Update app.py

app.py

@@ -28,30 +28,34 @@ class AgentMessage(BaseModel):
 # This would ideally call an LLM (OpenAI/Mistral) to 'think' like a Payer
 @app.post("/agent-chat")
 async def agent_chat(payload: AgentMessage):
-    # This prompt forces the Payer to be a "Strict Adjudicator"
+    # DYNAMIC POLICY DATABASE (Mirroring your Provider side)
+    POLICIES = {
+        "22558": "Policy LCD-L341 (Spinal Fusion): Requires Physical Therapy (6+ weeks), Instability, or Spondylolisthesis.",
+        "43239": "Policy MED-772 (EGD): Requires Weight Loss, Dysphagia, or 8-week PPI failure."
+    }
+
+    # Step 1: Tell the Payer to identify the code first
+    system_instruction = (
+        "You are an Oracle Health Payer Adjudication Agent. "
+        "Your goal is to verify medical necessity based on the following policies: \n"
+        f"1. {POLICIES['22558']}\n"
+        f"2. {POLICIES['43239']}\n\n"
+        "INSTRUCTIONS:\n"
+        "- Identify which CPT code the Provider is requesting.\n"
+        "- ONLY apply the criteria for THAT specific code.\n"
+        "- If evidence for THAT code is found, reply 'APPROVED'.\n"
+        "- If evidence is missing, ask for the specific missing documentation for THAT policy."
+    )
+
     prompt = [
-        {"role": "system", "content": "You are a Payer Adjudication Agent for EGD (CPT 43239). "
-         "Policy MED-772: Requires Weight Loss OR Dysphagia OR 8-week PPI failure. "
-         "If evidence is found, reply 'APPROVED: [Reason]'. If not, ask for it."},
+        {"role": "system", "content": system_instruction},
         {"role": "user", "content": payload.message}
     ]
     
     response = client.chat.completions.create(
-        model="gpt-3.5-turbo", # or gpt-4o
-        messages=prompt
+        model="gpt-4o", # Recommended for better logic than 3.5
+        messages=prompt,
+        temperature=0
     )
     
-    return {"agent_response": response.choices[0].message.content}
-
-
-#@app.post("/evaluate")
-#async def evaluate(request: PARequest):
-#    # Payer Logic
-#    approved = request.dysphagia or request.weight_loss or request.ppi_weeks >= 8
-    
-#   return {
-#        "status": "APPROVED" if approved else "DENIED",
-#        "auth_id": str(uuid.uuid4()) if approved else None,
-#        "reason": "Criteria met via alarm symptoms or PPI trial" if approved else "Insufficient clinical evidence",
-#        "payer_system": "Vim-Internal-Payer-Alpha"
-#    }
+    return {"agent_response": response.choices[0].message.content}