ManikandanandClaude Opus 5.5
ba15a574ab
Snapshot of the working project as of 2026-10-23 (local 2d4d4fc), one commit with no earlier history: the tracked files were de-identified first (synthetic claim ids and patient data only; see Context.md section 7). Credentials, run logs, screenshots, claim reports and client workbooks are gitignored and not included. Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
3.2 KiB
eCW Charge Validation
A bot that opens Salud's claims in eCW, checks them against the operator's charge conditions, and reports each claim; and the results portal that shows those reports and starts the bot.
Runs and outcomes
Run: One start-to-finish execution of the bot, from start to its exit code. Avoid: job, session, execution
Run Source: Where a Run was started from: the Portal or a Terminal on the bot's PC. Avoid: origin, trigger
Fail: A Charge Summary category: the claim was read and has a billing problem the conditions found. Never a bot problem. Avoid: error, failure (for a claim's category)
Run Error: Something that stopped a Run: an exit code other than 0, an unhandled exception, the browser crashing, a pre-flight check failing. Avoid: exception, crash, failure
Claim Error: A claim the bot could not check: its search raised, its form would not read, or it never finished loading. The Run carries on; the Charge Summary still shows it as Review. Avoid: failed claim, Fail
Not Reached: A claim in a Run's queue that the Run never got to, because a Run Error stopped it first. Avoid: skipped, pending
Warning: Something worth a look that stopped nothing: a fallback selector used, a Cancel that needed a retry, a dialog that appeared, a claim not found in eCW, low disk space.
Charge conditions
PPS Code: The Medicare FQHC visit code a claim must carry for its payer to accept it: G0466 (new patient), G0467 (established), G0468 (Initial Preventive Physical Exam or Annual Wellness Visit), G0469 / G0470 (mental health, new / established), and the home and nursing-home variants G0466H, G0467H, G0467NH. Avoid: G code, visit code
Qualifying Code: A billed CPT/HCPCS code that the Medicare G code crosswalk maps to a PPS Code (92002 → G0466, 99213 → G0467, G0439 → G0468). Avoid: trigger code, crosswalk code
PPS Payer: A payer whose claims need a PPS Code: Medicare, Medicare-Novitas, HCFA Medicare, HCFA Medicare Novitas, Humana Medicare, Devoted MCR UB, Cigna Healthspring, Cigna Health Spring/ Bravo. The two Cigna plans count here although every other rule treats them as Commercial. Avoid: Medicare payer (alone)
Signing in
eCW Login Attempt: One pass of the bot through eCW's login (password, captcha, 2FA approval mail), with its start, end and result. A Run may make more than one. Avoid: login (alone), sign-in
Portal: The results web page on the bot's PC: Dashboard, Claim status, Runs, Start / Stop. Avoid: web app, results page, UI
Portal User: A person with an account on the Portal, holding one Role. Avoid: user (alone), operator (for a person), account
Sign-in: A Portal User proving who they are to the Portal; ends with Sign-out or 30 minutes idle. Avoid: login, logon
Role: What a Portal User may do. Admin: everything, including managing Portal Users. Operator: see everything and start / stop a Run. Viewer: see only.
Started By: The Portal User who started a Run from the Portal, or the Windows user for a Run started from a Terminal. Avoid: triggered by, owner, run by
Stopped By: The Portal User who stopped a Run from the Portal before it finished.