======================================================================
  CLAIM VALIDATOR — FULL WORKFLOW REPORT
  Generated: 2026-03-04 19:26:35
======================================================================

INPUT DATA
----------------------------------------------------------------------

Eligibility Request (Waystar 270):
{
  "payer_id": "66666",
  "npi": "1245319599",
  "subscriber_id": "SUB987654321",
  "first_name": "Alice",
  "last_name": "Williams",
  "dob": "1980-07-22",
  "service_type": "30"
}

Eligibility Request (Validation):
{
  "provider_npi": "1245319599",
  "payer_id": "60054",
  "subscriber_id": "SUB987654321",
  "subscriber_first_name": "Alice",
  "subscriber_last_name": "Williams",
  "subscriber_dob": "1980-07-22",
  "date_of_service": "2026-03-04"
}

Claim Data:
{
  "claim_type": "professional",
  "billing_provider_npi": "1245319599",
  "payer_id": "60054",
  "subscriber_id": "SUB987654321",
  "patient_first_name": "Alice",
  "patient_last_name": "Williams",
  "patient_dob": "1980-07-22",
  "patient_gender": "F",
  "service_date": "2026-03-04",
  "diagnosis_codes": [
    {
      "code": "J06.9"
    }
  ],
  "lines": [
    {
      "procedure_code": "99213",
      "charge_amount": 150.0,
      "units": 1.0,
      "diagnosis_pointers": [
        1
      ],
      "service_date_from": "2026-03-04",
      "place_of_service": "11"
    }
  ]
}

======================================================================
  STEP 1: WAYSTAR ELIGIBILITY CHECK (270/271)
======================================================================

Status:       active
Eligible:     True
Reference ID: 218559495

Carrier:      ZIRMED (1234567890)
Address:      P.O. BOX 30555, SALT LAKE CITY, UT 841300555
Subscriber:   ALICE WILLIAMS | DOB: 7/22/1980 | ID: SUB987654321
File Status:  ACTIVE

Plans:
  Plan 1: CHOICE PLUS
    Status:          ACTIVE
    Effective:       3/4/2026
    Deductible IN:   $1500
    Deductible OUT:  $2000
    CoInsurance IN:  N/A
    CoInsurance OUT: N/A
    Ded Remaining:   $500
    OOP Remaining:   $1000

  Plan 2: 12
    Status:          ACTIVE
    Effective:       3/4/2026
    Deductible IN:   $N/A
    Deductible OUT:  $N/A
    CoInsurance IN:  .2
    CoInsurance OUT: .4

Benefits Detail:
  Service Type 30:
    IND: Deductible $0 (remaining $500) | OOP $0 (remaining $1000)
    FAM: Deductible $1500 (remaining $1500) | OOP $0 (remaining $2000)
  Service Type 12:
    IND: Deductible $- (remaining $-) | OOP $- (remaining $-)
    FAM: Deductible $0 (remaining $-) | OOP $- (remaining $-)

