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# Integration Contract: PM-07-EN-14 Payer-Specific Modifier Rules Engine

> Spec Reference: specs/pm/specs/PM-07-EN-14-payer-specific-modifier-rules-engine.md Core: PM Status: Draft Last Updated: 2026-04-02

**Spec Reference:** `specs/pm/specs/PM-07-EN-14-payer-specific-modifier-rules-engine.md`\
**Core:** PM\
**Status:** Draft\
**Last Updated:** 2026-04-02

## Purpose

Define how payer-specific modifier rule evaluation is shared between PM-07 charge capture flows and PM-18 scrub processing while preserving deterministic precedence and tenant isolation.

## Integration Summary

* **Producer:** PM payer modifier rules service (new PM-07-EN-14 capability)
* **Consumers:** PM-07 charge workflow validation, PM-18-EN-06 scrub engine
* **Fallbacks:** PF-96 jurisdiction profile defaults and system defaults
* **Tenancy:** `organization_id` scoped reads/writes for all rule operations

## Resolution Contract

### Input

* `organizationId`
* `payerId`
* `modifierSet` (array)
* Optional `encounterContext` metadata needed by PM-18 scrub flow

### Output

* `decision` (`allow`, `warn`, `block`)
* `matchedRuleLevel` (`payer`, `jurisdiction`, `system`)
* `messages` (user-facing validation details)
* `auditContext` (rule id/version for traceability)

## API Surface (Planned)

* Internal PM integration layer function:
  * `resolvePayerModifierRules(input): RuleResolutionResult`
* No external public API endpoints introduced by this enhancement.

## Security and Compliance

* No PHI in rule definitions, logs, or integration payloads.
* All data access constrained by tenant scope and role permissions.
* Rule version metadata retained for audit and compliance review.

## Testing Expectations

* Unit tests for precedence and severity outcomes.
* Integration tests proving parity between PM-07 and PM-18 decision outcomes.
* Regression tests for jurisdiction fallback behavior when payer overrides are absent.