commit 6a08b27e1443bbbd876357dccf34739dc458a025 Author: pyr0ball Date: Mon May 11 06:22:04 2026 -0700 docs: initial product stub diff --git a/PRIVACY.md b/PRIVACY.md new file mode 100644 index 0000000..afc7b9f --- /dev/null +++ b/PRIVACY.md @@ -0,0 +1,7 @@ +# Privacy Policy + +CircuitForge LLC's privacy policy applies to this product and is published at: + +**** + +Last reviewed: March 2026. diff --git a/README.md b/README.md new file mode 100644 index 0000000..ea57e2b --- /dev/null +++ b/README.md @@ -0,0 +1,47 @@ +# Harrier — Insurance Navigation + +> *Part of the Circuit Forge LLC "AI for the tasks you hate most" suite.* + +**Status:** Backlog — not yet started. Peregrine must prove the model first. + +## What it does + +Harrier handles the full insurance fight: prior authorization tracking, claim dispute drafting, EOB (Explanation of Benefits) reconciliation, internal and external appeal letters, and state insurance commissioner complaints. + +The harrier is low, fast, and persistent — exactly what fighting a denied claim requires. + +## Why it's hard + +Insurance disputes are engineered to be abandoned: +- Prior auth processes have no standard timeline or format across insurers +- EOBs are intentionally opaque — reconciling them against bills requires expertise +- Appeal deadlines are short (30–60 days internal, 4 months external) +- The regulatory landscape is complex: state insurance codes, ACA requirements, ERISA for employer plans + +## Core pipeline + +``` +Log claim / denial / prior auth request +→ AI analyzes EOB + denial reason → Drafts appeal with clinical rationale +→ Human review + attach supporting docs → Submit appeal +→ Track deadline + escalation windows → External appeal / commissioner complaint if needed +``` + +## Key differentiators vs. Peregrine + +- Medical + insurance jargon parsing (CPT codes, ICD codes, denial reason codes) +- Regulatory citation engine: state insurance code, ACA provisions, ERISA +- External appeal automation: state IDRE (Independent Dispute Resolution Entity) filing +- EOB reconciliation: match line items against Explanation of Benefits + +## Product code (license key) + +`CFG-HRRR-XXXX-XXXX-XXXX` + +## Tech notes + +- Shared `circuitforge-core` scaffold +- PDF parsing (pdfplumber) for EOBs and denial letters +- CPT/ICD code lookup: CMS public datasets +- State insurance department contact directory (structured YAML) +- Vision module: scan paper EOBs and denial letters via moondream2 / Claude vision