{
 "use_case": "nsa-idr-packet",
 "title": "No Surprises Act IDR: an eligible emergency anesthesia dispute and one filed a business day late",
 "about": "Two synthetic out-of-network disputes. The first (Pennsylvania, fully insured plan, emergency anesthesia) had its open negotiation notice sent on 24 Aug 2026, so the 4-business-day IDR window is 6 to 9 Oct 2026 (Labor Day skipped). The packet must read the facts from the EOB with quotes, screen it likely eligible, express the $2,350.00 offer as 198.48% of the $1,184.00 QPA, leave out the billed-charges, Medicare and FAIR Health lines (factors the arbiter may not consider), draft a brief, and seal a signed record that fails once changed. The second (Arizona) was initiated on 20 Aug 2026 after its window closed on 18 Aug: the screen must find it likely ineligible on the initiation check, from the documents alone.",
 "licence": "Synthetic (CC0): invented providers, plans, patients and figures (scripts/idr_samples.py). Part of decosa-api, AGPL-3.0-or-later.",
 "inputs": [
  {
   "file": "inputs/anesthesia-documents.json",
   "what": "The first dispute's EOB, open negotiation notice, anesthesia record, group profile, market memo and network history."
  },
  {
   "file": "inputs/late-documents.json",
   "what": "The second dispute's remittance, open negotiation notice and notice of IDR initiation."
  }
 ],
 "steps": [
  {
   "id": "clock",
   "method": "POST",
   "path": "/idr/clock",
   "auth": false,
   "body": {
    "claim": {
     "payment_received": "2026-08-13",
     "on_sent": "2026-08-24"
    },
    "today": "2026-09-27"
   }
  },
  {
   "id": "rules",
   "method": "POST",
   "path": "/idr/screen",
   "auth": false,
   "body": {
    "claim": {
     "state": "NJ",
     "coverage": "self_insured_private",
     "self_insured_opted_in": true,
     "service_kind": "emergency",
     "provider_in_network": false,
     "payment_received": "2026-08-13",
     "on_sent": "2026-08-24"
    },
    "today": "2026-09-27"
   }
  },
  {
   "id": "eligible",
   "method": "POST",
   "path": "/idr/packet",
   "timeout": 600,
   "body": {
    "documents": {
     "$file": "inputs/anesthesia-documents.json"
    },
    "claim": {
     "provider_in_network": false
    },
    "offer": {
     "amount": 2350.0
    },
    "side": "provider",
    "today": "2026-09-27",
    "title": "Rehearsal: emergency anesthesia"
   }
  },
  {
   "id": "verify",
   "method": "POST",
   "path": "/record/verify",
   "auth": false,
   "body": {
    "record": {
     "$ref": "eligible.record"
    }
   }
  },
  {
   "id": "tampered",
   "method": "POST",
   "path": "/record/verify",
   "auth": false,
   "body": {
    "record": {
     "$ref": "eligible.record"
    }
   },
   "tamper": {
    "at": "record.statement.verdict",
    "set": "likely_ineligible"
   }
  },
  {
   "id": "late",
   "method": "POST",
   "path": "/idr/packet",
   "timeout": 300,
   "body": {
    "mode": "screen",
    "documents": {
     "$file": "inputs/late-documents.json"
    },
    "offer": {
     "amount": 780.0
    },
    "today": "2026-09-27",
    "title": "Rehearsal: late initiation"
   }
  }
 ],
 "checks": [
  {
   "says": "the IDR window opens on business day 31 of open negotiation, 6 Oct 2026 (no model)",
   "path": "clock.initiation.opens",
   "equals": "2026-10-06"
  },
  {
   "says": "and closes on business day 34, 9 Oct 2026",
   "path": "clock.initiation.closes",
   "equals": "2026-10-09"
  },
  {
   "says": "a self-insured plan that opted into New Jersey's law fails the state-law check (no model)",
   "path": "rules.failed",
   "contains": "state_law"
  },
  {
   "says": "the eligible dispute is screened likely eligible from its documents",
   "path": "eligible.screen.verdict",
   "equals": "likely_eligible"
  },
  {
   "says": "the QPA is read from the EOB with its quote",
   "path": "eligible.provenance.qpa.quote",
   "contains": "1,184.00"
  },
  {
   "says": "the offer is expressed as a percentage of the QPA",
   "path": "eligible.figures.pct",
   "equals": 198.48
  },
  {
   "says": "the billed-charges line is left out as a prohibited factor",
   "path": "eligible.left_out.ref",
   "contains": "D1.L11"
  },
  {
   "says": "a brief is drafted",
   "path": "eligible.brief",
   "truthy": true
  },
  {
   "says": "and it does not mention Medicare rates or billed charges",
   "path": "eligible.brief",
   "not_contains": "Medicare"
  },
  {
   "says": "the signed packet verifies",
   "path": "verify.ok",
   "equals": true
  },
  {
   "says": "a packet whose verdict was changed no longer verifies",
   "path": "tampered.ok",
   "equals": false
  },
  {
   "says": "the late dispute is screened likely ineligible",
   "path": "late.screen.verdict",
   "equals": "likely_ineligible"
  },
  {
   "says": "on the initiation check",
   "path": "late.screen.failed",
   "contains": "initiation"
  },
  {
   "says": "and no brief is drafted",
   "path": "late.brief",
   "equals": null
  },
  {
   "says": "every model call has a signed receipt",
   "receipts": "signed",
   "min": 8
  }
 ]
}