Post-Denial Resolution

ERA (835) / Claim Status (277) received
  │
  ├─ Parse CARC and RARC codes from denial
  │
  ├─ Call RCI: POST /v1/agents/denial-resolution
  │   ├─ Interpret CARC/RARC in plain English
  │   ├─ Identify root cause category
  │   ├─ Get payer-specific appeal deadline (L4)
  │   ├─ Generate appeal strategy
  │   └─ List required documentation
  │
  ├─ Appeal strategy returned
  │   ├─ Auto-generate appeal letter
  │   ├─ Attach required documentation
  │   └─ Track appeal deadline
  │
  └─ Resubmit corrected claim or file appeal

import httpx

async def resolve_denial(api_key: str, denial: dict) -> dict:
    async with httpx.AsyncClient(
        base_url="https://api.rci.health",
        headers={"X-API-Key": api_key},
    ) as client:
        # Submit to denial resolution agent
        resp = await client.post("/v1/agents/denial-resolution", json={
            "query": f"Claim denied with CARC {denial['carc']}",
            "carc": denial["carc"],
            "rarc": denial.get("rarc"),
            "ccn": denial.get("facility_ccn"),
            "cpt": denial.get("cpt_code"),
        })
        job = resp.json()

        # Poll for completion
        while job["status"] not in ("completed", "failed"):
            resp = await client.get(f"/v1/agents/jobs/{job['job_id']}")
            job = resp.json()

    return {
        "explanation": job["result"]["explanation"],
        "root_cause": job["result"]["root_cause"],
        "appeal_strategy": job["result"]["appeal_strategy"],
        "appeal_deadline": job["result"]["appeal_deadline"],
        "required_docs": job["result"]["required_documentation"],
        "confidence": job["audit"]["composite_score"],
    }