slug: claim-md
provider: Claim.MD
generated_by: planning/capability-mapping/scripts/classify_capabilities.py
model: claude-opus-5
frame:
- Healthcare Providers
min_confidence: 0.7
capability_model:
  source: https://github.com/vincentmakes/turbo-ea-capabilities
  license: CC-BY-4.0
  attribution: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities,
    CC BY 4.0
  notice: NOTICE
edge_count: 4
edges:
- tag: Eligibility
  spec_file: claim-md-eligibility-api-openapi.yml
  capability_id: BC-2800.30
  capability_id_l1: BC-2800
  capability_name: Eligibility & Benefits Verification
  confidence: 0.92
  evidence: POST /services/elig/ 'Submit eligibility request (270 file)'; schemas EligibilityRequest,
    EligibilityResponse
  reason: The operations submit X12 270 eligibility inquiries and return 271 responses — verification
    of insurance coverage and benefits before service, which is precisely Eligibility & Benefits Verification.
- tag: Claim Status
  spec_file: claim-md-claim-status-api-openapi.yml
  capability_id: BC-2870.30
  capability_id_l1: BC-2870
  capability_name: Claim Production & Submission
  confidence: 0.85
  evidence: POST /services/response/  getClaimResponses  Retrieve claim status responses
  reason: Clearinghouse operations for retrieving claim status responses, modification events, notes and
    archiving claims — directly realises claim submission and status tracking within healthcare revenue
    cycle.
- tag: Claims
  spec_file: claim-md-claims-api-openapi.yml
  capability_id: BC-2870.30
  capability_id_l1: BC-2870
  capability_name: Claim Production & Submission
  confidence: 0.85
  evidence: POST /services/upload/  uploadClaims  Upload a batch claim file
  reason: Uploading batch 837 claim files to a clearinghouse for submission to payers is claim production
    and submission in the healthcare revenue cycle; the upload/list operations are the submission channel
    itself, not generic file plumbing.
- tag: ERA
  spec_file: claim-md-era-api-openapi.yml
  capability_id: BC-2870.50
  capability_id_l1: BC-2870
  capability_name: Cash Posting & Payer Reconciliation
  confidence: 0.75
  evidence: POST /services/eralist/ listEra 'List electronic remittance advice'; 'Retrieve raw 835 ERA'
  reason: Operations retrieve payer electronic remittance advice (835) in raw, structured and PDF form
    — the input to posting payer payments and reconciling against expected reimbursement in the provider
    revenue cycle. L2 cash posting/payer reconciliation is the closest fit, though the API itself only
    delivers the remittance data, hence moderate confidence.