SAIF.Business.Claim.Bill architecture

SAIF.Business.Claim.Bill is the claim-domain medical-bill business library for bill persistence, audited service adjustments, MCO billing, payment requests, support lookups, and imaging-based bill retrieval.

Responsibilities

• Persist medical bills, bill services, diagnoses, procedures, statuses, and payment requests.
• Maintain audited services, adjustments, and audit messages.
• Support MCO billing scenarios and national drug validation.
• Expose supporting-data lookups for audit categories, diagnosis codes, service codes, and provider-related billing data.
• Configure and call the imaging API for bill-image operations.

Component boundaries

• Core BOF business objects own bill, service, diagnosis, adjustment, and status lifecycle operations.
• Audit-support modules and services provide read-oriented support data and validation helpers.
• clsCallImageApi is the integration boundary to the imaging client and environment-service configuration.
• View libraries provide read-only claim/provider context instead of being reimplemented locally.
• The library is a reusable base for the automated-audit extension library.

Interaction model

Claim-bill workflows retrieve or save bill aggregates through BOF criteria objects and Oracle tables, enrich those workflows with audit-support lookups and national-drug validation, and optionally call the imaging API for bill documents. The library combines direct table CRUD, read-only support queries, and one supporting stored-procedure path inside the same package.

Inherited framework context (from Legends CLI)

• IBusinessCriteria supplies the CRUD SQL contract used by bill, service, diagnosis, adjustment, and payment-request criteria objects.*
• IDataPortalInfo provides the portal abstraction used for scalar execution, result-set retrieval, and database sequence access behind bill workflows.*
• clsBusinessBase contributes edit lifecycle behavior and the shared rules-manager model used by mutable bill objects.*
• clsBusinessCollectionBase contributes traversal, deleted-item tracking, and validation-state aggregation for bill collections.*

Architecture diagram

The following diagram shows the high-level medical-bill component architecture.

flowchart TD
    Consumer["Claim bill consumer"] --> Core["Bill core business objects"]
    Core --> Audit["Audit support and lookups"]
    Core --> Imaging["clsCallImageApi"]
    Core --> ViewClaim["SAIF.Business.View.Claim"]
    Core --> ViewProvider["Provider view data"]
    Core --> DPI["IDataPortalInfo"]
    Audit --> DPI
    DPI --> Oracle["Oracle CBP / claim tables"]
    Imaging --> ImagingApi["Imaging API"]

Sequence diagram

The following diagram shows a representative bill retrieval and enrichment sequence.

sequenceDiagram
    participant Consumer
    participant Bill as clsBill
    participant DPI as IDataPortalInfo
    participant Oracle
    participant Image as clsCallImageApi
    Consumer->>Bill: Retrieve or save bill
    Bill->>DPI: Execute bill criteria SQL
    DPI->>Oracle: CRUD / lookup queries
    Oracle-->>DPI: Bill, service, and audit data
    DPI-->>Bill: Hydrated bill aggregate
    opt Bill image required
        Bill->>Image: Request image endpoint
        Image-->>Bill: Imaging client response
    end
    Bill-->>Consumer: Bill result

Design constraints

• The library is strongly coupled to Oracle CBP billing tables and supporting lookups.
• Imaging operations require imagingApiUrl from the environment service plus Oracle provider registration in config.
• Audit-support data and mutable bill objects coexist in one package, so change impact crosses read-only and CRUD paths.
• Downstream automated-audit components extend this library rather than duplicating core bill persistence.

Related documentation

• Index
• Overview
• Dependencies
• Operations and processes
• Business rules
• Database tables
• SQL catalog
• Procedures
• Configuration
• API reference

Note: Statements marked with * were inferred from code structure, naming conventions, or contextual evidence where direct confirmation was not available in source artifacts. Statements marked with ** could not be confirmed; treat as unknown until verified.

Sources

• Business\SAIF.Business.Claim.Bill\SAIF.BOF.Business.Claim.Bill.vbproj
• Business\SAIF.Business.Claim.Bill\SAIF.BOF.Business.Claim.Bill.nuspec
• Business\SAIF.Business.Claim.Bill\packages.config
• Business\SAIF.Business.Claim.Bill\clsCBPBillPaymentRequest.vb
• Business\SAIF.Business.Claim.Bill\clsCallImageApi.vb
• Business\SAIF.Business.Claim.Bill\Core\clsBill.vb
• Business\SAIF.Business.Claim.Bill\Core\clsAudit.vb
• Business\SAIF.Business.Claim.Bill\Core\clsAuditedService.vb
• Business\SAIF.Business.Claim.Bill\Core\clsAuditedServiceAdjustment.vb
• Business\SAIF.Business.Claim.Bill\Core\clsAuditMessage.vb
• Business\SAIF.Business.Claim.Bill\Core\clsBillDiagnosis.vb
• Business\SAIF.Business.Claim.Bill\Core\clsBillProcedure.vb
• Business\SAIF.Business.Claim.Bill\Core\clsBillService.vb
• Business\SAIF.Business.Claim.Bill\Core\clsBillStatus.vb
• Business\SAIF.Business.Claim.Bill\MCOSupport\clsMCOBill.vb
• Business\SAIF.Business.Claim.Bill\AuditSupport\Services\clsNationalDrug.vb
• Business\SAIF.Business.Claim.Bill\AuditSupport\mdlCBPSupportingData.vb