34 lines
1.3 KiB
Markdown
34 lines
1.3 KiB
Markdown
# Rufous — Insurance Navigation
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> *Part of the Circuit Forge LLC "AI for the tasks you hate most" suite.*
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**Status:** Backlog — not yet started. Peregrine must prove the model first.
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## What it does
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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.
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## Why it is hard
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Insurance disputes are engineered to be abandoned:
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- Prior auth processes have no standard timeline or format across insurers
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- EOBs are intentionally opaque — reconciling them against bills requires expertise
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- Appeal deadlines are short (30–60 days internal, 4 months external)
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- The regulatory landscape is complex: state insurance codes, ACA requirements, ERISA for employer plans
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## Core pipeline
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```
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Log claim / denial / prior auth request
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→ AI analyzes EOB + denial reason → Drafts appeal with clinical rationale
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→ Human review + attach supporting docs → Submit appeal
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→ Track deadline + escalation windows → External appeal / commissioner complaint if needed
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```
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## Product code (license key)
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`CFG-RFUS-XXXX-XXXX-XXXX`
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## License
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Discovery pipeline: **MIT**. AI assist features: **BSL 1.1** (free for personal non-commercial self-hosting; converts to MIT after 4 years).
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