do that work for you.

What does "headless" mean?

"Headless" means virtually every Stedi feature is available through an API, the way one piece of software talks to another.

Stedi is a headless clearinghouse. Developers and AI agents use Stedi's API to build their own tools, apps, and scripts.

Stedi's Platform Partners – software vendors who build using Stedi – use the same API to build the software you can buy.

To learn more, see What is a headless clearinghouse?

I don't want to build my own software. Can I still use Stedi?

Yes, providers can use Stedi without building their own software.

Stedi apps
Several EHRs and practice management systems offer Stedi apps. A Stedi app connects your Stedi account to the partner's software.

For example, a Stedi app for an EHR may let you submit claims through Stedi using the EHR. You'd still get access to Stedi's broad payer network, reliability, and claim edits. But you don't have to write or maintain any code.

Stedi Platform Partners
To find software vendors that build on Stedi, check out our Platform Partners directory. It lists over 200 EHRs, practice management systems, and RCM platforms that use Stedi. If your current system isn't listed, it might still work with Stedi – just ask!

Stedi portal
You can also use the Stedi portal to find and verify patient insurance, manage claims, handle transaction enrollment, and reconcile payments. To learn more, see our Provider docs.

I don't have a developer. Can I still build my own RCM stack?

Yes. You can hire a Stedi Implementation Partner. Our Implementation Partners are vetted firms who design, develop, and launch custom software on Stedi for you. You still need a plan to maintain the software.

You can find a firm in our Implementation Partners directory.

Can I build some RCM tools and buy the rest?

Yes. Many practices and provider groups do both.

A health system might like its EHR and not want to switch. But the EHR can't find a patient's coverage from demographic data, like name and date of birth.

The health system's developers can build a tool that uses Stedi's Insurance Discovery API. Billing and front-desk staff then use the tool to find a patient's coverage while continuing to use their EHR.

How do I start building on Stedi?

Sign up for a free sandbox account. The sandbox uses test mode, so you can try Stedi's APIs without sending real transactions to payers.

To get started with an AI agent, see Build with AI in our docs. For an example, see how to build an insurance verification app with Stedi in less than 30 minutes. When you're ready to send real transactions, upgrade to production.