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AutomatedRCM Appeal Assessment
x402
AutomatedRCM Appeal Assessment is a paid API for AI agents from x402.getautomatedrcm.com, paid per call via x402, $1.5/call, status unknown (last checked 2026-09-14).
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.
Price / call$1.5
Success—
StatusUnknown
How this service works
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
Output
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.
Example use cases
Medicare CO-50 denial appeal
“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?”
UHC prior-auth denial verdict
“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?”
Aetna deadline check before write-off
“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?”
Technical details
Endpoint
POSThttps://x402.getautomatedrcm.com/appeal-assessmentWhen to prefer
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.
Side effects
- 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
Input
Schema · Request body
| Field | Type | Description |
|---|---|---|
| cpt | string | Optional CPT — unlocks criteria-mapped arguments |
| payer | string | US payer, e.g. UHC, MEDICARE |
| balance | number | Denied balance in USD |
| denial_code | string | CARC denial code, e.g. CO-50 |
| days_since_dos | number | Optional days since date of service |
| days_since_denial | number | Days since the denial posted |
Tags
x402
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