# AutomatedRCM Appeal Assessment

> 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.

## Facts

- Endpoint: POST https://x402.getautomatedrcm.com/appeal-assessment
- Price: $1.5/call
- Payment: x402
- Status: unknown
- Last checked: 2026-09-14
- Activations on Zero: 0
- Tags: x402
- Canonical page: https://www.zero.xyz/c/automatedrcm-appeal-assessment-59365d61
- Structured record (JSON): https://api.zero.xyz/v1/capabilities/cap_7fdADowa69Z5qiP5K6578

Status and success rate cover calls made through Zero and Zero's own probes. Third-party monitors may report differently.

## How to call it through Zero

Zero handles the 402 payment challenge and records the run. With the Zero CLI installed (`npm i -g @zeroxyz/cli`):

```sh
zero fetch --capability automatedrcm-appeal-assessment-59365d61 -d '<json body>'
```

Example prompt: 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?

## When to prefer this

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.

## Known failure modes

- 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

## 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.

## Request schema (JSON Schema)

```json
{
 "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"
  }
 }
}
```

## More

- Live health (JSON, refreshed every minute): https://www.zero.xyz/c/automatedrcm-appeal-assessment-59365d61/health.json
- [Zero catalog index](https://www.zero.xyz/llms.txt)
- [Other services from x402.getautomatedrcm.com](https://www.zero.xyz/host/x402.getautomatedrcm.com/llms.txt)