SAIF.Domain operations and processes¶

This page is the operation catalog and cross-operation hub for SAIF.Domain's ebilling assignment, indexing, CBP generation, EDI processing, audit, certificate-holder, Guidewire claim-mapping, and document-packet logic. No per-operation detail pages (operations/*.md) were generated for this library; each catalog row cites the enforcing class/method directly, and step-by-step detail lives in Business rules and the per-type pages under API reference.

Operation catalog¶

Operation	Intent	Trigger	Inputs	Outputs	Rules	Tables	SQL
OP-DOM-01 `BillAssignment.AssignBillsResponsibily`	Assign a bill's responsible party and status based on its pended errors	An indexed ebill has pended errors to resolve	Ebill, pended errors	Ebill status Assigned, `AuditNote` rows	DOM-BR-001-DOM-BR-007	EBILL, CBP_NOTE	SQL-024
OP-DOM-02 `PatientIndexer.IndexPatientToClaim`	Match an ebill's patient to a ClaimCenter claim	An ebill's patient has not yet been indexed	Ebill patient, claim number	Indexed patient or error condition	DOM-BR-010-DOM-BR-016	EBILL_ERROR_CONDITION	SQL-014
OP-DOM-03 `ProviderIndexer.IndexProvider` (v1)	Match a bill's billing provider to a provider location by address	An ebill's provider has not yet been indexed (legacy path)	Provider tax ID, addresses	Billing provider location or error condition	DOM-BR-020-DOM-BR-025	PROVIDER_LOCATION	—
OP-DOM-04 `ProviderIndexerV2.IndexProvider`	Match a bill's billing provider to a provider location using ordered match rules	An ebill's provider has not yet been indexed (current path)	Provider tax ID, addresses, provider type	Billing provider location or error condition	DOM-BR-020, DOM-BR-026-DOM-BR-029a	PROVIDER_LOCATION	—
OP-DOM-05 `BillServiceIndexer.IndexBillServices`	Resolve the rendering provider location for each bill service	Bill services have a rendering NPI and billing location	Services, rendering NPI	Ebill status Indexed	DOM-BR-040-DOM-BR-043	EBILL, PROVIDER_LOCATION	SQL-025
OP-DOM-06 `GenerateCbpBills.Generate`	Build CBP bills, services, procedures, and diagnoses from indexed ebills	An ebill has completed indexing	Indexed ebill	New `CbpBill` graph, ebill status CbpSetup	DOM-BR-050-DOM-BR-064	CBP_BILL, CBP_BILL_SERVICE, EBILL	SQL-016, SQL-017, SQL-032
OP-DOM-07 `ErrorConditionHandler`	Record an error/pend condition raised by any indexing or assignment step	An indexing/assignment step detects an error	Error kind	`EbillErrorCondition` row	DOM-BR-070	EBILL_ERROR_CONDITION	SQL-014
OP-DOM-08 `ServiceCodeManager`	Resolve the effective service code for a bill service	A service code lookup is needed during CBP generation	Service code, service date	Resolved code or Unknown type	DOM-BR-080, DOM-BR-081	—	—
OP-DOM-09 Batch lifecycle (`Batch`)	Create and progress an ebilling batch through its status lifecycle	A new batch arrives or an existing batch transitions	Batch data	`EbillBatch` row, status transitions	DOM-BR-090-DOM-BR-092	EBILL_BATCH	SQL-003, SQL-004, SQL-005, SQL-023
OP-DOM-10 `File837Extractor.ProcessFile`	Parse an inbound X12 837 file into ebill structures	An 837 file is received for a batch	Raw 837 segments	Ebill, bill, service, and document entities	DOM-BR-100-DOM-BR-108	EBILL_SERVICE	SQL-015
OP-DOM-11 `File277CaBuilder.Build277ResponseFile`	Build a 277 claim-acknowledgement response file	A batch of bills needs a 277 response	Bills, statuses	277 EDI file, updated ebill response-set links	DOM-BR-110, DOM-BR-111	EBILL	SQL-030
OP-DOM-12 `EobBuilder.GenerateEobs`	Generate explanation-of-benefits records and adjustments from payment extracts	A Guidewire payment extract is available	Payment extract, ebills	EOB, adjustment, and remittance-advice rows	DOM-BR-120-DOM-BR-126	EBILL, EBILL_EOB_ADJUSTMENT, EBILL_EOB_REMITTANCE_ADVICE, PROVIDER_LOCATION	SQL-010, SQL-011, SQL-012, SQL-013, SQL-020, SQL-021, SQL-029
OP-DOM-13 Bill behaviours (`Bill`)	Route, audit, pend, approve, and modify a bill's payment options and status	A bill needs a status or payment-option change	Bill, action	Status change, audit note, or exception	DOM-BR-030, DOM-BR-130-DOM-BR-135	CBP_BILL_STATUS	SQL-006
OP-DOM-14 `Audit`	Disallow or allow all services on an audit and compute totals	An audit is created or reviewed	Audited services	Adjusted allowed amounts, totals	DOM-BR-140-DOM-BR-142	—	—
OP-DOM-15 `AuditNote`	Attach, modify, or delete an audit note on a bill or claim	A note is added, edited, or removed	Note category, text	`CbpNote` row created/updated/deleted	DOM-BR-150	CBP_NOTE	SQL-001, SQL-002, SQL-033
OP-DOM-16 `BillRegenerator.Regenerate`	Clone an existing bill into a new bill for reprocessing	A bill must be regenerated	Source bill	New `CbpBill` and services	DOM-BR-160	CBP_BILL, CBP_BILL_SERVICE	SQL-007, SQL-008
OP-DOM-17 CertificateHolder lifecycle (`CertificateHolder`)	Create, update, expire, reinstate, and supersede policy certificate holders	A certificate holder is created or its state changes	Holder edit contract	`CertificateHolder` row created/updated	DOM-BR-170-DOM-BR-172	CERTIFICATE_HOLDER	SQL-009, SQL-026, SQL-027, SQL-028
OP-DOM-18 Claim read model (`Claim`, `GuidewireToLegacyMapper`)	Present a Guidewire-backed claim as a legacy-shaped read model	A consumer requests claim data	Claim number	`Claim` object with derived properties and `SecureClaimAttributes`	DOM-BR-180-DOM-BR-191, DOM-BR-193-DOM-BR-195	MCO_GSA_LOCATION, PROVIDER_LOCATION	SQL-018, SQL-019
OP-DOM-19 Packets (`PacketManager`, `PacketGenerator`, `PacketDefinition`)	Assemble document packets for policy correspondence	Documents are ready for packet evaluation	Documents, policy, period	Generated packets	DOM-BR-200-DOM-BR-203	ENDORSE_CODE	SQL-022
OP-DOM-20 Other (`ClaimReserveGenerator`, `Image`, `Employee`)	Build claim reserves, convert Vignette image IDs, and load employee display data	A consumer needs reserves, an image, or employee data	Claim, image ID, or user ID	Reserve amounts, converted image IDs, or employee data	DOM-BR-210, DOM-BR-211	—	—

