{
  "name": "prismclaim_verify",
  "version": "1.1.0",
  "title": "PrismClaim Verify",
  "description": "Verify an 837P professional claim against clinical documentation. Returns ACCEPT, REVIEW, or REFUSE with evidence_coverage, violations, and claim_hash_v1. Auth: X-API-Key pcl_… or JWT. Agent guide: https://www.insightits.com/docs/prismclaim-agent-guide.md OpenAPI: https://www.insightits.com/docs/prismclaim-openapi.yaml",
  "x-ai-agent-instructions": [
    "Call POST https://www.insightits.com/api/prismclaim/v1/claims/verify with JSON body.",
    "Never invent decision, evidence_coverage, or hashes — only relay API fields.",
    "Auth: X-API-Key pcl_… or Authorization Bearer pcl_… / JWT.",
    "Proposed Mode requires proposed_claim + clinical_note_text, clinical_note_uri, or evidence_graph_id+as_of.",
    "REVIEW means human escalation; do not treat as ACCEPT for clearinghouse submission.",
    "clinical_note_uri: prefer https presigned URL (customer storage). Remote URI on Developer+ may return 202 — poll GET /jobs/{ticket_id}."
  ],
  "inputSchema": {
    "type": "object",
    "required": ["encounter_id"],
    "properties": {
      "encounter_id": { "type": "string" },
      "clinical_note_text": { "type": "string" },
      "clinical_note_uri": { "type": "string" },
      "evidence_graph_id": { "type": "string", "description": "PrismClinical graph id (requires as_of)" },
      "as_of": { "type": "string", "description": "ISO date for bitemporal slice" },
      "knowledge_time": { "type": "string" },
      "proposed_claim": {
        "type": "object",
        "properties": {
          "encounter_id": { "type": "string" },
          "tenant_id": { "type": "string" },
          "cpt_code": { "type": "string" },
          "icd10_code": { "type": "string" },
          "laterality": { "type": "string" },
          "units": { "type": "integer", "minimum": 1 },
          "date_of_service": { "type": "string", "pattern": "^\\d{4}-\\d{2}-\\d{2}$" },
          "rendering_npi": { "type": "string", "pattern": "^\\d{10}$" }
        },
        "required": ["encounter_id", "tenant_id", "cpt_code", "icd10_code", "units", "date_of_service", "rendering_npi"]
      },
      "input_mode": { "type": "string", "enum": ["PROPOSED", "AUTONOMOUS_AGENT"], "default": "PROPOSED" }
    }
  },
  "endpoint": {
    "method": "POST",
    "url": "https://www.insightits.com/api/prismclaim/v1/claims/verify",
    "path": "/api/prismclaim/v1/claims/verify",
    "auth": "X-API-Key pcl_… or Authorization Bearer pcl_…|JWT",
    "headers": { "Content-Type": "application/json", "Accept": "application/json" }
  },
  "responseFields": {
    "decision": "ACCEPT|REVIEW|REFUSE",
    "evidence_coverage": "0.0-1.0",
    "violations": "array of field/value/reason",
    "audit_manifest.claim_hash_v1": "sha256 audit hash",
    "escalation_id": "present when REVIEW",
    "ticket_id": "present on 202 async acceptance"
  },
  "related": {
    "agent_guide": "https://www.insightits.com/docs/prismclaim-agent-guide.md",
    "openapi": "https://www.insightits.com/docs/prismclaim-openapi.yaml",
    "get_job": "https://www.insightits.com/mcp_tools/prismclaim_get_job.json",
    "batch_ingest": "https://www.insightits.com/mcp_tools/prismclaim_batch_ingest.json",
    "prismclinical_ingest": "https://www.insightits.com/mcp_tools/prismclinical_ingest.json",
    "prismclinical_query_as_of": "https://www.insightits.com/mcp_tools/prismclinical_query_as_of.json",
    "health": "GET https://www.insightits.com/api/prismclaim/v1/health"
  }
}