Revenue Cycle Agent
X12 Payer / RCM Evidence Test Kit
SCRIMED conformance evaluations execute deterministic checks against synthetic fixtures and declared connector contracts. A synthetic pass is not certification, partner acceptance, production authorization, or permission to exchange live healthcare data.
Deterministic checks
Trading-partner-selected X12 eligibility, authorization, claim, remittance, and acknowledgement guides
pass
Synthetic payer fixture present
synthetic · fixture
fixture-claims-utilization-dataset-v1
- A deterministic payer-data fixture must remain bound to the claims and utilization contract.
pass
Synthetic-only payer assertion
synthetic · privacy
syntheticOnly=true
- The test kit cannot accept live member, subscriber, policy, claim, or payer credentials.
pass
Structured line metadata
synthetic · structure
lineCount=3
- Synthetic line-level metadata supports deterministic completeness and denial-risk checks.
pass
Lineage and access partitioning
synthetic · governance
de-identification option required; lineage metadata required; schema versioning required; partition access by role; access partitioning; no final reimbursement determination
- Payer evidence must preserve source lineage and role-scoped access.
pass
Final reimbursement prohibited
synthetic · financial-safety
final reimbursement decision; unpartitioned access; unversioned schema change
- SCRIMED may prepare or validate evidence but cannot determine reimbursement or submit a transaction.
pass
Deterministic fixture validation
synthetic · quality
10/10 checks passed
- Required claims signals, safeguards, lineage, trace, and prohibited actions must pass.
block
Transaction version and guide selection
live-readiness · conformance
Licensed guide and partner decision required
- Select transaction sets, implementation guides, companion guides, code sets, and version pins with the trading partner.
block
Trading-partner acknowledgement testing
live-readiness · reliability
Clearinghouse or payer acceptance required
- Test envelope validation, acknowledgements, rejection paths, duplicates, retries, balancing, and reconciliation.
block
Human submission authority
live-readiness · governance
Payer submission remains disabled
- A named authorized operator, approved workflow, contract, audit trail, and explicit release gate are required before any payer-facing action.
Synthetic payer and claims fixture
Line-level metadata, lineage, denial signal, and no-final-reimbursement boundary.
Inspect evidenceIntegration fixture validation
10 deterministic checks currently pass.
Inspect evidenceTrading-partner implementation profile
Licensed implementation guide, companion guide, transaction scope, version, code sets, and endpoint rules.
Payer or clearinghouse acceptance report
Envelope, acknowledgement, rejection, duplicate, retry, balancing, security, and reconciliation evidence.
Required before live exchange
Production use remains denied until every deployment-specific blocker is resolved.
01Trading-partner agreement and licensed implementation or companion guides
02Transaction set, version, endpoint, code-set, and acknowledgement selection
03Payer or clearinghouse conformance, rejection, duplicate, retry, and reconciliation testing
04Authorized operator, least-privilege identity, audit, retention, and release workflow
05Revenue-cycle, compliance, privacy, security, legal, and payer-owner approval
06Payer submission remains disabled until separately authorized
Linked controls
Contract, fixture, and standards evidence remain inspectable.
Primary sources