medbill-dispute-kit/schemas/action.toml at main · k3rt4s/medbill-dispute-kit · GitHub

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# Schema: one action taken against a bill
# Examples: a letter sent, a complaint filed, a phone call made, a payment made, a settlement accepted.
# The action log is the chronological history; the tracker row holds the current state.
# Actions are append-only — never edit prior actions, add a new one to correct or supersede.

[meta]
schema = "action"
schema_version = "0.1.0"

[fields.action_id]
type = "string"
required = true
description = "Stable identifier. Format: A-YYYY-NNN."

[fields.bill_id]
type = "string"
required = true
description = "The bill this action is against. Matches bill.toml.bill_id."

[fields.action_type]
type = "string"
required = true
enum = [
  "received_bill",
  "requested_itemization",
  "received_itemization",
  "phone_call_to_billing",
  "phone_call_to_insurance",
  "initial_dispute_letter_sent",
  "no_surprises_letter_sent",
  "insurance_appeal_internal_sent",
  "insurance_appeal_external_sent",
  "30day_warning_sent",
  "state_doi_complaint_filed",
  "state_ag_complaint_filed",
  "cms_complaint_filed",
  "cms_hpt_complaint_filed",
  "ppdr_filed",
  "fdcpa_validation_request",
  "fap_application_submitted",
  "state_balance_billing_letter_sent",
  "ground_ambulance_letter_sent",
  "irs_501r_complaint_filed",
  "ebsa_intervention_request",
  "medicare_redetermination_filed",
  "medicare_reconsideration_filed",
  "medicare_alj_hearing_filed",
  "medicaid_mco_appeal_filed",
  "medicaid_fair_hearing_filed",
  "dental_appeal_filed",
  "emtala_complaint_filed",
  "ocr_hipaa_complaint_filed",
  "auto_med_pay_demand_sent",
  "force_health_insurance_billing",
  "hospital_lien_challenge",
  "wc_carrier_redirect_sent",
  "wc_appeal_filed",
  "wc_attorney_engaged",
  "small_claims_filed",
  "small_claims_hearing",
  "settlement_offered",
  "settlement_accepted",
  "payment_made",
  "writeoff_received",
  "sent_to_collections",
  "credit_report_dispute_filed",
  "records_request_sent",
  "records_received",
  "gfe_requested",
  "gfe_received",
  "idr_request_to_insurer",
  "subrogation_response_sent",
  "counter_offer_sent",
  "counter_offer_accepted",
  "counter_offer_rejected",
  "phone_call_to_billing_advocate",
  "phone_call_to_cfo",
  "evidence_bundle_archived",
  "audit_finding_logged",
  "other",
]

[fields.date]
type = "date"
required = true
description = "Date the action was taken (ISO 8601)."

[fields.recipient]
type = "string"
required = false
description = "Who the action was directed at — billing department, insurance company, CMS, state DOI, court, etc."

[fields.template_used]
type = "string"
required = false
description = "Relative path to the template file used to draft a letter, if applicable."
example = "templates/letter_initial_dispute.md"

[fields.certified_mail_tracking]
type = "string"
required = false
description = "USPS certified mail tracking number, if mailed."

[fields.response_due_by]
type = "date"
required = false
description = "When the recipient must respond per your letter or per statute."

[fields.amount_disputed]
type = "decimal"
required = false
description = "If applicable, the dollar amount this action contests, in USD."

[fields.amount_paid]
type = "decimal"
required = false
description = "If the action was a payment, the dollar amount, in USD."

[fields.status]
type = "string"
required = true
enum = ["completed", "awaiting_response", "response_received", "superseded"]

[fields.outcome]
type = "string"
required = false
description = "Brief outcome description once response received."

[fields.notes]
type = "string"
required = false