drChrono Eligibility and Billing

arazzo: 1.0.1
info:
  title: drChrono Eligibility and Billing
  summary: Run the revenue cycle by checking insurance eligibility, reviewing day sheet charges, and adding a claim billing note.
  description: >-
    A revenue cycle flow against the drChrono EHR REST API. Insurance eligibility is
    checked for the patient and appointment, the day sheet charges are reviewed, and a
    claim billing note is added to support clean claim submission. This connects the
    front-office eligibility check to the back-office billing and collections workflow.
    Every step inlines its request so the flow is self-contained.
  version: 1.0.0
  x-realizes-capability-ids:
  - BC-2830
  - BC-2870
  x-capability-derivation:
    method: 'deterministic join: sourceDescriptions -> per-tag OpenAPI -> tag/capability edge. No classification at this step.'
    min_confidence: 0.7
    sources:
    - capability_id: BC-2830
      capability_name: Clinical Documentation Management
      spec: drchrono-clinical-api-openapi.yml
      confidence: 0.78
    - capability_id: BC-2870
      capability_name: Healthcare Revenue Cycle Management
      spec: drchrono-billing-api-openapi.yml
      confidence: 0.9
    model: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities, CC BY 4.0
sourceDescriptions:
- name: billingApi
  url: ../openapi/drchrono-billing-api-openapi.yml
  type: openapi
- name: clinicalApi
  url: ../openapi/drchrono-clinical-api-openapi.yml
  type: openapi
workflows:
- workflowId: eligibility-and-billing
  summary: Check eligibility, review charges, and add a claim billing note.
  description: >-
    Checks insurance eligibility, reviews day sheet charges, and adds a billing note
    to the claim under the supplied provider.
  inputs:
    type: object
    required:
    - patientId
    - appointmentId
    - doctorId
    - billingNote
    properties:
      patientId:
        type: string
        description: Identifier of the patient in the revenue cycle.
      appointmentId:
        type: string
        description: Identifier of the appointment the charges and claim relate to.
      doctorId:
        type: string
        description: Identifier of the provider associated with the claim.
      billingNote:
        type: object
        description: The drChrono claim billing note resource to add to the claim.
  steps:
  - stepId: checkEligibility
    description: Check insurance eligibility for the patient and appointment.
    operationId: eligibility_checks_list
    parameters:
    - name: patient
      in: query
      value: $inputs.patientId
    - name: appointment
      in: query
      value: $inputs.appointmentId
    successCriteria:
    - condition: $statusCode == 200
    outputs:
      eligibility: $response.body
  - stepId: reviewCharges
    description: Review the day sheet charges for the patient.
    operationId: daysheet_charges_list
    parameters:
    - name: patient_id
      in: query
      value: $inputs.patientId
    successCriteria:
    - condition: $statusCode == 200
    outputs:
      charges: $response.body
  - stepId: addBillingNote
    description: Add a billing note to the claim for the appointment.
    operationId: claim_billing_notes_create
    parameters:
    - name: appointment
      in: query
      value: $inputs.appointmentId
    - name: doctor
      in: query
      value: $inputs.doctorId
    requestBody:
      contentType: application/json
      payload: $inputs.billingNote
    successCriteria:
    - condition: $statusCode == 201
    outputs:
      billingNoteId: $response.body#/id
  outputs:
    eligibility: $steps.checkEligibility.outputs.eligibility
    charges: $steps.reviewCharges.outputs.charges
    billingNoteId: $steps.addBillingNote.outputs.billingNoteId