CANONICAL SECTOR · 20 INSTITUTIONAL MODULES

Health Care & Social Assistance

Keep clinical judgment separate while proving administrative, authorization, referral, discharge, claim, payment and follow-up outcomes.

Test one workflow →

sector::health-care-social-assistance::prior_authorization_finality

Prior Authorization Finality

Prior Authorization Finality reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · prior_auth_decision · provider_available_state

sector::health-care-social-assistance::referral_loop_closure

Referral Loop Closure

Referral Loop Closure reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · referral_order · receiving_followup

sector::health-care-social-assistance::scheduling_to_encounter

Scheduling-to-Encounter

Scheduling-to-Encounter reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · schedule_record · encounter_record

sector::health-care-social-assistance::discharge_completion

Discharge Completion

Discharge Completion reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · discharge_order · transition_requirements

sector::health-care-social-assistance::care_transition_handoff

Care Transition Handoff

Care Transition Handoff reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · handoff_record · receiving_acceptance

sector::health-care-social-assistance::claims_finality

Claims Finality

Claims Finality reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · claim_adjudication · payment_or_patient_liability

sector::health-care-social-assistance::appeal_grievance

Appeal / Grievance

Appeal / Grievance reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · appeal_record · final_disposition

sector::health-care-social-assistance::provider_network_state

Provider Network State

Provider Network State reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · network_record · effective_state

sector::health-care-social-assistance::revenue_cycle_closure

Revenue Cycle Closure

Revenue Cycle Closure reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · account_balance · settlement_state

sector::health-care-social-assistance::patient_consent

Patient Consent

Patient Consent reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · consent_record · use_or_disclosure

sector::health-care-social-assistance::coverage_state

Coverage State

Coverage State reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · coverage_record · effective_date_state

sector::health-care-social-assistance::administrative_agent_action

Administrative Agent Action

Administrative Agent Action reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, freshness and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · agent_mandate · administrative_post_state

sector::health-care-social-assistance::patient_identity_matching

Patient Identity Matching Finality

Patient Identity Matching Finality reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · identity_evidence · match_ormerge_disposition

sector::health-care-social-assistance::provider_credentialing_state

Provider Credentialing State

Provider Credentialing State reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · credential_source · approved_network_orprivilege_state

sector::health-care-social-assistance::eligibility_benefit_verification

Eligibility / Benefit Verification

Eligibility / Benefit Verification reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · coverage_source · service_date_context

sector::health-care-social-assistance::administrative_order_handoff

Administrative Order / Handoff

Administrative Order / Handoff reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · order_orrequest · recipient_acknowledgement

sector::health-care-social-assistance::denial_reason_evidence

Denial Reason Evidence Finality

Denial Reason Evidence Finality reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · decision · reason_code · supporting_evidence

sector::health-care-social-assistance::payment_remittance_reconciliation

Payment / Remittance Reconciliation

Payment / Remittance Reconciliation reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · claim_orinvoice · payment_orera_state

sector::health-care-social-assistance::quality_reporting_submission

Quality Reporting Submission

Quality Reporting Submission reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · measure_input · submission_receipt

sector::health-care-social-assistance::records_request_release

Records Request / Release Finality

Records Request / Release Finality reaches the institution-defined required ending only when authority, execution, authoritative post-state, acceptance, temporal validity and contradiction rules all resolve.

Required evidence: authority_ref · execution_provenance · authoritative_post_state · acceptance_or_counterparty_state · request_authority · released_record_set

Detailed configuration

25 scenarios