{"uid":"cap_7fdADowa69Z5qiP5K6578","slug":"automatedrcm-appeal-assessment-59365d61","name":"AutomatedRCM Appeal Assessment","description":"Full denial-appeal verdict for a denied medical claim. Given the CARC denial code, payer, balance, and timing, returns: appeal/fix/write-off verdict, deadline math against the payer's typical appeal window, the evidence checklist, payer-specific argument points (criteria-mapped when the CPT is in the prior-auth ruleset), and a complete structured appeal-letter draft ready to fill. Replaces a professional appealability review. Deterministic rules engine — no PHI accepted. (AutomatedRCM agent: Dex","url":"https://x402.getautomatedrcm.com/appeal-assessment","method":"POST","headers":{},"bodySchema":{"type":"object","properties":{"cpt":{"type":"string","description":"Optional CPT — unlocks criteria-mapped arguments"},"payer":{"type":"string","description":"US payer, e.g. UHC, MEDICARE"},"balance":{"type":"number","description":"Denied balance in USD"},"denial_code":{"type":"string","description":"CARC denial code, e.g. CO-50"},"days_since_dos":{"type":"number","description":"Optional days since date of service"},"days_since_denial":{"type":"number","description":"Days since the denial posted"}}},"responseSchema":null,"example":null,"exampleRequest":null,"tags":["x402"],"displayCostAmount":"1.5","displayCostAsset":"USDC","priceDynamic":false,"priceHint":null,"priceStatus":"priced","priceSource":"probe","requiresHandshake":false,"reviewCount":0,"rating":{"score":"0.00","successRate":"0.00","reviews":0,"stars":null,"state":"unrated"},"availabilityStatus":"unknown","priceObserved":null,"sessionDeposit":null,"pricing":{"kind":"static","summary":"$1.5/call","primary":{"kind":"static","protocol":"x402","network":"base","amountUsd":"1.5","per":"call","confidence":"exact"},"accepted":[{"kind":"static","protocol":"x402","network":"base","amountUsd":"1.5","per":"call","confidence":"exact"}]},"paymentMethods":[{"uid":"pm_e-xtIaXn4ThngF85A0ZhI","protocol":"x402","methodType":"crypto","chain":"base","mode":"charge","costAmount":"1.5","costPer":"request","priority":0,"asset":"0x833589fCD6eDb6E08f4c7C32D4f71b54bdA02913","unit":"request","depositMicros":null,"planRef":null}],"brandName":null,"brandSlug":null,"brandBaseUrl":null,"brandDocsUrl":null,"whatItDoes":"Returns a full appeal-or-write-off verdict for a denied medical claim, including deadline math, evidence checklist, payer-specific arguments, and a ready-to-fill appeal letter draft.","exampleAgentPrompt":"I have a denied claim from UHC with a CO-50 denial code, the balance is $1,200, and the denial posted 18 days ago — the CPT is 99213. Should I appeal it, and if so, can you draft the appeal letter with the evidence checklist and deadline?","exampleUseCases":[{"title":"Medicare CO-50 denial appeal","prompt":"I got a CO-50 denial from Medicare on a claim for CPT 99214, the balance is $850, and the denial posted 12 days ago. Is it worth appealing, and can you give me the evidence I need and a draft appeal letter?"},{"title":"UHC prior-auth denial verdict","prompt":"UHC denied a claim under CO-197 for CPT 27447, the balance is $4,500, the denial came in 5 days ago, and it's been 30 days since the date of service. Should we appeal or write it off, and what are the payer-specific arguments we should use?"},{"title":"Aetna deadline check before write-off","prompt":"We have an Aetna denial with a PR-204 code, balance of $320, and the denial posted 45 days ago — are we still within the appeal window, or should we write this one off?"}],"resultDescription":"Returns an appeal/fix/write-off verdict, calculated deadline against the payer's typical appeal window, a checklist of required supporting evidence, payer-specific argument points (criteria-mapped when a CPT is provided and is in the prior-auth ruleset), and a complete structured appeal letter draft ready to fill in and submit.","failureModes":["Missing required fields (denial_code, payer, balance, days_since_denial) returns a validation error","Unrecognized payer name may return generic rather than payer-specific arguments","Unrecognized or unsupported CARC code may return a partial or fallback response","If days_since_denial exceeds the payer's appeal window, returns a write-off recommendation with explanation","CPT not in prior-auth ruleset returns appeal letter without criteria-mapped arguments"],"whenToPreferThis":"Use this endpoint when you need a full appealability decision plus a ready-to-use appeal letter draft for a specific denied claim — not just a plain-English explanation of the denial code. Prefer this over a basic denial-code lookup when you need deadline math, an evidence checklist, and payer-specific arguments all in one call. Ideal for RCM workflows that need to triage and action denials without a human appeals specialist reviewing each case.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-09-14T00:43:35.794Z","isFirstParty":false}