A valid request URL is required to generate request examples{
"result": {
"status": "draft",
"action_id": "<string>",
"result": {
"status": "draft"
}
},
"plan": {
"id": "<string>",
"action_context": {
"action_types": [
"<string>"
],
"has_insurance_card": true,
"patient": {
"name": "<string>",
"name_source": "<string>",
"member_id": "<string>",
"member_id_source": "<string>",
"date_of_birth": "<string>",
"group_number": "<string>"
},
"claim": {
"claim_id": "<string>",
"service_dates": [
"<string>"
],
"provider_name": "<string>",
"provider_npi": "<string>"
},
"services": [
{
"procedure_code": "<string>",
"procedure_description": "<string>",
"service_code": "<string>",
"service_description": "<string>",
"reason_code": "<string>",
"reason_description": "<string>",
"diagnosis_codes": [
"<string>"
],
"denied_amount": 123,
"service_date": "<string>"
}
],
"insurer": {
"name": "<string>",
"matched": true,
"verified": true,
"phone": "<string>",
"fax": "<string>",
"address": "<string>"
},
"authorization": {
"status": "not_started",
"signed": true
},
"delegation_authorization": {
"status": "draft",
"signed": true
},
"history": [
{}
],
"deadline": {},
"data_quality": {
"blockers": [
{
"field": "<string>",
"message": "<string>",
"action": "<string>",
"input_type": "<string>",
"placeholder": "<string>"
}
],
"warnings": [
{
"field": "<string>",
"message": "<string>"
}
],
"missing_fields": [
"<string>"
],
"user_actions_needed": [
{
"field": "<string>",
"action_type": "<string>",
"prompt": "<string>",
"required": true,
"input_type": "<string>",
"placeholder": "<string>"
}
],
"completeness_percent": 123
}
},
"actions": [
{
"id": "<string>",
"action_communications": [
{}
],
"action_type": "call",
"approved_at": "<string>",
"call_context": {
"greeting": "<string>",
"objective_summary": "<string>",
"objectives": [
{
"text": "<string>",
"priority": 123
}
],
"decision_branches": [
{
"scenario": "<string>",
"action": "<string>",
"capture": [
"<string>"
]
}
],
"extraction_schema": {
"reference_number": {
"type": "<string>",
"description": "<string>"
},
"rep_name": {
"type": "<string>",
"description": "<string>"
},
"rep_extension": {
"type": "<string>",
"description": "<string>"
},
"call_outcome": {
"type": "<string>",
"enum": [
"<string>"
],
"description": "<string>"
},
"next_steps_described": {
"type": "<string>",
"description": "<string>"
},
"callback_promised": {
"type": "<string>",
"description": "<string>"
},
"callback_within_days": {
"type": "<string>",
"description": "<string>"
},
"resolution_status": {
"type": "<string>",
"enum": [
"<string>"
],
"description": "<string>"
},
"appeal_address": {
"type": "<string>",
"description": "<string>"
},
"documentation_requirements": {
"type": "<string>",
"description": "<string>"
},
"appeal_deadline_confirmed": {
"type": "<string>",
"description": "<string>"
}
},
"claim_summary": {
"claim_id": "<string>",
"denial_count": 123,
"total_denied_amount": "<string>",
"denials": [
{
"id": "<string>",
"procedure_code": "<string>",
"description": "<string>",
"denied_amount": "<string>",
"service_date": "<string>",
"denial_code": "<string>",
"reason": "<string>",
"reason_code_description": "<string>"
}
]
},
"reference_data": {
"patient_name": "<string>",
"member_id": "<string>",
"date_of_birth": "<string>",
"claim_id": "<string>",
"denials": [
{
"id": "<string>",
"procedure_code": "<string>",
"description": "<string>",
"denied_amount": "<string>",
"service_date": "<string>",
"denial_code": "<string>",
"reason": "<string>",
"reason_code_description": "<string>"
}
],
"total_denied_amount": "<string>",
"prior_reference_numbers": [
"<string>"
