{
  "name": "Insurance Verification & Pre-Auth Bot",
  "nodes": [
    {
      "parameters": {
        "httpMethod": "POST",
        "path": "verify-insurance",
        "options": { "rawBody": false }
      },
      "id": "webhook-insurance",
      "name": "New Patient Submitted",
      "type": "n8n-nodes-base.webhook",
      "typeVersion": 1,
      "position": [250, 300]
    },
    {
      "parameters": {
        "url": "https://api.availity.com/availity/v1/coverages",
        "method": "POST",
        "authentication": "genericHeader",
        "sendBody": true,
        "bodyParameters": {
          "parameters": [
            { "name": "payerID", "value": "={{ $json.payer_id }}" },
            { "name": "memberId", "value": "={{ $json.member_id }}" },
            { "name": "dateOfBirth", "value": "={{ $json.dob }}" },
            { "name": "firstName", "value": "={{ $json.first_name }}" },
            { "name": "lastName", "value": "={{ $json.last_name }}" },
            { "name": "serviceType", "value": "{{ $json.service_type }}" }
          ]
        },
        "options": {}
      },
      "id": "check-eligibility",
      "name": "Check Insurance Eligibility",
      "type": "n8n-nodes-base.httpRequest",
      "typeVersion": 3,
      "position": [470, 300]
    },
    {
      "parameters": {
        "conditions": {
          "string": [
            {
              "value1": "={{ $json.coverage_status }}",
              "operation": "equal",
              "value2": "active"
            }
          ]
        }
      },
      "id": "is-active",
      "name": "Coverage Active?",
      "type": "n8n-nodes-base.if",
      "typeVersion": 1,
      "position": [690, 300]
    },
    {
      "parameters": {
        "functionCode": "const coverage = $input.first().json;\nreturn [{\n  json: {\n    patient_name: coverage.first_name + ' ' + coverage.last_name,\n    copay: coverage.copay_amount || 'N/A',\n    deductible: coverage.deductible_remaining || 'N/A',\n    coinsurance: coverage.coinsurance_pct || 'N/A',\n    in_network: coverage.in_network ? 'Yes' : 'No',\n    pre_auth_required: coverage.pre_auth_required || false,\n    max_benefit: coverage.annual_max_remaining || 'N/A',\n    coverage_details: JSON.stringify(coverage, null, 2)\n  }\n}];"
      },
      "id": "parse-benefits",
      "name": "Parse Benefits",
      "type": "n8n-nodes-base.function",
      "typeVersion": 1,
      "position": [910, 200]
    },
    {
      "parameters": {
        "conditions": {
          "boolean": [
            {
              "value1": "={{ $json.pre_auth_required }}",
              "operation": "equal",
              "value2": true
            }
          ]
        }
      },
      "id": "needs-preauth",
      "name": "Pre-Auth Needed?",
      "type": "n8n-nodes-base.if",
      "typeVersion": 1,
      "position": [1130, 200]
    },
    {
      "parameters": {
        "url": "https://api.yourehr.com/pre-auth-request",
        "method": "POST",
        "sendBody": true,
        "bodyParameters": {
          "parameters": [
            { "name": "patient_name", "value": "={{ $json.patient_name }}" },
            { "name": "service_type", "value": "={{ $json.service_type }}" },
            { "name": "payer_id", "value": "={{ $json.payer_id }}" },
            { "name": "diagnosis_code", "value": "={{ $json.diagnosis_code }}" }
          ]
        },
        "options": {}
      },
      "id": "submit-preauth",
      "name": "Submit Pre-Auth Request",
      "type": "n8n-nodes-base.httpRequest",
      "typeVersion": 3,
      "position": [1350, 100]
    },
    {
      "parameters": {
        "channel": "#front-desk",
        "text": "✅ Insurance Verified: {{ $json.patient_name }}\n• Copay: ${{ $json.copay }}\n• Deductible Remaining: ${{ $json.deductible }}\n• In-Network: {{ $json.in_network }}\n• Pre-Auth: {{ $json.pre_auth_required ? '⚠️ Required — auto-submitted' : '✅ Not needed' }}",
        "otherOptions": {}
      },
      "id": "notify-frontdesk",
      "name": "Notify Front Desk",
      "type": "n8n-nodes-base.slack",
      "typeVersion": 2,
      "position": [1570, 200]
    },
    {
      "parameters": {
        "channel": "#billing",
        "text": "❌ Insurance NOT Active: {{ $json.first_name }} {{ $json.last_name }}\nPayer: {{ $json.payer_id }}\nMember ID: {{ $json.member_id }}\n\nPlease follow up with patient before appointment.",
        "otherOptions": {}
      },
      "id": "alert-inactive",
      "name": "Alert Billing Team",
      "type": "n8n-nodes-base.slack",
      "typeVersion": 2,
      "position": [910, 450]
    },
    {
      "parameters": {
        "operation": "append",
        "documentId": { "__rl": true, "value": "YOUR_SPREADSHEET_ID" },
        "sheetName": "Verification Log",
        "columns": {
          "mappingMode": "defineBelow",
          "value": {
            "Patient": "={{ $json.patient_name || $json.first_name + ' ' + $json.last_name }}",
            "Payer": "={{ $json.payer_id }}",
            "Status": "={{ $json.coverage_status === 'active' ? 'Active' : 'Inactive' }}",
            "Copay": "={{ $json.copay || 'N/A' }}",
            "Pre-Auth": "={{ $json.pre_auth_required ? 'Yes' : 'No' }}",
            "Timestamp": "={{ $now.toISO() }}"
          }
        }
      },
      "id": "log-verification",
      "name": "Log to Sheets",
      "type": "n8n-nodes-base.googleSheets",
      "typeVersion": 4,
      "position": [1570, 400]
    }
  ],
  "connections": {
    "New Patient Submitted": { "main": [[{ "node": "Check Insurance Eligibility", "type": "main", "index": 0 }]] },
    "Check Insurance Eligibility": { "main": [[{ "node": "Coverage Active?", "type": "main", "index": 0 }]] },
    "Coverage Active?": {
      "main": [
        [{ "node": "Parse Benefits", "type": "main", "index": 0 }],
        [{ "node": "Alert Billing Team", "type": "main", "index": 0 }]
      ]
    },
    "Parse Benefits": { "main": [[{ "node": "Pre-Auth Needed?", "type": "main", "index": 0 }]] },
    "Pre-Auth Needed?": {
      "main": [
        [{ "node": "Submit Pre-Auth Request", "type": "main", "index": 0 }],
        [{ "node": "Notify Front Desk", "type": "main", "index": 0 }]
      ]
    },
    "Submit Pre-Auth Request": { "main": [[{ "node": "Notify Front Desk", "type": "main", "index": 0 }]] },
    "Alert Billing Team": { "main": [[{ "node": "Log to Sheets", "type": "main", "index": 0 }]] },
    "Notify Team on Slack": { "main": [[{ "node": "Log to Sheets", "type": "main", "index": 0 }]] }
  },
  "settings": { "executionOrder": "v1" },
  "meta": {
    "templateCredsSetupCompleted": false,
    "instanceId": "nexhealth-insurance-verification"
  },
  "tags": [{ "name": "Healthcare" }, { "name": "Insurance" }, { "name": "Verification" }, { "name": "Billing" }]
}