@nexalink/coding-contracts 0.2.0 → 0.4.0

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Files changed (21) hide show
  1. package/README.md +48 -8
  2. package/dist/cjs/index.cjs +4756 -76
  3. package/dist/index.d.ts +1090 -3
  4. package/dist/index.js +4728 -75
  5. package/package.json +8 -2
  6. package/schemas/coding-batch.schema.json +63 -0
  7. package/schemas/coding-case-clinical.schema.json +428 -0
  8. package/schemas/coding-case-context.schema.json +128 -0
  9. package/schemas/coding-case-payer.schema.json +126 -0
  10. package/schemas/coding-case.schema.json +97 -0
  11. package/schemas/coding-decision-line.schema.json +172 -0
  12. package/schemas/coding-decision.schema.json +430 -0
  13. package/schemas/coding-evidence.schema.json +100 -0
  14. package/schemas/coding-extension.schema.json +36 -0
  15. package/schemas/coding-reviewer-action.schema.json +64 -0
  16. package/schemas/coding-rule-result.schema.json +90 -0
  17. package/schemas/coding-service-line.schema.json +120 -0
  18. package/schemas/rcm-reviewer-event.schema.json +160 -0
  19. package/schemas/rcm-workflow-catalog.schema.json +62 -5
  20. package/versions.json +67 -2
  21. package/workflow-constants.json +2 -1
package/schemas/coding-case-payer.schema.json ADDED
@@ -0,0 +1,126 @@
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+ {
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+ "$schema": "https://json-schema.org/draft/2020-12/schema",
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+ "$id": "https://nexalink.care/contracts/coding-case-payer.schema.json",
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+ "title": "CodingCasePayer",
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+ "description": "Payer, plan, program, contract, and MAC context used to resolve applicability. memberId is a direct identifier and must never leave tenant-scoped storage for analytics surfaces. Contract and program fields are customer configuration, never immutable server policy.",
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+ "version": "1.0.0",
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+ "x-wire-version": "coding-case-payer-v1",
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+ "x-wire-constant": "CODING_CASE_PAYER_SCHEMA_VERSION",
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+ "x-code": "payer",
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+ "x-keys-code": "payer_keys",
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+ "type": "object",
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+ "additionalProperties": false,
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+ "required": ["payerName"],
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+ "properties": {
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+ "payerName": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 200,
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+ "x-strip-nonempty": true,
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+ "x-code": "payer_name"
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+ },
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+ "payerId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 120,
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+ "x-code": "payer_id"
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+ },
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+ "lineOfBusiness": {
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+ "type": "string",
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+ "enum": ["commercial", "government", "self_pay", "other"],
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+ "x-code": "payer_line_of_business"
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+ },
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+ "memberId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 120,
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+ "x-code": "payer_member_id"
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+ },
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+ "plan": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "x-code": "payer_plan",
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+ "x-keys-code": "payer_plan_keys",
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+ "properties": {
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+ "planName": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 200,
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+ "x-code": "payer_plan_name"
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+ },
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+ "planId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 120,
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+ "x-code": "payer_plan_id"
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+ }
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+ }
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+ },
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+ "program": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "x-code": "payer_program",
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+ "x-keys-code": "payer_program_keys",
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+ "properties": {
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+ "programName": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 160,
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+ "x-code": "payer_program_name"
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+ },
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+ "programCode": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 80,
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+ "x-code": "payer_program_code"
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+ }
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+ }
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+ },
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+ "contract": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "x-code": "payer_contract",
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+ "x-keys-code": "payer_contract_keys",
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+ "properties": {
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+ "contractId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 120,
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+ "x-code": "payer_contract_id"
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+ },
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+ "contractVersion": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 40,
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+ "x-code": "payer_contract_version"
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+ },
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+ "effectiveDate": {
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+ "type": "string",
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+ "pattern": "^\\d{4}-\\d{2}-\\d{2}$",
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+ "format": "date",
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+ "x-code": "payer_contract_effective_date"
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+ }
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+ }
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+ },
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+ "mac": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "x-code": "payer_mac",
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+ "x-keys-code": "payer_mac_keys",
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+ "properties": {
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+ "macId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 40,
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+ "x-code": "payer_mac_id"
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+ },
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+ "jurisdiction": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 80,
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+ "x-code": "payer_mac_jurisdiction"
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+ }
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+ }
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+ }
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+ }
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+ }
package/schemas/coding-case.schema.json ADDED
@@ -0,0 +1,97 @@
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+ {
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+ "$schema": "https://json-schema.org/draft/2020-12/schema",
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+ "$id": "https://nexalink.care/contracts/coding-case.schema.json",
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+ "title": "CodingCase",
