Encore OS — Documentation

Status: ✅ Complete Spec Reference: specs/pm/specs/PM-46-payer-enrollment-edi-onboarding.md
Last Updated: 2026-04-08

Integration Overview

PM-46 tracks EDI enrollment lifecycle per payer, per NPI, per transaction type. It integrates with several PM-internal specs and PF platform layers.

Platform Foundation Dependencies

PF Spec	Integration Type	What PM-46 Consumes
PF-01 (Organizations & Sites)	Direct dependency	`organization_id`, `site_id` scoping
PF-02 (RBAC)	Direct dependency	Role-based access control
PF-10 (Notifications)	Platform Integration Layer	Alert delivery for stalled enrollments, credentialing prompts
PF-30 (Permissions)	Direct dependency	Permission key enforcement (`pm.edi-enrollment.*`)

Internal PM Dependencies

PM-17 → PM-46: Credentialing-to-Enrollment Event

Pattern: Platform Event (Pattern 2)
Status: 📝 Planned Event: pm.credentialing.completed
Publisher: PM-17 (Provider Credentialing)
Subscriber: PM-46 (EDI Onboarding) Purpose: When PM-17 marks a provider as credentialed with a payer, PM-46 receives a notification to prompt EDI enrollment initiation. Payload (planned):

{
  "organization_id": "uuid",
  "provider_enrollment_id": "uuid",
  "provider_id": "uuid",
  "payer_id": "uuid",
  "npi": "string",
  "credentialing_effective_date": "date",
  "event_type": "pm.credentialing.completed"
}

Subscriber action: Create task/notification prompting user to initiate EDI enrollment; optionally pre-populate enrollment record stubs.

PM-15: Clearinghouse Reference

Pattern: Data reference (FK)
Status: 📝 Planned PM-46’s pm_payer_edi_enrollments.clearinghouse_id references pm_clearinghouse_config.id from PM-15. PM-46 tracks the enrollment application lifecycle; PM-15’s pm_payer_enrollments tracks submission-readiness status. These are complementary, not competing.

PM-27: NPI & Site Data

Pattern: Data reference (read)
Status: 📝 Planned PM-46 reads NPI and site data from PM-27’s pm_site_billing_config to populate the enrollment matrix. No write dependency.

PM-07: Payer Reference

Pattern: Data reference (FK)
Status: 📝 Planned PM-46’s payer_id references the shared pm_payers table (also used by PM-07, PM-08, PM-15).

PM-08: Remittance Volume Data

Pattern: Data read (query)
Status: 📝 Planned PM-46 FR-4.1 (ERA gap report) queries PM-08 claims data for estimated monthly remittance volume per payer. Fallback is manual priority score when PM-08 data is insufficient.

Scheduled Processing

Job	Schedule	Edge Function	Purpose
`pm-edi-enrollment-stall-check`	`0 8 * * *` (daily 8 AM)	`/supabase/functions/pm-edi-enrollment-stall-check`	Detect stalled enrollments, create PF-10 notifications

Validation Checklist

Event contract for pm.credentialing.completed added to EVENT_CONTRACTS.md
FK relationships validated against PM-15, PM-17, PM-27 schemas
PF-10 notification types registered for stalled enrollment alerts
Permission keys seeded in migration
Cross-core integration matrix updated

Last Updated: 2026-04-08

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Payer Enrollment & EDI Onboarding — Integration Contract

Integration Overview

Platform Foundation Dependencies

Internal PM Dependencies

PM-17 → PM-46: Credentialing-to-Enrollment Event

PM-15: Clearinghouse Reference

PM-27: NPI & Site Data

PM-07: Payer Reference

PM-08: Remittance Volume Data

Scheduled Processing

Validation Checklist

​Integration Overview

​Platform Foundation Dependencies

​Internal PM Dependencies

​PM-17 → PM-46: Credentialing-to-Enrollment Event

​PM-15: Clearinghouse Reference

​PM-27: NPI & Site Data

​PM-07: Payer Reference

​PM-08: Remittance Volume Data

​Scheduled Processing

​Validation Checklist

Integration Overview

Platform Foundation Dependencies

Internal PM Dependencies

PM-17 → PM-46: Credentialing-to-Enrollment Event

PM-15: Clearinghouse Reference

PM-27: NPI & Site Data

PM-07: Payer Reference

PM-08: Remittance Volume Data

Scheduled Processing

Validation Checklist