AI Insurance Claim Denial Appeal Writer

AI Prompts to Build This

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1. 1. Project Setup

   Create a Next.js 14 (App Router, TypeScript, Tailwind) app called "AppealDraft" for generating health insurance claim appeal letters. Provision Supabase with these tables: users (id, email, role TEXT CHECK role IN ('patient','practice_staff'), practice_id NULLABLE, plan TEXT default 'free'), practices (id, name, stripe_customer_id, seat_count), denials (id, user_id, practice_id NULLABLE, carc_code, rarc_code, denied_amount_cents INT, plan_name, service_description, deadline_at DATE, status TEXT default 'new', raw_document_url), appeals (id, denial_id, letter_body, generated_at TIMESTAMPTZ, submitted_at TIMESTAMPTZ, outcome TEXT CHECK outcome IN ('pending','overturned','upheld','partial')), reminders (id, denial_id, send_at TIMESTAMPTZ, channel, sent BOOLEAN default false). Enable row-level security so patients only see their own denials and practice staff only see denials scoped to their practice_id. Wire Stripe with Free, Individual ($15/mo), and Practice ($99/mo, 5 seats) products. Add env vars for ANTHROPIC_API_KEY, AWS Textract (or Google Document AI) credentials, RESEND_API_KEY, and TWILIO credentials.

2. 2. Denial Parsing + Appeal Letter Generation

   Build the core pipeline. Step 1: POST /api/denials/upload accepts a PDF or image of a denial letter/EOB, sends it to AWS Textract (or Google Document AI) for raw text and key-value extraction, then passes that text to Claude with a strict JSON schema prompt: "Extract from this insurance denial letter: carc_code, rarc_code, plan_name, denied_amount, service_description, appeal_deadline (ISO date), and appeal_level ('first'|'second'|'external'). If a field is not present, return null. Never guess a deadline — only extract dates explicitly stated as an appeal or reconsideration deadline." Store the result on the denials row and schedule reminders at deadline_at minus 14, 3, and 1 days.
   
   Step 2: build POST /api/appeals/generate. Given a denial_id, gather the denial's extracted fields plus any user-provided clinical notes and prior-treatment history from a short intake form. Prompt Claude: "You are drafting a formal health insurance claim appeal letter. Cite the specific CARC/RARC code and its stated reason. Reference the patient's clinical necessity using only the notes provided. Use a formal, insurer-ready business-letter format with patient identification, claim number, date of service, and a clear, explicit request for reconsideration by the deadline. Do not fabricate clinical facts not present in the provided notes — flag any gaps as a comment to the user instead." Return the letter as plain text plus a rendered PDF, and let the user edit before export.

3. 3. Deadline Dashboard + Status Tracking

   Build a dashboard at /app/denials showing every open denial sorted by deadline_at ascending, with a color-coded urgency badge (red under 7 days, amber under 21 days, green otherwise). Each row expands to show the extracted CARC/RARC code and plain-English meaning, denied amount, current status (new, drafted, submitted, pending, overturned, upheld), and a one-click "Log insurer response" action that updates the appeals.outcome field and, if upheld, offers to generate a second-level or external-review appeal referencing the first appeal's arguments. Build a Vercel Cron job that runs daily, finds reminders where send_at is today and sent = false, and dispatches via Resend (email) or Twilio (SMS) with a short deadline nudge naming the denied service and days remaining. Mark reminders sent = true after dispatch. For practice accounts, add a roster view filtering denials by patient name across the whole practice.

4. 4. Landing Page

   Design a single-page marketing site for AppealDraft. Hero headline: "Insurance denies you. We help you win the appeal." Sub-headline: "Upload your denial letter, get a formal appeal citing the exact reason code, and never miss a deadline again." Sections: a before/after showing a raw denial letter next to a generated formal appeal; a stats strip citing the 55% appeal success rate against the under-1% of people who actually appeal; how-it-works (3 steps: upload, draft, track); pricing (Free / Individual $15 / Practice $99) with a callout that billing advocates charge hourly or a contingency cut of recovered amounts; an FAQ covering data privacy, whether this replaces a lawyer for large denials, and how deadline reminders work. Use a calm, clinical-but-warm palette (deep navy, single lime-green accent), Geist font, and a primary CTA: "Upload your denial letter — free."