DenialGPT

{
  "name": "DenialGPT",
  "description": "Denial Prevention and Gap Analysis Agent for hospital revenue cycle teams. Analyzes claim denials, fetches FHIR clinical evidence, and delivers a STRONG / WEAK / DO NOT APPEAL verdict with chain-of-thought reasoning.",
  "url": "https://denialgpt.onrender.com",
  "version": "1.0.0",
  "defaultInputModes": [
    "text/plain"
  ],
  "defaultOutputModes": [
    "text/plain"
  ],
  "capabilities": {
    "streaming": false,
    "pushNotifications": false,
    "stateTransitionHistory": false,
    "extensions": [
      {
        "uri": "https://app.promptopinion.ai/schemas/a2a/v1/fhir-context",
        "description": "FHIR R4 context for querying patient clinical records.",
        "required": false,
        "params": {
          "scopes": [
            {
              "name": "patient/Condition.rs",
              "required": true
            },
            {
              "name": "patient/Procedure.rs",
              "required": true
            },
            {
              "name": "patient/MedicationRequest.rs",
              "required": true
            },
            {
              "name": "patient/DocumentReference.rs",
              "required": false
            },
            {
              "name": "patient/Observation.rs",
              "required": false
            },
            {
              "name": "patient/ExplanationOfBenefit.rs",
              "required": false
            }
          ]
        }
      }
    ]
  },
  "supportedInterfaces": [
    {
      "url": "https://denialgpt.onrender.com",
      "protocolBinding": "JSONRPC",
      "protocolVersion": "1.0"
    }
  ],
  "skills": [
    {
      "id": "analyze_denial",
      "name": "analyze_denial",
      "description": "Classifies a claim denial, extracts CARC codes, identifies required evidence, calculates appeal deadline, and diagnoses root cause.",
      "tags": [
        "denial",
        "billing",
        "revenue-cycle"
      ]
    },
    {
      "id": "fetch_clinical_evidence",
      "name": "fetch_clinical_evidence",
      "description": "Queries the FHIR sandbox for patient clinical records relevant to the denial type using SHARP context headers.",
      "tags": [
        "fhir",
        "clinical",
        "evidence"
      ]
    },
    {
      "id": "gap_analysis",
      "name": "gap_analysis",
      "description": "Compares payer requirements against FHIR clinical evidence. Returns STRONG / WEAK / DO NOT APPEAL verdict with chain-of-thought reasoning.",
      "tags": [
        "gap-analysis",
        "appeal",
        "revenue-cycle"
      ]
    },
    {
      "id": "check_claim_policy",
      "name": "check_claim_policy",
      "description": "Checks a claim draft (CPT code + ICD-10 diagnosis + payer + place of service) against CMS LCD/NCD coverage policies and historical payer denial patterns to identify denial risks before submission. Returns overall risk level, specific risk flags with policy citations, and payer intelligence.",
      "tags": [
        "prevention",
        "prior-auth",
        "billing",
        "revenue-cycle"
      ]
    }
  ],
  "securitySchemes": {
    "apiKey": {
      "apiKeySecurityScheme": {
        "name": "X-API-Key",
        "location": "header",
        "description": "API key required to access DenialGPT."
      }
    }
  },
  "security": [
    {
      "apiKey": []
    }
  ]
}