],
"prior_rep_names": [
"<string>"
],
"promise_details": [
{}
],
"authorization_status": "<string>",
"ivr_steps": true,
"insurer_tips": true,
"overturn_reasoning": "<string>"
},
"prior_interactions": [
{}
],
"data_completeness": {
"completeness_percent": 123,
"missing_fields": [
{
"field": "<string>",
"tier": "<string>"
}
],
"field_availability": {
"patient_name": true,
"member_id": true,
"claim_id": true,
"phone_number": true,
"date_of_birth": true,
"authorization_status": true,
"denial_code": true,
"service_date": true,
"denied_amount": true,
"ivr_steps": true,
"insurer_tips": true,
"prior_reference_numbers": true,
"policy_number": true
}
},
"state_signals": {
"is_first_contact": true,
"has_pending_promises": true,
"escalation_warranted": true,
"forms_pending_confirmation": true,
"denial_count": 123,
"prior_call_count": 123
},
"overturn_arguments": {
"reasoning": "<string>",
"confidence_score": 123,
"denial_type": "<string>",
"recommended_strategy": "<string>"
},
"call_config": {
"voice": "<string>",
"model": "<string>",
"language": "<string>",
"wait_for_greeting": true,
"record": true
},
"max_duration": 123,
"voice": "<string>",
"phone_number": "<string>",
"insurer_name": "<string>",
"department": "<string>",
"deadline_urgency": {}
},
"completed_at": "<string>",
"created_at": "<string>",
"error_message": "<string>",
"executed_at": "<string>",
"metadata": {
"purpose": "<string>",
"objectives": [
"<string>"
],
"llm_call_context": {
"greeting": "<string>",
"objectives": [
{
"text": "<string>",
"priority": 123
}
],
"decision_branches": [
{
"scenario": "<string>",
"action": "<string>",
"capture": [
"<string>"
]
}
],
"objective_summary": "<string>"
}
},
"prerequisite_action_ids": [
"<string>"
],
"prerequisites_check": {
"satisfied": true,
"missing_forms": [
"<string>"
],
"missing_deliveries": [
"<string>"
],
"missing_confirmations": [
"<string>"
],
"missing_actions": [
"<string>"
]
},
"result": {},
"retry_count": 123,
"scheduled_for": "<string>",
"sequence_order": 123,
"status": "pending_prereqs",
"supported": true,
"target_denial_ids": [
"<string>"
],
"target_denials": [
{
"id": "<string>",
"procedure_code": "<string>",
"procedure_description": "<string>"
}
],
"target_entity_matched": true,
"target_name": "<string>",
"target_party": "insurer",
"unsupported_reasons": [
"<string>"
],
"updated_at": "<string>"
}
],
"ai_reasoning": "<string>",
"approved_at": "<string>",
"claim_id": "<string>",
"completed_at": "<string>",
"created_at": "<string>",
"denial_count": 123,
"insurer_matched": true,
"insurer_name": "<string>",
"narrative": {},
"overturnable_denial_id": "<string>",
"overturnable_denial_ids": [
"<string>"
],
"overturnable_denials": [
{
"id": "<string>",
"action_plan_generating": true,
"assessment_count": 123,
"claim_denial_count": 123,
"claim_id": "<string>",
"claim_insurer_name": "<string>",
"claim_patient_name": "<string>",
"claim_provider_name": "<string>",
"claim_total_denied": 123,
"denial_code": "<string>",
"denial_reason": "<string>",
"denied_amount": 123,
"detected_at": "<string>",
"formatted_reference_code": "<string>",
"needs_reassessment": true,
"organization_name": "<string>",
"policy_document_id": "<string>",
"procedure_code": "<string>",
"procedure_description": "<string>",
"reason_code_description": "<string>",
"reference_code": "<string>",
"reviewed_at": "<string>",
"service_date": "<string>",
"source_document_id": "<string>",
"status": "new",
"summary_title": "<string>"
}
],
"status": "draft",
"total_denied_amount": 123,
"updated_at": "<string>",
"version": 123
}
}Triggers execution of the next pending action in the plan.