Operation index¶

Each operation below anchors to a stable #op-dom-nn target for cross-references from the API reference and SQL catalog; full Intent/Trigger/Inputs/Outputs/Rules/Tables/SQL detail is in the Operation catalog table above.

OP-DOM-01¶

BillAssignment.AssignBillsResponsibily — assign a bill's responsible party and status based on its pended errors.

OP-DOM-02¶

PatientIndexer.IndexPatientToClaim — match an ebill's patient to a ClaimCenter claim.

OP-DOM-03¶

ProviderIndexer.IndexProvider (v1) — match a bill's billing provider to a provider location by address.

OP-DOM-04¶

ProviderIndexerV2.IndexProvider — match a bill's billing provider to a provider location using ordered match rules.

OP-DOM-05¶

BillServiceIndexer.IndexBillServices — resolve the rendering provider location for each bill service.

OP-DOM-06¶

GenerateCbpBills.Generate — build CBP bills, services, procedures, and diagnoses from indexed ebills.

OP-DOM-07¶

ErrorConditionHandler — record an error/pend condition raised by any indexing or assignment step.

OP-DOM-08¶

ServiceCodeManager — resolve the effective service code for a bill service.

OP-DOM-09¶

Batch lifecycle (Batch) — create and progress an ebilling batch through its status lifecycle.

OP-DOM-10¶

File837Extractor.ProcessFile — parse an inbound X12 837 file into ebill structures.

OP-DOM-11¶

File277CaBuilder.Build277ResponseFile — build a 277 claim-acknowledgement response file.

OP-DOM-12¶

EobBuilder.GenerateEobs — generate explanation-of-benefits records and adjustments from payment extracts.

OP-DOM-13¶

Bill behaviours (Bill) — route, audit, pend, approve, and modify a bill's payment options and status.

OP-DOM-14¶

Audit — disallow or allow all services on an audit and compute totals.

OP-DOM-15¶

AuditNote — attach, modify, or delete an audit note on a bill or claim.

OP-DOM-16¶

BillRegenerator.Regenerate — clone an existing bill into a new bill for reprocessing.

OP-DOM-17¶

CertificateHolder lifecycle (CertificateHolder) — create, update, expire, reinstate, and supersede policy certificate holders.

OP-DOM-18¶

Claim read model (Claim, GuidewireToLegacyMapper) — present a Guidewire-backed claim as a legacy-shaped read model.

