[
{
"id": "1234abcd-56ef-78gh-90ij-klmnopqrstuv",
"apiStatus": "PROCESSING",
"message": "Claim optimization in progress",
"createdAt": "2025-04-07T19:00:00.000Z",
"updatedAt": "2025-04-07T20:00:00.000Z"
},
{
"id": "5678wxyz-12ab-34cd-56ef-ghijklmnopqr",
"apiStatus": "COMPLETED",
"message": "Claim optimization completed successfully",
"createdAt": "2025-04-06T19:00:00.000Z",
"updatedAt": "2025-04-06T20:00:00.000Z",
"result": {
"claim_id": "123456789",
"patient_control_number": "PCN12345",
"edits": [
{
"difference": "The uploaded claim's total charge amount is $536.53, while the AI-generated claim's total charge amount is $311.00.",
"rationale": "The AI removed the denied procedure code T1015 from the claim, resulting in a lower total charge amount. The original claim was denied for several reasons, including the inclusion of procedure code T1015, which was deemed not medically necessary and ineligible for the patient's plan."
},
{
"difference": "The uploaded claim contains two service lines, while the AI-generated claim contains one.",
"rationale": "The AI removed the service line for procedure code T1015, as it was denied in the original claim. The 835 denial reason indicated that the code was not medically necessary and the patient was not eligible for the service."
},
{
"difference": "The uploaded claim's transaction set trailer segment (SE) count is 38, while the AI-generated claim's count is 30.",
"rationale": "The AI-generated claim removed eight segments corresponding to the denied procedure code T1015, resulting in a lower segment count in the SE segment."
},
{
"difference": "The uploaded claim reports the patient's gender as \"M\" (male) in the DMG segment, while the Cair Health Claims Optimizer AI's Claim reports the patient's gender as \"F\" (female).",
"rationale": "The encounter details specify that Amanda Smith is a female patient. The Cair Health Claims Optimizer AI correctly identifies and uses the appropriate gender code based on the provided information."
}
],
"ai_generated_claim": "**Patient:** Amanda Smith, **Date of Birth**: ...",
"ai_generated_encounter_summary": "Amanda Smith is a 45 year-old female patient of Victoria Green. On November 15, 2024, Ms. Taylor underwent a ..."
}
}
]