A valid request URL is required to generate request examples{
"result": {
"status": "draft",
"action_id": "<string>",
"result": {
"status": "draft"
}
},
"plan": {
"id": "<string>",
"action_context": {
"action_types": [
"<string>"
],
"has_insurance_card": true,
"patient": {
"name": "<string>",
"name_source": "<string>",
"member_id": "<string>",
"member_id_source": "<string>",
"date_of_birth": "<string>",
"group_number": "<string>"
},
"claim": {
"claim_id": "<string>",
"service_dates": [
"<string>"
],
"provider_name": "<string>",
"provider_npi": "<string>"
},
"services": [
{
"procedure_code": "<string>",
"procedure_description": "<string>",
"service_code": "<string>",
"service_description": "<string>",
"reason_code": "<string>",
"reason_description": "<string>",
"diagnosis_codes": [
"<string>"
],
"denied_amount": 123,
"service_date": "<string>"
}
],
"insurer": {
"name": "<string>",
"matched": true,
"verified": true,
"phone": "<string>",
"fax": "<string>",
"address": "<string>"
},
"authorization": {
"status": "not_started",
"signed": true
},
"delegation_authorization": {
"status": "draft",
"signed": true
},
"history": [
{}
],
"deadline": {},
"data_quality": {
"blockers": [
{
"field": "<string>",
"message": "<string>",
"action": "<string>",
"input_type": "<string>",
"placeholder": "<string>"
}
],
"warnings": [
{
"field": "<string>",
"message": "<string>"
}
],
"missing_fields": [
"<string>"
],
"user_actions_needed": [
{
"field": "<string>",
"action_type": "<string>",
"prompt": "<string>",
"required": true,
"input_type": "<string>",
"placeholder": "<string>"
}
],
"completeness_percent": 123
}
},
"actions": [
{
"id": "<string>",
"action_communications": [
{}
],
"action_type": "call",
"approved_at": "<string>",
"call_context": {
"greeting": "<string>",
"objective_summary": "<string>",
"objectives": [
{
"text": "<string>",
"priority": 123
}
],
"decision_branches": [
{
"scenario": "<string>",
"action": "<string>",
"capture": [
"<string>"
]
}
],
"extraction_schema": {
"reference_number": {
"type": "<string>",
"description": "<string>"
},
"rep_name": {
"type": "<string>",
"description": "<string>"
},
"rep_extension": {
"type": "<string>",
"description": "<string>"
},
"call_outcome": {
"type": "<string>",
"enum": [
"<string>"
],
"description": "<string>"
},
"next_steps_described": {
"type": "<string>",
"description": "<string>"
},
"callback_promised": {
"type": "<string>",
"description": "<string>"
},
"callback_within_days": {
"type": "<string>",
"description": "<string>"
},
"resolution_status": {
"type": "<string>",
"enum": [
"<string>"
],
"description": "<string>"
},
"appeal_address": {
"type": "<string>",
"description": "<string>"
},
"documentation_requirements": {
"type": "<string>",
"description": "<string>"
},
"appeal_deadline_confirmed": {
"type": "<string>",
"description": "<string>"
}
},
"claim_summary": {
"claim_id": "<string>",
"denial_count": 123,
"total_denied_amount": "<string>",
"denials": [
{
"id": "<string>",
"procedure_code": "<string>",
"description": "<string>",
"denied_amount": "<string>",
"service_date": "<string>",
"denial_code": "<string>",
"reason": "<string>",
"reason_code_description": "<string>"
}
]
},
"reference_data": {
"patient_name": "<string>",
"member_id": "<string>",
"date_of_birth": "<string>",
"claim_id": "<string>",
"denials": [
{
"id": "<string>",
"procedure_code": "<string>",
"description": "<string>",
"denied_amount": "<string>",
"service_date": "<string>",
"denial_code": "<string>",
"reason": "<string>",
"reason_code_description": "<string>"
}
],
"total_denied_amount": "<string>",
