Staged case evidence

Claims-Denial Case — Mission 2 Evidence

Claims-Denial Case — Mission 2 Evidence: a bounded synthetic evidence reveal for the Lumyn FDE School claims-denial practice case.

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Reveal this fictional source only after completing the Mission 1 field map. It adds normative policy and exact-build behavior. Neither source grants disposition authority or establishes behavior outside its stated scope.

Available sources

Source ID	Source and revision	Evidence class	Scope	Limitation
S4	Claims security policy, revision 8, effective 1 Jul	Authoritative policy	Corrected-claim approval and submission	Policy owner must confirm applicability to the pilot service account
S5	Adapter test report, build `nl-adapter-2026.08.03`, 6 Aug	Exact-build test	NorthLake adapter build only	Does not prove Summit behavior or production configuration

S4 — Claims security policy revision 8

Only an authenticated billing specialist assigned to the applicable facility may approve and submit a corrected claim. Approval is scoped to the claim, correction revision, actor, facility, and policy revision. Recommendation tools may not reuse the specialist credential or infer approval from prior cases.

A submission is complete only after the claims system of record returns a status for the same claim and correction revision. A timeout after a possible submission must be reconciled before retry.

Policy owner: Director of Product Security. No pilot exception is recorded.

S5 — NorthLake adapter exact-build test

Tested build: nl-adapter-2026.08.03, test fixture revision mod25-r2.

Test	Expected	Observed
Same-day evaluation documented	Preserve modifier 25	Modifier 25 removed
No separate evaluation documented	Remove modifier 25	Modifier 25 removed
Duplicate correction request	One recommendation record	Two recommendation records

The report does not cover Summit, production deployment identity, specialist approval, submission, or claims-system readback.

Complete Mission 2 before opening the Mission 3 evidence.