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+ "description": "The canonical case envelope for encounter, claim-review, longitudinal, monthly time aggregation, and batch coding workflows. caseId is a client-supplied direct reference; analyticsId is the separate analytics-safe identifier that may be referenced by decisions and metrics without exposing case identity.",
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+ "version": "1.0.0",
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+ "x-wire-version": "coding-case-v1",
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+ "x-wire-constant": "CODING_CASE_SCHEMA_VERSION",
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+ "x-code": "coding_case",
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+ "x-keys-code": "coding_case_keys",
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+ "type": "object",
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+ "additionalProperties": false,
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+ "required": [
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+ "caseId",
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+ "codingIntent",
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+ "servicePeriod",
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+ "context",
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+ "clinical"
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+ ],
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+ "properties": {
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+ "caseId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 128,
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+ "x-code": "case_id"
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+ },
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+ "analyticsId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 128,
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+ "x-code": "case_analytics_id"
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+ },
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+ "tenantReference": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 128,
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+ "x-code": "case_tenant_reference"
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+ },
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+ "codingIntent": {
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+ "type": "string",
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+ "enum": [
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+ "encounter_review",
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+ "claim_review",
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+ "longitudinal_review",
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+ "monthly_time_aggregation",
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+ "batch_review"
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+ ],
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+ "x-code": "case_coding_intent"
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+ },
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+ "servicePeriod": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "required": ["startDate"],
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+ "x-code": "case_service_period",
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+ "x-keys-code": "case_service_period_keys",
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+ "properties": {
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+ "startDate": {
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+ "type": "string",
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+ "pattern": "^\\d{4}-\\d{2}-\\d{2}$",
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+ "format": "date",
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+ "x-code": "case_service_period_start"
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+ },
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+ "endDate": {
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+ "type": "string",
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+ "pattern": "^\\d{4}-\\d{2}-\\d{2}$",
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+ "format": "date",
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+ "x-code": "case_service_period_end"
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+ }
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+ }
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+ },
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+ "context": {
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+ "$ref": "coding-case-context.schema.json"
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+ },
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+ "payer": {
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+ "$ref": "coding-case-payer.schema.json"
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+ },
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+ "clinical": {
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+ "$ref": "coding-case-clinical.schema.json"
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+ },
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+ "submittedClaimLines": {
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+ "type": "array",
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+ "maxItems": 100,
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+ "x-code": "case_submitted_claim_lines",
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+ "items": {
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+ "$ref": "coding-service-line.schema.json"
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+ }
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+ },
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+ "extensions": {
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+ "type": "array",
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+ "maxItems": 25,
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+ "x-code": "case_extensions",
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+ "items": {
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+ "$ref": "coding-extension.schema.json"
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+ }
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+ }
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+ }
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+ }
package/schemas/coding-decision-line.schema.json ADDED
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+ {
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+ "$schema": "https://json-schema.org/draft/2020-12/schema",
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+ "$id": "https://nexalink.care/contracts/coding-decision-line.schema.json",
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+ "title": "CodingDecisionLine",
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+ "description": "One proposed claim-line action within a CodingDecision. Actions are add, retain, replace, remove, or review; each line carries code identity, modifiers, units, linked diagnoses, sequencing, confidence, rationale, and evidence references.",
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+ "version": "1.0.0",
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+ "x-wire-version": "coding-decision-line-v1",
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+ "x-wire-constant": "CODING_DECISION_LINE_SCHEMA_VERSION",
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+ "x-code": "decision_line",
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+ "x-keys-code": "decision_line_keys",
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+ "type": "object",
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+ "additionalProperties": false,
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+ "required": ["lineId", "action", "code", "confidence", "rationale"],
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+ "properties": {
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+ "lineId": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 60,
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+ "x-code": "decision_line_id"
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+ },
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+ "action": {
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+ "type": "string",
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+ "enum": ["add", "retain", "replace", "remove", "review"],
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+ "x-code": "decision_line_action"
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+ },
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+ "code": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "required": ["code", "codeSystem"],
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+ "x-code": "decision_line_code",
