{
  "name": "Claim Status & A/R Follow-Up Agent",
  "version": "1.0",
  "objective": "Determine authoritative claim status and next safe action.",
  "inputs": [
    "claim_id",
    "date_of_service",
    "billed_amount",
    "payer",
    "member_id",
    "provider_id",
    "submission_timestamp",
    "clearinghouse_ack",
    "prior_touches"
  ],
  "states": [
    "queued",
    "submitted",
    "accepted",
    "pending",
    "paid",
    "partially_paid",
    "denied",
    "records_requested",
    "no_claim_found",
    "escalated",
    "resolved"
  ],
  "source_precedence": [
    "payer_api_or_277",
    "payer_portal",
    "clearinghouse_ack",
    "pms_note"
  ],
  "autonomy_boundaries": [
    "Do not infer payment from ambiguous evidence",
    "Do not resubmit possible duplicates without validation",
    "Escalate clinical/document requests to mapped owner"
  ],
  "kpis": [
    "status_accuracy",
    "correct_next_action_rate",
    "false_resubmission_rate",
    "touches_avoided",
    "days_to_resolution"
  ]
}