Knowledge verification
Nobody can verify a payer policy by writing code. Verification means a person read the payer's published document and confirmed the entry matches it. This machinery makes that a governed, recorded, expiring act.
#What a verification must carry
| Field | Why |
|---|---|
sourceUrl | Where the reviewer read it. A citation nobody can follow is not a citation. |
sourceTitle | What the document is called, so a later reviewer finds the same thing. |
sourceDate | The publication date of the source, not the date it was read. |
excerpt | The passage relied on. It is what a future reviewer re-checks against. |
verifiedBy | A named person. "The team" cannot be asked what they meant. |
#Separation of duties
The person who authored an entry may not verify it. Someone confirming their own work against a source they chose is not a second pair of eyes.
#Expiry
| Kind | Valid for |
|---|---|
| Payer rule | 90 days |
| Documentation rule | 180 days |
| Question set | 180 days |
| CMS obligation | 365 days |
Payer policies move faster than statute. A lapsed verification returns the entry to abstention rather than to a confident stale answer.
#Verifying a fixture does not make it servable
The dangerous shortcut
A reviewer can honestly record that they checked a fixture and it says what the entry says. That is true, and worth nothing clinically. Service requires both a verification and a published provenance - a fixture has to be replaced, not signed off.
#Readiness is reported honestly
The readiness report separates two blockers because they need different work: verifying is a reviewer-hours problem, and replacing a fixture is a content-acquisition problem. The current deployment reports clinicallyServable: 0 of 14, and sellable: false.