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AutomatedRCM Claim Triage – Unpaid Claim Work Queue
x402
AutomatedRCM Claim Triage – Unpaid Claim Work Queue is a paid API for AI agents from x402.getautomatedrcm.com, paid per call via x402, $0.03/call, status unknown (last checked 2026-09-13).
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.
Price / call$0.03
Success—
StatusUnknown
How this service works
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)
Output
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.
Example use cases
Urgent same-day AR worklist
“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?”
Stale claim prioritization after payer response
“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?”
Payment-pending claim monitoring
“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.”
Technical details
Endpoint
POSThttps://x402.getautomatedrcm.com/claim-triageWhen to prefer
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.
Side effects
- 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
Input
Schema · Request body
| Field | Type | Description |
|---|---|---|
| balance | number | Outstanding balance in USD |
| action_code | string | Follow-up action code RES|CPE|CRO|APP|PAY, or empty string |
| days_since_dos | number | Days since date of service |
| days_since_last_touch | number | Days since the claim was last worked |
| timely_filing_limit_days | number | Optional, default 365 |
Tags
x402
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