"prior_reference_numbers": [
"<string>"
],
"prior_rep_names": [
"<string>"
],
"promise_details": [
{}
],
"authorization_status": "<string>",
"ivr_steps": true,
"insurer_tips": true,
"overturn_reasoning": "<string>"
},
"prior_interactions": [
{}
],
"data_completeness": {
"completeness_percent": 123,
"missing_fields": [
{
"field": "<string>",
"tier": "<string>"
}
],
"field_availability": {
"patient_name": true,
"member_id": true,
"claim_id": true,
"phone_number": true,
"date_of_birth": true,
"authorization_status": true,
"denial_code": true,
"service_date": true,
"denied_amount": true,
"ivr_steps": true,
"insurer_tips": true,
"prior_reference_numbers": true,
"policy_number": true
}
},
"state_signals": {
"is_first_contact": true,
"has_pending_promises": true,
"escalation_warranted": true,
"forms_pending_confirmation": true,
"denial_count": 123,
"prior_call_count": 123
},
"overturn_arguments": {
"reasoning": "<string>",
"confidence_score": 123,
"denial_type": "<string>",
"recommended_strategy": "<string>"
},
"call_config": {
"voice": "<string>",
"model": "<string>",
"language": "<string>",
"wait_for_greeting": true,
"record": true
},
"max_duration": 123,
"voice": "<string>",
"phone_number": "<string>",
"insurer_name": "<string>",
"department": "<string>",
"deadline_urgency": {}
},
"completed_at": "<string>",
"created_at": "<string>",
"error_message": "<string>",
"executed_at": "<string>",
"metadata": {
"purpose": "<string>",
"objectives": [
"<string>"
],
"llm_call_context": {
"greeting": "<string>",
"objectives": [
{
"text": "<string>",
"priority": 123
}
],
"decision_branches": [
{
"scenario": "<string>",
"action": "<string>",
"capture": [
"<string>"
]
}
],
"objective_summary": "<string>"
}
},
"prerequisite_action_ids": [
"<string>"
],
"prerequisites_check": {
"satisfied": true,
"missing_forms": [
"<string>"
],
"missing_deliveries": [
"<string>"
],
"missing_confirmations": [
"<string>"
],
"missing_actions": [
"<string>"
]
},
"result": {},
"retry_count": 123,
"scheduled_for": "<string>",
"sequence_order": 123,
"status": "pending_prereqs",
"supported": true,
"target_denial_ids": [
"<string>"
],
"target_denials": [
{
"id": "<string>",
"procedure_code": "<string>",
"procedure_description": "<string>"
}
],
"target_entity_matched": true,
"target_name": "<string>",
"target_party": "insurer",
"unsupported_reasons": [
"<string>"
],
"updated_at": "<string>"
}
],
"ai_reasoning": "<string>",
"approved_at": "<string>",
"claim_id": "<string>",
"completed_at": "<string>",
"created_at": "<string>",
"denial_count": 123,
"insurer_matched": true,
"insurer_name": "<string>",
"narrative": {},
"overturnable_denial_id": "<string>",
"overturnable_denial_ids": [
"<string>"
],
"overturnable_denials": [
{
"id": "<string>",
"action_plan_generating": true,
"assessment_count": 123,
"claim_denial_count": 123,
"claim_id": "<string>",
"claim_insurer_name": "<string>",
"claim_patient_name": "<string>",
"claim_provider_name": "<string>",
"claim_total_denied": 123,
"denial_code": "<string>",
"denial_reason": "<string>",
"denied_amount": 123,
"detected_at": "<string>",
"formatted_reference_code": "<string>",
"needs_reassessment": true,
"organization_name": "<string>",
"policy_document_id": "<string>",
"procedure_code": "<string>",
"procedure_description": "<string>",
"reason_code_description": "<string>",
"reference_code": "<string>",
"reviewed_at": "<string>",
"service_date": "<string>",
"source_document_id": "<string>",
"status": "new",
"summary_title": "<string>"
}
],
"status": "draft",
"total_denied_amount": 123,
"updated_at": "<string>",
"version": 123
}
}