SAIF.Business.Claim.MedicalBill architecture

SAIF.Business.Claim.MedicalBill is the medical-bill business component for retrieving claim bill data, loading audit-service and EOB detail, maintaining national-drug pricing tables, and enforcing confidentiality and authorization checks around medical-bill access.

Responsibilities

• Retrieve medical-bill collections and expose bill-level business objects to claim workflows.
• Retrieve audit services, service adjustments, and EOB notes through PK82396_MEDICAL_BILLS.
• Maintain national-drug, national-drug-price, and NDC price-history records through BOF CRUD objects.
• Provide adjustment-code lookup collections used by medical-bill audit workflows.
• Apply caller-classification and authorization-aware confidentiality rules around medical-bill data.

Inherited framework context (from Legends CLI)

Cached resolvedTypes[].queries[] results for SAIF.Business.Claim.MedicalBill indicate the following inherited framework behavior:

• IBusinessCriteria provides the BOF criteria contract that supplies overridable create/retrieve/insert/update/delete request slots for database and API-backed requests.* (source: saif-framework-core library docs)
• IDataPortalInfo supplies connection, data-access-layer, API-client, and scalar-execution context to business objects during persistence and retrieval.* (source: saif-framework-core library docs)
• IDataRequest represents the request abstraction used by the Oracle and SQL portal implementations beneath BOF business objects.* (source: saif-framework-core library docs)
• clsBusinessBase contributes edit lifecycle support and a per-object clsRulesManager used to surface validation state.* (source: saif-framework-core library docs)
• clsBusinessCollection(Of T) contributes typed collection traversal, deleted-item tracking, and collection-level validation surfacing.* (source: saif-framework-core library docs)
• clsBusinessCollectionBase contributes collection traversal, deleted-item tracking, and IDataErrorInfo validation surfacing for collection objects.* (source: saif-framework-core library docs)
• clsResultSet is identified as a framework result-wrapper type, but no deeper indexed behavior was returned by the cached Legends results.* (source: saif-framework-core library docs)
• clsSAIFDataReader is identified as a framework data-reader abstraction, but no deeper indexed behavior was returned by the cached Legends results.* (source: saif-framework-core library docs)
• clsSecurityPrincipal is identified as the security principal abstraction referenced by the library's authorization helpers, but the cached Legends results did not return deeper indexed behavior for it.* (source: saif-framework-core library docs)
• clsSmartDate is part of the BOF smart-value wrapper set used to carry null-safe date values through business objects.* (source: saif-framework-core library docs)
• clsSmartDecimal is part of the BOF smart-value wrapper set used to carry null-safe decimal values through business objects.* (source: saif-framework-core library docs)
• clsSmartString is part of the BOF smart-value wrapper set used to carry null-safe string values through business objects.* (source: saif-framework-core library docs)

Component boundaries

• Medical-bill boundary: clsMedicalBill and clsMedicalBillCollection own claim-bill retrieval and bill-level confidentiality behavior.
• Audit-detail boundary: clsAuditServiceCollection, clsEOBNoteCollection, and clsServiceAdjustmentCollection expose procedure-backed retrieval of audit-facing medical-bill detail.
• Drug-pricing boundary: clsNationalDrug, clsNationalDrugPrice, clsNdcPriceHistory, and related collections own pricing-table CRUD behavior.
• Lookup boundary: clsAdjustmentCode* objects isolate adjustment-code lookups for audit-service processing.
• Security boundary: HasExposureAccess, HasHealthIssueAccess, IsSAIFEmployee, and worker-name masking logic isolate confidentiality decisions from the rest of the model.

Interaction model

Callers retrieve medical-bill collections through framework access layers, collection objects classify the caller and propagate confidentiality flags to child bill objects, and procedure-backed collections retrieve audit detail from Oracle. Drug-pricing entities follow the standard BOF CRUD path directly against Oracle tables.

Architecture diagram

The following diagram shows high-level component interactions.

flowchart TD

    A[Claim applications] --> B[Medical bill collection]

    B --> C[SecurityPrincipal checks]

    B --> D[Data API access layer]

    B --> E[Audit and EOB collections]

    E --> F[PK82396_MEDICAL_BILLS]

    D --> G[Medical bill data source]

    F --> H[Medical bill Oracle tables]

Sequence diagram

The following diagram shows the primary request/response sequence.

sequenceDiagram

    participant App as Claim application

    participant Bills as clsMedicalBillCollection

    participant Sec as clsSecurityPrincipal

    participant API as DataApiAccessLayer

    participant Child as clsMedicalBill

    App->>Bills: Retrieve medical bills for a claim

    Bills->>Sec: Check exposure and collateral-health access

    Sec-->>Bills: Authorization result

    Bills->>API: Retrieve bill result set

    API-->>Bills: Medical bill data

    Bills->>Child: Propagate employee and conflict flags

    Child-->>Bills: Masked or unmasked worker names

    Bills-->>App: Filtered bill collection

Design constraints

• Retrieval is split between an API-oriented collection path and Oracle procedure-backed audit-detail collections, so medical-bill behavior spans two data-access patterns.
• Authorization helpers for exposure and collateral-health access are present, but Stage 1c did not observe local call sites that actively deny or filter data through those helpers.
• Worker-name masking relies on caller classification and conflict detection, so consumer-visible output can vary without any schema change.
• PK82396_MEDICAL_BILLS is the sole traced package contract for audit-detail retrieval and must remain aligned with the BOF collection expectations.

Related documentation

• Index
• Overview
• Dependencies
• Operations and processes
• Business rules
• Database tables
• SQL catalog
• Procedures
• Security and authorization
• 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.MedicalBill\clsMedicalBill.vb
• Business\SAIF.Business.Claim.MedicalBill\clsMedicalBillCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\clsAuditServiceCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\clsEOBNoteCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\clsServiceAdjustmentCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\clsNationalDrug.vb
• Business\SAIF.Business.Claim.MedicalBill\clsNationalDrugPrice.vb
• Business\SAIF.Business.Claim.MedicalBill\clsNdcPriceHistory.vb
• Business\SAIF.Business.Claim.MedicalBill\packages.config
• Business\SAIF.Business.Claim.MedicalBill\SAIF.BOF.Business.Claim.MedicalBill.nuspec
• Business\SAIF.Business.Claim.MedicalBill\Pipelines\build-vars.yml
• Business\SAIF.Business.Claim.MedicalBill\clsAdjustmentCode.vb
• Business\SAIF.Business.Claim.MedicalBill\clsAdjustmentCodeCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\clsNationalDrugPriceCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\clsNdcPriceHistoryCollection.vb
• Business\SAIF.Business.Claim.MedicalBill\SAIF.BOF.Business.Claim.MedicalBill.vbproj