check_claim

io.github.maxbeech/denialpath · Verify this server

Scrub a claim against the NCCI procedure-to-procedure (PTP) edits and medically unlikely edits (MUE) in force on its date of service. Deterministic: no model, so identical input always returns an identical verdict. Every finding.status is one of pass (checked against a real edit and clean), fail (an edit fires), bypassed (an edit fires but a modifier already on the line legitimately resolves it), or no_data (we hold no edit for this code or pair in our dataset). no_data is NOT a pass: treat it as unchecked, since CMS may still deny the line under an edit outside our loaded subset. summary.clean is true only when every finding is pass and none are no_data - never report a claim clean because nothing failed if some lines were never checked. The response echoes editQuarter (the CMS quarter version the verdict was computed against) and coverage (how many PTP pairs and MUE codes are loaded), so you can tell a caller exactly what was checked. Free, no API key needed; a key only raises the rate limit.