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ClaimJumper was built as a hackathon vertical slice for OpenAI Build Week 2026. It demonstrates AI-assisted denial triage — turning a remittance screenshot into a ranked denial work queue with cited drafts — but it does not replace a full billing system, coding judgment, or payer-specific workflow expertise. Every triage decision and every generated draft artifact requires human review before any real-world action is taken.

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What ClaimJumper does not do

ClaimJumper is explicitly scoped to preparing and organizing work, not performing it. The following are outside its boundaries by design:
  • Does not submit, file, email, or send anything to a payer. The download button produces a human-review work packet. A billing team member carries that packet into the organization’s approved payer workflow.
  • Does not have a database, persistence layer, or multi-remittance workflow. There is no storage backend. The application holds all state in the current browser session only.
  • Does not have authentication, user accounts, or access control. Anyone with access to the running URL can upload and process a remittance.
  • Does not generate patient billing letters or write-off approval forms. Patient-bill and write-off lanes receive a disposition only. The organization’s own patient-billing and adjustment policies govern what happens next.
  • Does not replace coding, compliance, or payer-specific judgment. ClaimJumper reduces first-pass triage effort. It does not interpret clinical documentation, validate payer-specific filing requirements, or substitute for a certified medical coder or billing compliance officer.
  • Does not accept PDF, CSV, EDI 835, HL7, or any format other than PNG. The ingest stage is a vision model call that reads a PNG screenshot. Other formats are not supported.
  • Approval state is browser session-only. Closing or refreshing the tab clears all approvals. There is no way to resume a session.

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Input constraints

ClaimJumper accepts PNG screenshots of EOB or remittance documents. The ingest model transcribes only the values that are visible and legible on the page. If a required field — such as a claim number, service date, billed amount, or adjustment code — is absent, illegible, or cropped out of frame, the affected claim or service line may be omitted from the structured output entirely. The quality of the triage output depends directly on the completeness and legibility of the source image.

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AI limitations

GPT-5.6 can misroute unfamiliar code combinations. Three code-enforced invariants catch the most critical failures:
  • A CO (contractual obligation) group code can never produce a patient_bill recommendation.
  • Low-confidence routing and risky CO patient-bill recommendations are escalated to human review.
  • CARC 197 write-offs are escalated to human review with explicit override reasons.
These invariants run in code after the model decision and are tested in the regression suite. However, the model may be wrong in ways the invariants do not cover — for example, misidentifying an adjustment code, misjudging recovery probability, or producing a draft that omits a required element. Human review of every triage decision is expected, not optional.

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Scope boundaries retained by design

The following constraints are deliberate architectural decisions documented in the project, not incidental gaps:
  • No database. Approval state is browser session-only. This prevents the application from accumulating real patient data without appropriate controls.
  • No autonomous payer action. The download is a human work packet. ClaimJumper never contacts a payer on behalf of a user.
  • Draft artifacts are not filing-ready forms. A reviewer must verify payer-specific requirements, supporting records, signer information, deadlines, and submission instructions before acting on any generated draft.
  • Human-review lines are never approvable or exportable. If the routing safety overrides apply, the line surfaces a deterministic human-review brief. It cannot be approved or included in a download.
  • Patient-bill and write-off lines receive a disposition only. No letter or adjustment form is generated for these lanes. The organization’s own policies govern the next step.
ClaimJumper is a hackathon prototype. It is not a HIPAA-compliant or production-grade billing system. Do not process real patient data in a deployment of this application without appropriate legal, security, and compliance review by qualified personnel at your organization.
For the three code-enforced routing invariants and how they interact with the model’s lane decisions, see Safety Invariants.

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