chatgpt

Returns the negotiated rate a named hospital publishes in its federally required machine-readable file for a CPT/HCPCS code, with the file's as-of date. Public hospital-transparency data; educational, not billing advice.

{
  "type": "object",
  "properties": {
    "hospital": {
      "type": "string",
      "maxLength": 200,
      "description": "Hospital / facility name."
    },
    "cpt": {
      "type": "string",
      "maxLength": 10,
      "description": "CPT/HCPCS procedure code."
    }
  },
  "required": [
    "hospital",
    "cpt"
  ]
}

Compares one billed line to the hospital's own published negotiated rate for that code and returns the multiple. You type the code and amount; no bill upload. Educational, not billing advice.

{
  "type": "object",
  "properties": {
    "hospital": {
      "type": "string",
      "maxLength": 200,
      "description": "Hospital / facility name."
    },
    "cpt": {
      "type": "string",
      "maxLength": 10,
      "description": "CPT/HCPCS procedure code."
    },
    "billed_amount": {
      "type": "number",
      "minimum": 0,
      "description": "Amount billed, USD."
    }
  },
  "required": [
    "hospital",
    "cpt",
    "billed_amount"
  ]
}

Explains a CARC claim-adjustment reason code from the public X12 code list: what it means, whether it is typically appealable, and the general appeal path. Not legal advice.

{
  "type": "object",
  "properties": {
    "carc_code": {
      "type": "string",
      "maxLength": 20,
      "description": "CARC/RARC code, e.g. 'CO-16', '16', 'CO-50'."
    }
  },
  "required": [
    "carc_code"
  ]
}

Returns the appeal window that applies to a plan type (employer ERISA plan, marketplace/individual, Medicare Advantage, Medicaid) with the federal citation and how the clock is counted. Cites the rule; does not tell you whether to file.

{
  "type": "object",
  "properties": {
    "state": {
      "type": "string",
      "maxLength": 32,
      "description": "2-letter US state (echoed on the row; the window itself is federal)."
    },
    "plan_type": {
      "type": "string",
      "maxLength": 40,
      "description": "e.g. 'self_funded', 'aca_marketplace', 'medicare', 'medicaid'."
    }
  },
  "required": [
    "state",
    "plan_type"
  ]
}

Returns, for one insurer in one state, the share of external-review appeals the state regulator reports as overturned, with the sample size, the regulator's report as the source, and the as-of date. Available for CA, NY, MD, NJ, MI, OH, NC. This is one insurer's own historical rate — not a ranking or comparison against other insurers, and not a prediction for your case.

{
  "type": "object",
  "properties": {
    "insurer": {
      "type": "string",
      "maxLength": 100,
      "description": "Insurer / payer name."
    },
    "state": {
      "type": "string",
      "maxLength": 32,
      "description": "Venue state: CA, NY, MD, NJ, MI, OH, or NC."
    }
  },
  "required": [
    "insurer",
    "state"
  ]
}

Plain-English description of a CPT/HCPCS procedure code and its category, from public code references.

{
  "type": "object",
  "properties": {
    "cpt_code": {
      "type": "string",
      "maxLength": 200,
      "description": "CPT / HCPCS-J code ('99213', 'J1885') or keyword ('knee MRI', 'colonoscopy')."
    }
  },
  "required": [
    "cpt_code"
  ]
}