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Documentation Index

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Version: 1.0.0 Last Updated: 2026-02-18 Source: CL-PM-SPEC-REVIEW Finding 8.6 This document defines JSONB column shapes for critical CL and PM tables. Implementations MUST validate or document deviations. 
{
  "purposes": ["treatment", "payment", "healthcare_operations", "other"],
  "entities_allowed": ["array of entity names or IDs"],
  "expiration_type": "date|event|none",
  "expiration_date": "ISO8601 date or null",
  "sud_notes_included": false
}

​
cl_consents.revocation_reason (if JSONB)

{
  "reason_code": "string",
  "revoked_at": "ISO8601",
  "revoked_by": "profile_id UUID"
}

​
PM-02: Insurance & Eligibility

​
pm_insurance_policies.bh_benefits (if JSONB)

{
  "mental_health_visits_per_year": 20,
  "substance_use_visits_per_year": 30,
  "deductible_met": 100.00,
  "copay_amount": 25.00,
  "prior_auth_required": true
}

​
pm_eligibility_checks.benefit_details (if JSONB)

{
  "response_raw": "string or truncated",
  "active": true,
  "service_type": "30",
  "coverage_level": "individual",
  "dates": { "effective": "ISO8601", "termination": "ISO8601" }
}

​
PM-08: Claims

​
pm_claims.denial_codes (JSONB — array of objects)

Canonical format per PM-08 Clarifications (2026-02-19) and X12-EDI-TECHNICAL-DESIGN.md CAS segment mapping. Preserves per-adjustment amounts and group codes required for ERA 835 posting (PM-09). 
[
  {
    "carc": "CO-45",
    "rarc": "N362",
    "group_code": "CO",
    "amount": -25.00
  },
  {
    "carc": "PR-3",
    "rarc": null,
    "group_code": "PR",
    "amount": -15.00
  }
]

​
pm_claim_lines.adjustment_reason (JSONB — array of objects)

Same structure as claim-level denial_codes, applied per line. 
[
  {
    "group_code": "CO",
    "reason_code": "45",
    "amount": -10.00
  }
]

​
CL-04: Progress Notes

​
cl_progress_notes.sections or note body (if JSONB)

{
  "subjective": "string",
  "objective": "string",
  "assessment": "string",
  "plan": "string",
  "interventions": "string",
  "member_response": "string"
}
Use consistent keys per template; validate required sections before finalize.

​
CL-08: Clinical Decision Support

​
cl_cds_rules.rule_config (if JSONB)

{
  "condition": { "field": "diagnosis", "operator": "includes", "value": ["F32.1"] },
  "action": "alert",
  "message_template": "string",
  "severity": "warning|error|info"
}

​
Unlinked FK Resolution (Reference)

SpecColumnTargetResolution
CL-12cl_transitions.discharge_summary_idDocument or CL tableDefine in CL-12: e.g. REFERENCES pf_documents(id) or cl_discharge_summaries(id) when spec exists
CL-12cl_transitions.medication_reconciliation_idCL-05Add cl_medication_reconciliations in CL-05 or reference by ID with doc
PM-07pm_charges.encounter_idpm_encountersFK to pm_encounters(id) per CL-PM-ENCOUNTER-TO-BILLING
CL-14cl_group_sessions.curriculum_idCurriculum entityPF or CL picklist/reference table; document in CL-14
CL-14cl_group_sessions.program_idrh_programs or PFFK to rh_programs(id) or pf_programs(id) when defined
PM-04pm_group_definitions.program_idSame as aboveAlign with CL-14 program reference
Implement migrations with FKs when target tables exist; otherwise document as “intentionally unlinked until [spec].”