OP-DOM-19¶

Packets (PacketManager, PacketGenerator, PacketDefinition) — assemble document packets for policy correspondence.

OP-DOM-20¶

Other (ClaimReserveGenerator, Image, Employee) — build claim reserves, convert Vignette image IDs, and load employee display data.

Process flow diagram¶

The following diagram visualizes the ebilling lifecycle that most of the catalog operations above participate in, from batch receipt through EOB generation.

flowchart TD
    Start([837 file received]) --> Extract["OP-DOM-10<br>File837Extractor.ProcessFile"]
    Extract --> Patient["OP-DOM-02<br>PatientIndexer"]
    Patient --> Provider["OP-DOM-04<br>ProviderIndexerV2"]
    Provider --> Service["OP-DOM-05<br>BillServiceIndexer"]
    Service --> Assign["OP-DOM-01<br>BillAssignment"]
    Assign --> Generate["OP-DOM-06<br>GenerateCbpBills"]
    Generate --> Audit{"Audit required?"}
    Audit -->|Yes| AuditFlow["OP-DOM-14<br>Audit review"]
    Audit -->|No| Eob["OP-DOM-12<br>EobBuilder.GenerateEobs"]
    AuditFlow --> Eob
    Eob --> End([EOB and 835/277 output])

Database interactions¶

SAIF.Domain's own database interactions are all NHibernate ORM operations mediated by IRepositoryFactory/IUnitOfWork — there is no raw SQL, no stored procedures, and no IBusinessCriteria usage in this library. See Database tables and the SQL catalog for the full 33-operation catalog (18 explicit repository calls, 5 cascade inserts, 10 implicit dirty-check updates).

Operation	SQL	Tables	Type
OP-DOM-01 BillAssignment	SQL-024	EBILL	Write
OP-DOM-05 BillServiceIndexer.IndexBillServices	SQL-025	EBILL	Write
OP-DOM-06 GenerateCbpBills.Generate	SQL-016, SQL-017, SQL-032	CBP_BILL, CBP_BILL_SERVICE, EBILL	Read/Write
OP-DOM-07 ErrorConditionHandler	SQL-014	EBILL_ERROR_CONDITION	Write
OP-DOM-09 Batch lifecycle	SQL-003, SQL-004, SQL-005, SQL-023	EBILL_BATCH	Read/Write
OP-DOM-10 File837Extractor.ProcessFile	SQL-015	EBILL_SERVICE	Write
OP-DOM-11 File277CaBuilder.Build277ResponseFile	SQL-030	EBILL	Write
OP-DOM-12 EobBuilder.GenerateEobs	SQL-010, SQL-011, SQL-012, SQL-013, SQL-020, SQL-021, SQL-029	EBILL, EBILL_EOB_ADJUSTMENT, EBILL_EOB_REMITTANCE_ADVICE, PROVIDER_LOCATION	Read/Write
OP-DOM-13 Bill behaviours	SQL-006	CBP_BILL_STATUS	Write
OP-DOM-15 AuditNote	SQL-001, SQL-002, SQL-033	CBP_NOTE	Read/Write/Delete
OP-DOM-16 BillRegenerator.Regenerate	SQL-007, SQL-008	CBP_BILL, CBP_BILL_SERVICE	Write
OP-DOM-17 CertificateHolder lifecycle	SQL-009, SQL-026, SQL-027, SQL-028	CERTIFICATE_HOLDER	Write
OP-DOM-18 Claim read model	SQL-018, SQL-019	MCO_GSA_LOCATION, PROVIDER_LOCATION	Read
OP-DOM-19 Packets	SQL-022	ENDORSE_CODE	Read

Indirect reads via SAIF.Data query providers¶

Beyond the 33 ORM operations above, SAIF.Domain calls 98 distinct SAIF.Data query-provider methods (e.g. BatchQueries.GetBatch, BillQueries.GetNonAssignedBills, SaifProviderQueries.GetProviderByTaxId) to look up reference data, status codes, and related entities during these same operations. These calls execute SQL owned and cataloged by SAIF.Data, not by this library — see the SAIF.Data SQL catalog for the underlying SQL IDs*. A representative sample:

Provider call	SAIF.Data SQL ID(s)	Called from (operation)
`BatchQueries.GetBatch`	SQL-078, SQL-079, SQL-080, SQL-081 (SAIF.Data)	OP-DOM-09, OP-DOM-11
`BillQueries.GetNonAssignedBills`	SQL-123 (SAIF.Data)	OP-DOM-01
`SaifProviderQueries.GetProviderByTaxId`	SQL-203, SQL-204 (SAIF.Data)	OP-DOM-03, OP-DOM-04
`CbpBillQueries.GetCbpServiceCodeNotExpired` / `GetCbpServiceCodeExpired`	SQL-039, SQL-040 (SAIF.Data)	OP-DOM-08
`AuditQueries.GetAudit`	SQL-013 (SAIF.Data, candidate by method name)*	OP-DOM-14
`EobQueries.GetCompletedZeroPaymentBillsForEob`	SQL-100, SQL-101 (SAIF.Data)	OP-DOM-12

The full 98-row mapping (provider call → SAIF.Data SQL ID → call site) is recorded in the Stage 1b analysis and is not repeated in full here; consult the SAIF.Data SQL catalog for the authoritative SQL definitions once that library's documentation set is generated.

