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Design: insurance workflow taxonomy — prior auth, EOB, appeals #1

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opened 2026-03-14 16:14:49 -07:00 by pyr0ball · 0 comments
pyr0ball commented 2026-03-14 16:14:49 -07:00
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Map the full insurance adversarial workflow that Harrier must navigate.

Coverage areas

  • Prior authorization: submission, follow-up, peer-to-peer request, denial appeal
  • EOB reconciliation: line-item parsing, mystery codes, provider billing disputes
  • Claim disputes: internal appeal, external review (IRO), state DOI complaint
  • Surprise billing: No Surprises Act dispute process

Reference

Circuit-Forge/roadmap#6

Map the full insurance adversarial workflow that Harrier must navigate. ### Coverage areas - Prior authorization: submission, follow-up, peer-to-peer request, denial appeal - EOB reconciliation: line-item parsing, mystery codes, provider billing disputes - Claim disputes: internal appeal, external review (IRO), state DOI complaint - Surprise billing: No Surprises Act dispute process ### Reference https://git.opensourcesolarpunk.com/Circuit-Forge/roadmap/issues/6
pyr0ball added this to the Alpha — Pipeline milestone 2026-03-14 16:14:49 -07:00
ClaudeCode added this to the The Menagerie project 2026-04-04 19:28:49 -07:00
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Reference: Circuit-Forge/harrier#1
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