Use-Cases
Claims Status
Use-Cases
Claims Status
A common use-case for Opkit is contacting insurance companies to check on the status of an outstanding claim. In this use-case, the user provides context about the claim they are interested in and instructs Opkit to contact the relevant insurance company and collect the following pieces of information:
- Claim status
- Claim rejected reason (if applicable)
- Claim paid amount (in cents)
- Claim adjudication date
Example values for task components are included below.
Target:
Humana (+18009999)
Context:
[
{
"name": "Claim details",
"items": [
{
"name": "Reference number",
"value": "123456"
},
{
"name": "Submission date",
"value": "1990-01-01"
}
]
},
{
"name": "Patient details",
"items": [
{
"name": "Name",
"value": "John Smith"
},
{
"name": "Date of birth",
"value": "1990-01-01"
},
{
"name": "Relationship to subscriber",
"value": "self"
}
]
},
{
"name": "Subscriber details",
"items": [
{
"name": "Name",
"value": "John Smith"
},
{
"name": "Date of birth",
"value": "1990-01-01"
},
{
"name": "Member ID",
"value": "123456"
}
]
},
{
"name": "Provider details",
"items": [
{
"name": "Name",
"value": "Jane Doe"
},
{
"name": "NPI number",
"value": "123456"
},
{
"name": "Tax ID",
"value": "123456"
}
]
}
]
Objectives:
[
{
"name": "Claim status",
"type": "enum",
"enum": ["paid", "rejected", "pending"]
},
{
"name": "Claim rejected reason",
"type": "string"
},
{
"name": "Claim paid amount cents",
"type": "number"
},
{
"name": "Claim adjudication date",
"type": "date"
}
]
Results:
Results are only available on completed tasks.
[
{
"name": "Claim status",
"value": "paid"
},
{
"name": "Claim rejected reason",
"value": null
},
{
"name": "Claim paid amount cents",
"value": 35000
},
{
"name": "Claim adjudication date",
"value": "2023-01-01"
}
]