Part of the Circuit Forge LLC "AI for the tasks you hate most" suite.
Status: Backlog — not yet started. Peregrine must prove the model first.
Rufous handles the full insurance fight: prior authorization tracking, claim dispute drafting, EOB (Explanation of Benefits) reconciliation, internal and external appeal letters, and state insurance commissioner complaints.
Insurance disputes are engineered to be abandoned:
- Prior auth processes have no standard timeline or format across insurers
- EOBs are intentionally opaque — reconciling them against bills requires expertise
- Appeal deadlines are short (30–60 days internal, 4 months external)
- The regulatory landscape is complex: state insurance codes, ACA requirements, ERISA for employer plans
Log claim / denial / prior auth request
→ AI analyzes EOB + denial reason → Drafts appeal with clinical rationale
→ Human review + attach supporting docs → Submit appeal
→ Track deadline + escalation windows → External appeal / commissioner complaint if needed
CFG-RFUS-XXXX-XXXX-XXXX
Discovery pipeline: MIT. AI assist features: BSL 1.1 (free for personal non-commercial self-hosting; converts to MIT after 4 years).