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GET
/
api
/
v1
/
overturnable_denials
/
{overturnable_denial_id}
/
action_plans
Error
A valid request URL is required to generate request examples
[
  {
    "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
      }
    },
    "action_count": 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>"
          ],
          "forms_needed": [
            {
              "form_type": "<string>",
              "template_id": "<string>",
              "template_name": "<string>",
              "status": "pending_prereqs",
              "message": "<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_action_count": 123,
    "completed_at": "<string>",
    "created_at": "<string>",
    "denial_count": 123,
    "insurer_matched": true,
    "insurer_name": "<string>",
    "narrative": {},
    "next_action": {
      "id": "<string>",
      "action_type": "<string>",
      "approved_at": "<string>",
      "completed_at": "<string>",
      "created_at": "<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>"
        }
      },
      "sequence_order": 123,
      "status": "draft",
      "supported": true,
      "target_denial_ids": [
        "<string>"
      ],
      "target_entity_matched": true,
      "target_name": "<string>",
      "target_party": "<string>",
      "unsupported_reasons": [
        "<string>"
      ],
      "updated_at": "<string>"
    },
    "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
  }
]

Path Parameters

overturnable_denial_id
string
required

Response

200 - application/json

OK

id
string
required
action_context
object
required
action_count
integer
required
actions
object[]
required
ai_reasoning
string
required
approved_at
string | null
required
claim_id
string | null
required
completed_action_count
integer
required
completed_at
string | null
required
created_at
string
required
denial_count
integer
required
insurer_matched
boolean
required
insurer_name
string | null
required
narrative
object
required
next_action
object
required
overturnable_denial_id
string
required
overturnable_denial_ids
string[]
required
overturnable_denials
object[]
required
status
enum<string>
required
Available options:
draft,
pending_approval,
approved,
in_progress,
completed,
failed,
cancelled
total_denied_amount
number<float>
required
updated_at
string
required
version
integer
required