Overturn
Overturn is an agentic pipeline that turns denied prior-auth claims into evidence-chained appeals - citing the payer's own policy against its own denial, with a configurable autonomy dial deciding when a human steps in.
Core trick
Agent drafts appeals by citing the payer's own policy text against its denial, with a configurable autonomy threshold for human handoff.
Description
Overturn is an agentic pipeline that turns denied prior-auth claims into evidence-chained appeals - citing the payer's own policy against its own denial, with a configurable autonomy dial deciding when a human steps in.
README excerpt
# Overturn **An agentic appeals pipeline for clinic patient-access teams.** Denials arrive the way they arrive at every clinic — by fax. Each one flows through a visible pipeline (parse → evidence-chained draft → adversarial QA → decision), and a configurable **autonomy policy** decides when a human gets interrupted versus when the agent runs the show.  ## The wedge Everyone builds the gate — the systems that determine whether care gets authorized. Overturn is for what happens **after the gate says no**: - **81.7%** of appealed Medicare Advantage prior-auth denials are fully or partially **overturned** (KFF/CMS, 2023) - …but only **11.7%** of denials are ever appealed - Each manual appeal takes ~45 minutes of chart-digging that patient-access teams don't have The care — and the revenue — sit in the unfought appeals. The payer's own published policy is usually the strongest evidence against the payer's own denial. **The agent reads the policy more carefully than the payer did.** ## What it does 1. **Intake** — vision-parses the scanned denial PDF into a typed record (payer, member, CPT/ICD, reason code, cited policy section, deadlines) and classifies the root cause — via structured outputs against a JSON schema. 2. **Evidence & draft** — the centerpiece. The payer's own medical policy and the patient chart are attached as citation-enforced documents ([Anthropic citations API](https://platform.claude.com/docs/en/build-wit