Sample: Health Insurance Review

Sample: Health Insurance Review

This is a sample, not the Claims Processing product. It exists to show how a use-case extension is built on the Feature Platform. A full, production-grade claims solution is planned as a separate AWS Marketplace offering — this demo is intentionally minimal and is not it.

Sample: Health Insurance Review is the bundled use-case sample feature for the Feature Platform — the counterpart to the simpler feature add-on sample, Sample: Document Status. Where Document Status is a minimal contract reference, this sample demonstrates a complete industry vertical — health insurance claims — exercising the parts of the platform Document Status does not: a config preset applied at install, a pipeline hook, host-GraphQL calls from a feature UI, and a multi-route feature API. It builds directly on the accelerator’s rule validation capability.

What it does

Adds a Claims Review page with two tabs:

1. Claims Dashboard — lists every document that has run through rule validation, with a deterministic claim status, the Pass / Fail / Information Not Found counts, and a drill-down showing each rule’s recommendation, supporting pages, and reasoning (plus the full markdown summary).
2. Rules Discovery — upload a payer policy document (e.g. an NCCI Medicare Policy Manual) and the host’s Rules Discovery pipeline extracts the validation rules into a configuration version, which the tab then renders as a browsable rule set.

Claim status

The claim status is derived deterministically (no LLM) by the feature’s postRuleValidation hook from the consolidated rule-validation summary:

Condition	Status
Every rule recommendation is Pass	Clean claim
Any rule recommendation is Fail	Review required
No failures, but rules are Information Not Found	Insufficient documentation

How it works

It exercises the full host contract:

• Config preset (with the hook baked in) — the feature bundles a prior-authorization rule-validation configuration (config-preset/claims-config.yaml). At install, the feature’s ui-deployer injects its postRuleValidation hook into the preset’s rule_validation.postHook (using the hook Lambda’s resolved ARN), then calls the host’s applyFeatureConfigPreset mutation, which writes the preset as a new, non-active configuration version (sample-health-insurance-review-v<version>). An admin reviews and activates it from the Configuration page — installing the feature never silently changes the active configuration. Because the hook lives inside the preset version, activating that version brings the rules and the hook together atomically.
• Pipeline hook — after rule validation completes for a document, the host’s pipeline-hooks dispatcher (which reads hooks from the active config version) invokes the feature’s hook Lambda, which derives the claim status and records it in the feature’s own DynamoDB table. The hook is shipped as part of the config preset above rather than via a separate registerFeatureHooks call — that keeps it attached to the very version the admin activates, instead of being orphaned in whatever version happened to be active at install time.
• Feature API — an HTTP API + Lambda (Cognito-authenticated) over that table with routes for the claim list (filterable by status/time window), a single claim’s detail (merged with the consolidated summary from the output bucket), and the markdown summary.
• Host-GraphQL from the feature UI — the Rules Discovery tab calls the host’s own uploadDiscoveryDocument, listDiscoveryJobs, and getConfigVersion operations directly, using the shared signed-in Amplify instance the host exposes to features. (Rules Discovery requires the Admin or Author role; the tab shows a friendly message to read-only users.)

Installing

Claims Review is bundled with the accelerator and listed in the catalog, so it appears under Extensions in the nav once the Feature Platform is enabled (the default). Install it from its feature page with one click.

After installing:

1. Open Configuration, find the sample-health-insurance-review-v<version> version, and activate it.
2. Upload a prior-auth packet from samples/rule-validation/ (e.g. Prior-Auth-12345678.pdf) to the input bucket.
3. When processing finishes, the claim appears in the Claims Dashboard with its status and per-rule breakdown.
4. In the Rules Discovery tab, upload samples/rule-validation/NCCI Medicare Policy Manual.pdf, watch the job run, and browse the discovered rules.

Source & authoring

The full source lives in feature-platform/sample-health-insurance-review/. For the host contracts it builds on — pipeline hooks and config presets — see the Feature Platform Developer Guide.