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Update app.py
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app.py
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from fastapi import FastAPI
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from pydantic import BaseModel
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import uuid
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app = FastAPI()
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class PARequest(BaseModel):
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procedure_code: str
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summary: str
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dysphagia: bool
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weight_loss: bool
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ppi_weeks: int
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@app.get("/")
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def read_root():
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return {"status": "Payer API is Live"}
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"status": "APPROVED" if approved else "DENIED",
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"auth_id": str(uuid.uuid4()) if approved else None,
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"reason": "Criteria met via alarm symptoms or PPI trial" if approved else "Insufficient clinical evidence",
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"payer_system": "Vim-Internal-Payer-Alpha"
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}
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from fastapi import FastAPI
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from pydantic import BaseModel
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import uuid
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import os
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app = FastAPI()
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#class PARequest(BaseModel):
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# procedure_code: str
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# summary: str
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# dysphagia: bool
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# weight_loss: bool
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# ppi_weeks: int
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class AgentMessage(BaseModel):
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message: str
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@app.get("/")
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def read_root():
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return {"status": "Payer API is Live"}
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from fastapi import FastAPI
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from pydantic import BaseModel
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import os
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app = FastAPI()
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class AgentMessage(BaseModel):
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message: str
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# This would ideally call an LLM (OpenAI/Mistral) to 'think' like a Payer
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@app.post("/agent-chat")
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async def agent_chat(payload: AgentMessage):
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incoming_text = payload.message
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# SYSTEM PROMPT FOR THE PAYER AGENT
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# "You are a Payer Adjudication Agent. You strictly follow MED-772 policy for EGD.
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# Policy: Requires Weight Loss OR Dysphagia OR 8 weeks of failed PPI.
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# If the provider gives evidence of these, respond with 'APPROVED: [Reason]'.
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# If evidence is missing, ask a clinical question."
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# SIMULATED AGENT REASONING LOGIC
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# In a real version, you'd pass 'incoming_text' to an LLM here.
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# Example logic for the demo:
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if "weight loss" in incoming_text.lower() or "12 lbs" in incoming_text.lower():
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return {"agent_response": "APPROVED: Clinical evidence of unintentional weight loss verified. Auth ID: PA-9982"}
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elif "dysphagia" in incoming_text.lower() or "swallow" in incoming_text.lower():
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return {"agent_response": "APPROVED: Dysphagia documented. Auth ID: PA-4551"}
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else:
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return {"agent_response": "The initial summary lacks specific alarm symptoms. Has the patient experienced unintended weight loss or dysphagia?"}
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#@app.post("/evaluate")
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#async def evaluate(request: PARequest):
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# # Payer Logic
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# approved = request.dysphagia or request.weight_loss or request.ppi_weeks >= 8
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# return {
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# "status": "APPROVED" if approved else "DENIED",
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# "auth_id": str(uuid.uuid4()) if approved else None,
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# "reason": "Criteria met via alarm symptoms or PPI trial" if approved else "Insufficient clinical evidence",
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# "payer_system": "Vim-Internal-Payer-Alpha"
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# }
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