slug: silna provider: Silna 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: 19 edges: - tag: V1BenefitsCheckResource spec_file: silna-v1benefitscheckresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.9 evidence: POST /public/v1/benefits-checks/ Create Benefits Check; schemas BenefitsCheckEligibilityStatus, NetworkStatus, BenefitsCheckAuthRequiredTime, BenefitsCheckIneligibilityReason reason: Creates and retrieves insurance benefits checks returning eligibility status, network status and whether authorisation is required — the definition of Eligibility & Benefits Verification. (Patient cost-of-service estimate is a secondary output.) - tag: V1PatientPlanBenefitsChecksResource spec_file: silna-v1patientplanbenefitschecksresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.9 evidence: GET /public/v1/patient-plans/{patient_plan_id}/benefits-checks 'Get Benefits Checks for Patient Plan'; schema BenefitsCheckStatusPublic reason: Operation retrieves insurance benefits checks against a patient's insurance plan, which is precisely pre-service verification of coverage and benefits. - tag: V2BenefitsCheckResource spec_file: silna-v2benefitscheckresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.9 evidence: GET /public/v2/benefits-checks/{benefits_check_id} "Get Benefits Check V2"; schemas BenefitsCheckPatientInformation, NetworkStatus, V2PatientCostOfServiceEstimate; vendor "handles prior authorizations, benefit checks, eligibility verification" reason: The single operation retrieves an insurance benefits check with network status, copay/coinsurance modifiers and patient cost-of-service estimates — i.e. verification of coverage and benefits before service delivery. Maps cleanly to Eligibility & Benefits Verification rather than to financial counselling, since the resource is the benefits check itself. - tag: V1PatientPlanPriorAuthorizationsResource spec_file: silna-v1patientplanpriorauthorizationsresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.88 evidence: '''Get Patient Plan Prior Authorizations''; PublicPriorAuthorizationStatus' reason: Prior authorisation status per patient insurance plan is authorisation-requirement verification before service delivery, within Eligibility & Benefits Verification. - tag: V1PriorAuthorizationResource spec_file: silna-v1priorauthorizationresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.88 evidence: '"Create Prior Authorization", "Update Prior Authorization", "Abort Prior Authorization"; schemas PublicPriorAuthorizationStatus, V1TreatmentCodesRequirement, V1PriorAuthorizationApprovalDocument' reason: Full CRUD lifecycle over prior authorization requests including status, treatment-code and document requirements — i.e. obtaining payer authorisation before service delivery, which the frame places in Eligibility & Benefits Verification within Patient Access Management. - tag: V1PriorAuthorizationRecordApprovalResource spec_file: silna-v1priorauthorizationrecordapprovalresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.82 evidence: POST /public/v1/prior-authorizations/{prior_authorization_id}/sync "Record Approval for Prior Authorization"; schemas V1RecordApprovalCreate, V1RecordApprovedTreatmentCodeCreate, PriorAuthorizationUnit reason: The single operation records a payer approval outcome against a prior authorization, with approved treatment codes and units. Prior authorization determination is pre-service payer authorisation, which sits under Eligibility & Benefits Verification ('authorisation requirements before service delivery'). Not revenue-cycle claim production — no claim, remittance or coding production surface here. - tag: OldV1PriorAuthorizationResource spec_file: silna-oldv1priorauthorizationresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.8 evidence: GET /public/v1/prior_authorizations/{prior_authorization_id} Get Prior Authorization (Deprecated); schemas V1PriorAuthorization, V1PriorAuthorizationApprovalDocument, V1PriorAuthorizationDenialDocument reason: Retrieves payer prior-authorisation records with approval/denial documents, treatment codes and units — pre-service authorisation determination, which sits under Eligibility & Benefits Verification (verification of coverage and authorisation requirements before service delivery) in Patient Access Management. - tag: V1BenefitsCheckReportResource spec_file: silna-v1benefitscheckreportresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.8 evidence: POST /public/v1/benefits-checks/{benefits_check_id}/reports Generate Benefits Check Report reason: Generates a report for a completed insurance benefits check; the vendor describes handling 'benefit checks, eligibility verification' upfront so providers confirm patients are clear to receive care — squarely pre-service eligibility and benefits verification. - tag: V1PatientPlanResource spec_file: silna-v1patientplanresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.8 evidence: '''Create