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
Platform Foundation (PF) Dependencies
Same-Core Dependencies (PM)
Event Contracts
Events Consumed
Events Published
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_ratestable
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
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