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"
  }
]
Prior AuthorizationSecurity and Compliance