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POST
Catalog denial packet (coverage + NCCI + PA + payment + policy + CARC)

Authorizations

X-API-Key
string
header
required

Body

application/json

Post-adjudication denial packet: coverage + NCCI + PA + payment + policy + CARC + filing.

One call so a trial key can assemble the packet without burning the daily quota on six round trips. Does not run the LLM denial-resolution agent.

lines
EncounterCoverageLine · object[]
required

Denied procedure lines (CPT + DX + optional modifiers)

Required array length: 1 - 25 elements
payer_slug
string
required

Payer slug or alias (e.g. uhc, medicare_ffs)

carc
string | null

Claim Adjustment Reason Code (CO-197, 197, 4)

claim_type
string
default:professional

professional or institutional

date_of_service
string | null

Date of service (YYYY-MM-DD)

dx
EncounterDiagnosis · object[]

Claim-level DX; used for institutional claims and lines with no DX

locality
string | null

GPCI locality for payment estimates

plan_type
string | null

commercial, medicare_advantage, medicaid, ffs

rarc
string | null

Remittance Advice Remark Code

state
string | null

2-letter state for LCD MAC + filing overrides

Response

Successful Response

Catalog denial packet. Not an LLM appeal letter.

codes
string[]
required
packet_ready
boolean
required

True when coverage has no blocker, NCCI is clean, and timely filing has not expired. PA-required is a warning, not a blocker.

payer_slug
string
required
appeal_deadlines
AppealDeadlineResponse · object | null

Appeal deadline calculation for a payer given a denial date.

appeal_rules
AppealRuleResponse · object[]
carc
string | null
coverage
EncounterCoverageResult · object[]
coverage_clean
boolean
default:true
date_of_service
string | null
denial
DenialCodeLookupResponse · object | null

Denial code resolution across one or all payers.

filing_status
ClaimFilingStatus · object | null

Timely filing status for the claim.

ncci_clean
boolean
default:true
ncci_conflicts
NCCIBatchConflict · object[]
pa_required_count
integer
default:0
pa_results
EncounterPAResult · object[]
payer_name
string | null
payment_estimates
EncounterPaymentEstimate · object[]
policies
DenialPolicyHit · object[]
rarc
string | null
state
string | null
total_estimated_payment
number
default:0
warnings
EncounterWarning · object[]