{"uid":"cap_C8I_ol2C0yRw-58V0HWa7","slug":"automatedrcm-claim-triage-unpaid-claim-work-queue-81e7e4b9","name":"AutomatedRCM Claim Triage – Unpaid Claim Work Queue","description":"Unpaid-claim follow-up triage. Given an action code (RES/CPE/CRO/APP/PAY or blank), balance, and claim ages, returns the work bucket (WORK_NOW / WAITING / REVIEW / COMPLETE), risk flags (FELL_THROUGH, OVERDUE, TIMELY_RISK), a priority score, and the recommended next action with its deadline. (AutomatedRCM agent: WorkQueue)","url":"https://x402.getautomatedrcm.com/claim-triage","method":"POST","headers":{},"bodySchema":{"type":"object","properties":{"balance":{"type":"number","description":"Outstanding balance in USD"},"action_code":{"type":"string","description":"Follow-up action code RES|CPE|CRO|APP|PAY, or empty string"},"days_since_dos":{"type":"number","description":"Days since date of service"},"days_since_last_touch":{"type":"number","description":"Days since the claim was last worked"},"timely_filing_limit_days":{"type":"number","description":"Optional, default 365"}}},"responseSchema":null,"example":null,"exampleRequest":null,"tags":["x402"],"displayCostAmount":"0.03","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":"$0.03/call","primary":{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.03","per":"call","confidence":"exact"},"accepted":[{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.03","per":"call","confidence":"exact"}]},"paymentMethods":[{"uid":"pm_1vLTgustOowaY8cuXpPVK","protocol":"x402","methodType":"crypto","chain":"base","mode":"charge","costAmount":"0.03","costPer":"request","priority":0,"asset":"0x833589fCD6eDb6E08f4c7C32D4f71b54bdA02913","unit":"request","depositMicros":null,"planRef":null}],"brandName":null,"brandSlug":null,"brandBaseUrl":null,"brandDocsUrl":null,"whatItDoes":"Triages unpaid healthcare claims by action code, balance, and claim age to assign a work bucket, risk flags, priority score, and recommended next action with deadline.","exampleAgentPrompt":"Triage this unpaid claim for me: the action code is CPE, the outstanding balance is $840, it's been 210 days since date of service, 45 days since we last touched it, and our timely filing limit is 365 days — tell me what work bucket it falls in, any risk flags, and what we should do next.","exampleUseCases":[{"title":"Urgent same-day AR worklist","prompt":"I have a claim with no action code, a $1,200 balance, 340 days since date of service, 60 days since last touch, and a 365-day timely filing limit — is this a WORK_NOW situation and am I at timely filing risk?"},{"title":"Stale claim prioritization after payer response","prompt":"Our payer just sent back a RES code on a $475 claim that's 90 days from DOS and was last touched 30 days ago with a 365-day filing limit — what's the priority score and recommended next action?"},{"title":"Payment-pending claim monitoring","prompt":"We have a PAY action code claim for $2,300, it's been 180 days since DOS and 15 days since last touch — flag any risk issues and tell me if this is in WAITING or if I need to act now."}],"resultDescription":"Returns a work bucket label (WORK_NOW, WAITING, REVIEW, or COMPLETE), a set of risk flags (FELL_THROUGH, OVERDUE, TIMELY_RISK — any combination), a numeric priority score, and a recommended next action string along with its associated deadline date or timeframe.","failureModes":["Missing required fields (balance, days_since_dos, days_since_last_touch) returns a 400 validation error","Invalid action_code value not in RES/CPE/CRO/APP/PAY set may return an error or be treated as blank","Negative or implausible numeric inputs (e.g. negative balance) may produce unexpected triage results","Payment failure or insufficient USDC balance results in x402 payment-required error and no triage result"],"whenToPreferThis":"Use this endpoint when you need rule-based, real-time triage of individual unpaid claims to drive AR work queues — especially when you need timely filing risk detection and standardized action recommendations. Prefer it over manual AR logic or general-purpose LLMs when you need consistent, auditable priority scoring tied to payer-standard action codes.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-09-13T18:39:03.290Z","isFirstParty":false}