/claims/intakeSubmit healthcare claims for AI-powered adjudication. Claims flow through fraud detection, pricing validation, and policy reasoning to produce a deterministic outcome.
| Field | Type | Description |
|---|---|---|
| claim_id | string | Unique claim identifier from your system |
| member_id | string | Member/patient identifier |
| provider_id | string | Healthcare provider identifier |
| diagnosis_codes | array[string] | ICD-10 diagnosis codes |
| procedure_codes | array[string] | CPT/HCPCS procedure codes |
| claim_amount | number | Total claim amount in minor currency units |
| currency | string | ISO 4217 currency code (e.g. NGN) |
| service_date | string | Date of service (ISO 8601) |
curl -X POST http://localhost:8000/api/v1/claims/intake \
-H "Authorization: Bearer YOUR_TOKEN" \
-H "Content-Type: application/json" \
-d '{
"claim_id": "CLM-2026-1001",
"member_id": "MBR-88273",
"provider_id": "PRV-102",
"diagnosis_codes": ["J18.9"],
"procedure_codes": ["71045"],
"claim_amount": 125000,
"currency": "NGN",
"service_date": "2026-05-20"
}'1. IntakeClaim received, validated, and queued2. FraudAI fraud scoring and anomaly detection3. PricingAmount validated against contract rates4. PolicyRAG rules engine evaluates coverage5. Decisionadjudicated → APPROVED / DECLINED / FLAGGED / BLOCKED6. WebhookReal-time notification to your endpoint/claims/process-batchDispatch adjudication for multiple claims in a single atomic request. All claims are queued before the response returns — a browser refresh cannot leave claims un-dispatched mid-batch.
{ "claim_ids": ["uuid-1", "uuid-2", "uuid-3"] }/claims/{id}/cancelCancel a claim that is still in received or under_review status. Transitions the workflow task to cancelled and marks the claim record accordingly.
/claims/{id}Permanently delete a claim and its associated workflow tasks and rule executions. Only allowed for claims in received or cancelled status — processed claims cannot be deleted.
| Status | Meaning | Next action |
|---|---|---|
| received | Claim submitted, awaiting adjudication | Process to run adjudication |
| under_review | Claimed by a reviewer for manual inspection | Reviewer completes assessment |
| adjudicated | Auto-adjudication passed — no blocks or flags | Officer can approve or decline |
| flagged | One or more rules raised an advisory flag | Officer reviews and approves or declines |
| blocked | One or more rules triggered a hard stop | Provider must correct and resubmit |
| approved | Officer approved — eligible for payment | Payment processing |
| declined | Officer declined — provider notified | Provider may appeal or resubmit |
| cancelled | Claim cancelled before processing | Can be deleted |
| rejected_at_intake | Rejected during intake (schema, duplicate, etc.) | Submitter must correct and resubmit |