Waystar Raw Response (JSON):
{
  "RawOutput": "ISA*00*          *00*          *ZZ*ZIRMED         *ZZ*605            *260304*0856*^*00501*007158038*0*P*:~GS*HB*ZIRMED*605*20260304*0856*7158038*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*REQ001*20260304*085636~HL*1**20*1~NM1*P5*2*TEST DATA*****PI*87726~HL*2*1*21*1~NM1*1P*1*ZIRMED*DEMO****XX*1234567890~HL*3*2*22*0~TRN*2*217648508*9ZIRMEDCOM~TRN*2*220686992*9ZIRMEDCOM*ELR ID~TRN*1*218559495*9ZIRMEDCOM*ELI ID~NM1*IL*1*WILLIAMS*ALICE****MI*SUB987654321~DMG*D8*19800722~DTP*291*D8*20260304~EB*1**30*C1*CHOICE PLUS~LS*2120~NM1*P5*2*TEST DATA*****PI*87726~N3*P.O. BOX 30555~N4*SALT LAKE CITY*UT*841300555~PER*IC~LE*2120~EB*C*IND*30***23*500*****W~EB*G*FAM*30*C1**23*2000*****W~EB*G*IND*30*C1**23*1000*****W~EB*C*FAM*30***24*0*****W~EB*C*IND*30***24*0*****W~EB*G*FAM*30*C1**24*0*****W~EB*G*IND*30*C1**24*0*****W~EB*C*IND*30***29*500*****W~EB*G*FAM*30*C1**29*2000*****W~EB*G*IND*30*C1**29*1000*****W~EB*C*FAM*30***23*1500*****Y~EB*C*FAM*30***29*2000*****N~EB*C*FAM*30***23*2000*****N~EB*C*FAM*30***29*1500*****Y~EB*1**12*********W~EB*A*IND*12***27**.4****N~EB*A*IND*12***27**.2****Y~EB*B*IND*12***27*0*****W~EB*C*FAM*12****0*****W~EB*F*IND*12****0*****W~EB*F*IND*12****0*****W~MSG*ADDITIONAL COVERED PER OCCURRENCE~EB*X~LS*2120~NM1*1P*1*ZIRMED*DEMO****XX*1234567890~LE*2120~SE*47*0001~GE*1*7158038~IEA*1*007158038~",
  "ParsedOutput": {
    "CarrierCode": "1234567890",
    "CarrierName": "ZIRMED",
    "CarrierAddress1": "P.O. BOX 30555",
    "CarrierCity": "SALT LAKE CITY",
    "CarrierState": "UT",
    "CarrierZip": "841300555",
    "Dtps": [
      {
        "Type": "291",
        "Date": "20260304"
      }
    ],
    "ClaimsInfo": {
      "Name": "TEST DATA",
      "Address1": "P.O. BOX 30555",
      "City": "SALT LAKE CITY",
      "State": "UT",
      "Zip": "841300555"
    },
    "MemberId": "SUB987654321",
    "SubscriberRelationship": "SUBSCRIBER",
    "Subscriber": {
      "First": "ALICE",
      "Last": "WILLIAMS",
      "Dob": "7/22/1980",
      "MemberId": "SUB987654321"
    },
    "Patient": {
      "First": "ALICE",
      "Last": "WILLIAMS",
      "Dob": "7/22/1980"
    },
    "FileStatus": 1,
    "FileStatusDescription": "ACTIVE",
    "HasMedicarePassportadvantage": 0,
    "Plans": [
      {
        "InsurancePlan": "30",
        "InsurancePlanName": "CHOICE PLUS",
        "FileStatus": 1,
        "FileStatusDescription": "ACTIVE",
        "PatientEffectiveBenefitDate": "3/4/2026",
        "DeductibleInNetwork": "1500",
        "DeductibleOutNetwork": "2000",
        "ServiceType": "30",
        "Name": "C1",
        "ActiveDate": "3/4/2026",
        "IsActive": true,
        "PlanBinDed": "1500",
        "PlanBinDedRem": "500",
        "PlanBinOopRem": "1000",
        "PlanBonDed": "2000",
        "PlanBonDedRem": "2000"
      },
      {
        "InsurancePlan": "12",
        "FileStatus": 1,
        "FileStatusDescription": "ACTIVE",
        "PatientEffectiveBenefitDate": "3/4/2026",
        "CoInsuranceInNetwork": ".2",
        "CoInsuranceOutNetwork": ".4",
        "ServiceType": "12",
        "Name": "12",
        "ActiveDate": "3/4/2026",
        "IsActive": true
      }
    ],
    "Benefits": {
      "30": {
        "IND": {
          "BinDed": "0",
          "BinDedRem": "500",
          "Deds": [
            {
              "Value": "500",
              "NetFlag": "W"
            },
            {
              "Value": "0",
              "NetFlag": "W"
            }
          ],
          "DedRems": [
            {
              "Value": "500",
              "NetFlag": "W"
            }
          ],
          "Oops": [
            {
              "Value": "1000",
              "NetFlag": "W"
            },
            {
              "Value": "0",
              "NetFlag": "W"
            }
          ],
          "OopRems": [
            {
              "Value": "1000",
              "NetFlag": "W"
            }
          ],
          "CoverageStatus": "Active",
          "PlanType": "30",
          "InsuranceType": "C1",
          "PlanCoverageDescription": "CHOICE PLUS",
          "BinOop": "0",
          "BinOopRem": "1000"
        },
        "FAM": {
          "Deds": [
            {
              "Value": "0",
              "NetFlag": "W"
            },
            {
              "Value": "1500",
              "NetFlag": "Y"
            },
            {
              "Value": "2000",
              "NetFlag": "N"
            }
          ],
          "DedRems": [
            {
              "Value": "2000",
              "NetFlag": "N"
            },
            {
              "Value": "1500",
              "NetFlag": "Y"
            }
          ],
          "Oops": [
            {
              "Value": "2000",
              "NetFlag": "W"
            },
            {
              "Value": "0",
              "NetFlag": "W"
            }
          ],
          "OopRems": [
            {
              "Value": "2000",
              "NetFlag": "W"
            }
          ],
          "BinOop": "0",
          "BinDed": "1500",
          "BinOopRem": "2000",
          "BonDedRem": "2000",
          "BonDed": "2000",
          "BinDedRem": "1500"
        }
      },
      "12": {
        "IND": {
          "CovgPercs": [
            {
              "Value": "60%",
              "NetFlag": "N"
            },
            {
              "Value": "80%",
              "NetFlag": "Y"
            }
          ],
          "Copays": [
            {
              "Value": "0",
              "Tq": "27",
              "NetFlag": "W"
            }
          ],
          "Days": [
            {
              "NetFlag": "W"
            },
            {
              "NetFlag": "W",
              "Msg": "ADDITIONAL COVERED PER OCCURRENCE"
            }
          ],
          "CoverageStatus": "Active",
          "PlanType": "12",
          "BonCovgPerc": "60%",
          "BinCovgPerc": "80%",
          "BinCopay1": "0",
          "BinDaysMsg": "ADDITIONAL COVERED PER OCCURRENCE"
        },
        "FAM": {
          "Deds": [
            {
              "Value": "0",
              "NetFlag": "W"
            }
          ],
          "BinDed": "0"
        }
      },
      "It-none": {
        "St-none": {
          "Benefits": [
            {
              "ProviderName": "DEMO ZIRMED",
              "Npi": "1234567890"
            }
          ]
        }
      }
    },
    "PlanName": "CHOICE PLUS"
  },
  "InquiryId": 218559495
}

======================================================================
  STEP 2: WORKFLOW RESULT — process_claim()
======================================================================

Workflow Passed: True
Stopped At:      (completed all stages)
Execution Time:  0.0145s
Total Findings:  0

----------------------------------------------------------------------
STAGE RESULTS
----------------------------------------------------------------------
  [PASS] eligibility  (0.0085s)
  [PASS] pa_determination  (0.0000s)
  [SKIPPED] prior_auth — Prior authorization not required  (0.0000s)
  [PASS] claim_validation  (0.0058s)

----------------------------------------------------------------------
DOMAIN RESULTS
----------------------------------------------------------------------
  Eligibility:      passed=True  findings=0
    Time: 0.0070s
  PA Determination: required=False
    Reason: authOrCertIndicator is unknown/missing and no free-text PA indicators found
  Claim Validation: passed=True  findings=0
    Time: 0.0012s

======================================================================
  END OF REPORT
======================================================================