DenialGPT

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.

Skills

• analyze_denial
  Classifies a claim denial, extracts CARC codes, identifies required evidence, calculates appeal deadline, and diagnoses root cause.
  denialbillingrevenue-cycle
• fetch_clinical_evidence
  Queries the FHIR sandbox for patient clinical records relevant to the denial type using SHARP context headers.
  fhirclinicalevidence
• gap_analysis
  Compares payer requirements against FHIR clinical evidence. Returns STRONG / WEAK / DO NOT APPEAL verdict with chain-of-thought reasoning.
  gap-analysisappealrevenue-cycle
• check_claim_policy
  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.
  preventionprior-authbillingrevenue-cycle

How to call

https://denialgpt.onrender.com