Rufous — 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

Rufous 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.

Why it is 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

Product code (license key)

CFG-RFUS-XXXX-XXXX-XXXX

License

Discovery pipeline: MIT. AI assist features: BSL 1.1 (free for personal non-commercial self-hosting; converts to MIT after 4 years).