Patient Plan''; schemas PatientPlanEligibilityStatus, V1BenefitsInformation, V1EligibilityInformation, InsuranceType' reason: CRUD over a patient's insurance plan carrying eligibility and benefits information — coverage verification data stewardship, not generic registration. - tag: V1PatientPlansResource spec_file: silna-v1patientplansresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.8 evidence: GET /public/v1/patients/{patient_id}/patient-plans 'Get Patient Plans'; EligibilityCheckCompleteStatus, BenefitsCheckCompleteStatus reason: Lists a patient's insurance plans with eligibility and benefits check status — insurance coverage verification surface. - tag: V1PriorAuthorizationCompletedResource spec_file: silna-v1priorauthorizationcompletedresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.8 evidence: POST /public/v1/prior-authorizations/sync 'Create Completed Prior Authorization'; V1CompletedAuthorizationCreate, V1RecordApprovedTreatmentCodeCreate reason: Records completed/approved prior authorisations with approved treatment codes — authorisation verification ahead of care delivery. - tag: V1PriorAuthorizationCompleteRequestResource spec_file: silna-v1priorauthorizationcompleterequestresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.78 evidence: POST /public/v1/prior-authorizations/{prior_authorization_id}/complete-request 'Complete Prior Authorization' reason: Completing a prior authorisation request is management of payer authorisation requirements before service delivery. - tag: V1ContractResource spec_file: silna-v1contractresource-api-openapi.yml capability_id: BC-2870.70 capability_id_l1: BC-2870 capability_name: Payer Contract Management confidence: 0.75 evidence: GET /public/v1/payor-contracts/{contract_id} Get Payor Contract; PATCH ... Update Payor Contract; schemas V1Contract, V1ContractPlan, V1ContractServiceLocation, InsuranceType reason: Operations manage payor (payer) contract records including plans and covered service locations, which is provider-side payer contract stewardship. Some ambiguity remains because the contracts also drive authorisation rules rather than reimbursement modelling only. - tag: V1ContractsResource spec_file: silna-v1contractsresource-api-openapi.yml capability_id: BC-2870.70 capability_id_l1: BC-2870 capability_name: Payer Contract Management confidence: 0.75 evidence: GET /public/v1/payor-contracts/ List Payor Contracts; POST /public/v1/payor-contracts/ Create Payor Contract reason: Create and list payer contract records with plan and service-location detail — provider-side payer contract management. Ambiguity only over whether the contracts serve reimbursement modelling or authorisation configuration. - tag: V1PatientResource spec_file: silna-v1patientresource-api-openapi.yml capability_id: BC-2800.20 capability_id_l1: BC-2800 capability_name: Patient Registration Management confidence: 0.75 evidence: '''Get Patient'' / ''Update Patient'' / ''Delete Patient''; schemas V1Patient, PatientSex, PatientStatus, V1PatientSpecialtyDetail' reason: Maintains patient demographic/identity records used for the pre-service workflow, matching capture and stewardship of patient registration data. - tag: V1PatientsResource spec_file: silna-v1patientsresource-api-openapi.yml capability_id: BC-2800.20 capability_id_l1: BC-2800 capability_name: Patient Registration Management confidence: 0.75 evidence: POST /public/v1/patients/ 'Create Patient'; PUT 'Create or Update Patient'; V1PatientCreate, PatientSex reason: Creation and listing of patient demographic records is patient registration data capture and stewardship. - tag: V1PayorDetectionRunResource spec_file: silna-v1payordetectionrunresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.75 evidence: Create payor detection run; PayorDetectionCategory, PayorDetectionStatus reason: Automated detection of a patient's insurance payor is coverage discovery feeding eligibility/benefits verification in this prior-auth platform; sub-capability inference rests on vendor context rather than explicit summaries. recovered_from: healthcare-vertical-edges.json - tag: V1PayorInferenceResource spec_file: silna-v1payorinferenceresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.75 evidence: Create Payor Inference; V1PayorInferencePlanSchema, InsuranceType reason: Infers the payor and insurance plan for a patient — insurance coverage identification supporting benefits/eligibility verification before service. recovered_from: healthcare-vertical-edges.json - tag: V1BenefitsCheckTemplatesResource spec_file: silna-v1benefitschecktemplatesresource-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.7 evidence: GET /public/v1/benefits-checks/templates Get Benefits Check Templates reason: Lists templates used to configure benefits checks; it is configuration metadata but is unambiguously scoped to the insurance benefits-verification workflow, so the same capability applies with reduced confidence.