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+ "x-keys-code": "decision_line_code_keys",
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+ "properties": {
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+ "code": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 64,
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+ "x-strip-nonempty": true,
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+ "x-code": "decision_line_code_value"
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+ },
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+ "codeSystem": {
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+ "type": "string",
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+ "enum": [
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+ "ICD-10-CM",
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+ "ICD-10-PCS",
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+ "CPT",
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+ "HCPCS",
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+ "NDC",
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+ "CDT",
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+ "REVENUE_CODE",
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+ "DRG",
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+ "OTHER"
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+ ],
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+ "x-code": "decision_line_code_system"
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+ },
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+ "codeVersion": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 40,
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+ "x-code": "decision_line_code_version"
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+ }
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+ }
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+ },
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+ "modifiers": {
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+ "type": "array",
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+ "maxItems": 8,
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+ "x-code": "decision_line_modifiers",
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+ "items": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 8,
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+ "x-code": "decision_line_modifiers"
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+ }
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+ },
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+ "units": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "x-code": "decision_line_units",
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+ "x-keys-code": "decision_line_units_keys",
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+ "properties": {
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+ "count": {
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+ "type": "integer",
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+ "minimum": 0,
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+ "maximum": 999999,
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+ "x-code": "decision_line_units_count"
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+ },
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+ "unitOfMeasure": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 20,
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+ "x-code": "decision_line_units_measure"
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+ }
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+ }
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+ },
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+ "linkedDiagnoses": {
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+ "type": "array",
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+ "maxItems": 20,
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+ "x-code": "decision_line_linked_diagnoses",
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+ "items": {
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+ "type": "object",
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+ "additionalProperties": false,
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+ "required": ["diagnosisRef"],
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+ "x-code": "decision_line_linked_diagnosis",
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+ "x-keys-code": "decision_line_linked_diagnosis_keys",
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+ "properties": {
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+ "diagnosisRef": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 60,
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+ "x-code": "decision_line_diagnosis_ref"
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+ },
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+ "sequence": {
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+ "type": "integer",
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+ "minimum": 1,
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+ "maximum": 99,
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+ "x-code": "decision_line_diagnosis_sequence"
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+ }
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+ }
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+ }
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+ },
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+ "sequence": {
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+ "type": "integer",
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+ "minimum": 1,
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+ "maximum": 999,
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+ "x-code": "decision_line_sequence"
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+ },
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+ "confidence": {
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+ "type": "string",
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+ "enum": ["low", "medium", "high"],
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+ "x-code": "decision_line_confidence"
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+ },
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+ "rationale": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 2000,
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+ "x-strip-nonempty": true,
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+ "x-code": "decision_line_rationale"
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+ },
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+ "evidenceRefs": {
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+ "type": "array",
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+ "maxItems": 10,
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+ "x-code": "decision_line_evidence_refs",
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+ "items": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 64,
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+ "x-code": "decision_line_evidence_refs"
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+ }
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+ },
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+ "gapRefs": {
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+ "type": "array",
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+ "maxItems": 10,
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+ "x-code": "decision_line_gap_refs",
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+ "items": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 64,
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+ "x-code": "decision_line_gap_refs"
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+ }
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+ },
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+ "conflictRefs": {
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+ "type": "array",
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+ "maxItems": 10,
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+ "x-code": "decision_line_conflict_refs",
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+ "items": {
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+ "type": "string",
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+ "minLength": 1,
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+ "maxLength": 64,
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+ "x-code": "decision_line_conflict_refs"
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+ }
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+ }
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+ }
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+ }