{
 "use_case": "payer-audit",
 "title": "Answer a payer audit: a 12-claim records request against a published therapy documentation policy",
 "about": "A synthetic records request from a made-up review contractor, dated 21 Sep 2026, with ten calendar days to respond, for 12 psychotherapy claims of a made-up solo practice, and the practice's progress notes. Checked against BCBSM's published individual-therapy documentation requirements (the built-in pack). Four claims are planted weak: two notes with no start and stop times, one with an empty interventions field, and one whose times appear only in an addendum dated after the request. Two sessions on the same day overlap, which an auditor would ask about. The run must mark exactly the four weak, mark the overlapping pair to check by hand and list them first, cite every found requirement by chart, page and line, give the respond-by date 2026-10-01, and seal a record that verifies.",
 "licence": "Synthetic (CC0): practice, clinician, clients, IDs, plan and auditor are invented (scripts/payer_audit_cases.py). Policy: BCBSM's published documentation requirements, quoted short with the source. Part of decosa-api.",
 "inputs": [
  {
   "file": "inputs/letter.txt",
   "what": "The auditor's request letter with its claim list (Attachment A)."
  },
  {
   "file": "inputs/charts.json",
   "what": "The practice's progress notes: one chart per client, one page per note."
  }
 ],
 "steps": [
  {
   "id": "deadline",
   "method": "POST",
   "path": "/payer-audit/deadline",
   "auth": false,
   "body": {
    "letter": {
     "text": {
      "$file": "inputs/letter.txt"
     }
    },
    "today": "2026-09-24"
   }
  },
  {
   "id": "run",
   "method": "POST",
   "path": "/payer-audit/run",
   "timeout": 600,
   "body": {
    "letter": {
     "text": {
      "$file": "inputs/letter.txt"
     }
    },
    "charts": {
     "$file": "inputs/charts.json"
    },
    "pack": "bcbsm-bh-individual-therapy",
    "today": "2026-09-24",
    "practice": {
     "name": "Cedar Row Counseling"
    },
    "title": "Rehearsal: 12-claim request"
   }
  },
  {
   "id": "verify",
   "method": "POST",
   "path": "/record/verify",
   "auth": false,
   "body": {
    "record": {
     "$ref": "run.record"
    }
   }
  }
 ],
 "checks": [
  {
   "says": "the respond-by date is the letter date + 10 calendar days (no model)",
   "path": "deadline.respond_by",
   "equals": "2026-10-01"
  },
  {
   "says": "the run gives the same date",
   "path": "run.deadline.respond_by",
   "equals": "2026-10-01"
  },
  {
   "says": "12 claims are read from the letter",
   "path": "run.summary.claims",
   "equals": 12
  },
  {
   "says": "exactly the four planted claims are weak",
   "path": "run.claims[status=weak].n",
   "all_in": [
    4,
    5,
    6,
    10
   ]
  },
  {
   "says": "four weak claims",
   "path": "run.claims[status=weak]",
   "count": 4
  },
  {
   "says": "and they are listed first",
   "path": "run.summary.weak_first[0]",
   "equals": 4
  },
  {
   "says": "the two sessions that overlap (same clinician, same day) are marked check, not supported",
   "path": "run.claims[status=check].n",
   "all_in": [
    1,
    2
   ]
  },
  {
   "says": "claim 6's times are only in an addendum dated after the request",
   "path": "run.claims[n=6][0].reasons[0]",
   "contains": "after the request"
  },
  {
   "says": "a draft cover letter names the request reference",
   "path": "run.cover_letter",
   "contains": "NPI-PPR-2026-0418"
  },
  {
   "says": "the signed record verifies",
   "path": "verify.ok",
   "equals": true
  },
  {
   "says": "every model call has a signed receipt",
   "receipts": "signed"
  }
 ]
}