Tech debt and design findings¶

REST-only query providers, not database access. ClaimQueryProvider (used by Claim, Bill.GenrateEob, and Worker) and WorkerQueryProvider (used by Worker.GetClaimCount) make REST API calls to Guidewire ClaimCenter — they perform no direct database access despite living in SAIF.Data alongside ORM query providers. Methods such as GetClaim, GetLatestClaimStatus, GetWorkStatus, GetCompensabilityStatus, GetVocationalDetails, HasLegalRepresentativeHistory, GetThirdPartyCase, GetRecoverableOverpaymentBalance, and GetWorker/GetClaimCount are all REST-backed*, which means OP-DOM-18 (the Claim read model) and parts of OP-DOM-13/OP-DOM-20 depend on ClaimCenter availability and latency rather than local database performance characteristics.
GetLatestClaimTypeActivity is retired. ClaimQueryProvider.GetLatestClaimTypeActivity, called from Claim.cs:590, throws NotImplementedException unconditionally. Any code path that still reaches Claim's activity-related property depending on this method will fail at runtime; the trigger conditions under which a caller would hit this path are unverified**.
File837Extractor static mutable state. The 837 parser holds static mutable state, so batch jobs that process files concurrently could corrupt each other's parsing state*.
File837Extractor unimplemented path. A code path in ProcessFile (around line 843) throws NotImplementedException; the trigger conditions are unverified**.
ServiceLocationCodeManager possible dead code. A source-code comment on this class states it is not referenced anywhere in the codebase**.

Failure and edge-case behavior¶

A ClaimCenter API failure during patient indexing is recorded as an indexing error rather than raised to the caller (DOM-BR-012).
Assignment failures are wrapped and rethrown with the ebill ID for traceability (DOM-BR-007).
An unknown bill status passed to BillStatusCode.GetStatusCode throws rather than defaulting (DOM-BR-030).
A batch retrieved by Batch.GetBatch that does not match the expected status/type throws InvalidBatchException (DOM-BR-091).
An untranslated Guidewire claim status throws InvalidDataException from GuidewireToLegacyMapper (DOM-BR-194).
Claim.MyClaimLastLogin swallows a "No row with the given identifier" exception and returns null instead of propagating it (DOM-BR-190).

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¶

Domain/SAIF.Domain/Claims/Ebilling/BillAssignment.cs, GenerateCBPBills.cs, File837Extractor.cs, File835Builder.cs, File277CaBuilder.cs, File837AckBuilder.cs, EdiBuildSegments.cs, EobBuilder.cs, ServiceCodeManager.cs, ServiceLocationCodeManager.cs
Domain/SAIF.Domain/Claims/Ebilling/Indexing/PatientIndexer.cs, ProviderIndexer.cs, ProviderIndexerV2.cs, BillServiceIndexer.cs, ProviderMatcher.cs
Domain/SAIF.Domain/Claims/Bills/BillRegenerator.cs
Domain/SAIF.Domain/Model/Claims/Bills/Bill.cs, BillStatusCode.cs
Domain/SAIF.Domain/Model/Claims/Bills/Audits/Audit.cs
Domain/SAIF.Domain/Model/Claims/Bills/Notes/AuditNote.cs
Domain/SAIF.Domain/Model/Claims/Claim.cs, ClaimReserveGenerator.cs, Worker.cs
Domain/SAIF.Domain/Model/Claims/Ebilling/Batch.cs, ErrorConditionHandler.cs
Domain/SAIF.Domain/Model/Employees/Employee.cs
Domain/SAIF.Domain/Model/Imaging/Image.cs
Domain/SAIF.Domain/Model/Policies/Certificates/CertificateHolder.cs
Domain/SAIF.Domain/Mappers/GuidewireToLegacyMapper.cs
Domain/SAIF.Domain/Tasks/Documents/Packets/PacketManager.cs, PacketGenerator.cs, PacketDefinition.cs
Data/SAIF.Data/Queries/Claims/ClaimQueryProvider.cs, Data/SAIF.Data/Queries/Claims/WorkerQueryProvider.cs