Documentation Index
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Version: 1.0
Created: 2026-04-08
Last Updated: 2026-04-08
Status: 📝 Planned
Overview
PM-44 integrates with multiple PM-core specs and Platform Foundation services to provide automated ERA-to-contract reconciliation, underpayment detection, payer performance analytics, and appeal workflow initiation.
Integration Points
| PF Spec | Integration Type | Description |
|---|
| PF-01 (Organizations & Sites) | Direct dependency | Tenant context (organization_id, site_id) for all reconciliation data |
| PF-02 (RBAC) | Direct dependency | Permission checks via pf_has_permission() for billing/collections access |
| PF-10 (Notifications) | Platform Integration Layer | Alert billing team on high-variance underpayments |
| PF-12 (Reports) | Platform Integration Layer | Export reconciliation and payer performance reports |
| PF-96 (Jurisdiction Profiles) | Data dependency | Jurisdiction-scoped compliance parameters for state-specific reconciliation rules |
Same-Core Dependencies (PM)
| PM Spec | Integration Type | Description |
|---|
| PM-09 (Payment Posting & ERA) | Event consumer | payment_posted triggers reconciliation; reads pm_payments for paid amounts |
| PM-23 (Contract & Fee Schedule) | Data dependency | Reads pm_contracted_rates for allowable amounts per CPT/modifier/payer/date |
| PM-29 (Denial Management & Appeals) | API / action | Initiates underpayment appeals with pre-populated variance data |
| PM-11 (Revenue Cycle Dashboard) | Data provider | Payer performance snapshot data feeds PM-11 dashboard widgets |
| PM-36 (Charge Reconciliation) | Adjacent | PM-36 handles pipeline gaps (missing charges/payments); PM-44 handles amount variance (paid vs contracted) |
Event Contracts
Events Consumed
| Event | Publisher | Payload | Purpose |
|---|
payment_posted | PM-09 | { era_file_id, payment_ids[], organization_id } | Triggers reconciliation for each claim line in the posted ERA |
Events Published
| Event | Subscribers | Payload | Purpose |
|---|
pm_underpayment_detected | PM-29 (if auto-appeal enabled), PM-11 (dashboard widget) | { reconciliation_id, claim_id, payer_id, variance_amount, cpt_code, organization_id } | Notify downstream systems of detected underpayments |
Boundary Clarifications
PM-23 Boundary
- PM-23 owns: Contract rate data, rate lookup logic, initial variance flag on claim/payment line
- PM-44 owns: Operational reconciliation queue, bulk actions, payer performance analytics, appeal initiation workflow, AI pattern detection
- Shared: PM-44 reads contracted rates from PM-23’s
pm_contracted_rates table
PM-29 Boundary
- PM-29 owns: Denial tracking, appeal templates, appeal submission workflow
- PM-44 owns: Underpayment detection, variance data, appeal initiation (one-click from queue)
- Handoff: PM-44 creates appeal record in PM-29 with pre-populated variance data
PM-36 Boundary
- PM-36 owns: Charge pipeline gap detection (missing charge, missing claim, missing payment)
- PM-44 owns: Payment amount variance detection (paid vs contracted)
- Distinction: PM-36 = “is there a payment?” vs PM-44 = “is the payment correct?”
Scheduled Processing
| Job Name | Schedule | Edge Function | Purpose |
|---|
pm-payer-performance-snapshot | 0 2 * * * (daily 2:00 AM UTC; windowing uses org-local timezone with UTC persistence per PM-44 Clarification) | generate-payer-performance-snapshot | Refresh payer performance data |
pm-underpayment-pattern-detection | 0 3 * * 1 (weekly Monday 3:00 AM UTC; windowing uses org-local timezone with UTC persistence per PM-44 Clarification) | detect-underpayment-patterns | AI pattern analysis on historical data |
References
- Spec:
specs/pm/specs/PM-44-automated-era-reconciliation-underpayment-detection.md
- PM-09:
specs/pm/specs/PM-09-payment-posting-era-processing.md
- PM-23:
specs/pm/specs/PM-23-contract-fee-schedule-management.md
- PM-29:
specs/pm/specs/PM-29-claims-denial-management-appeals.md
- PM-11:
specs/pm/specs/PM-11-revenue-cycle-dashboard-analytics.md
- PM-36:
specs/pm/specs/PM-36-automated-charge-reconciliation.md
- Cross-Core Matrix:
docs/architecture/integrations/CROSS_CORE_INTEGRATIONS.md
