{
  "tool_id": "art-399-lint-x12-claim-records",
  "note": "X12 837/835 envelope + balancing lint (FORMAT-ONLY, FL-2). Vector 1: compliant 837. Vector 2: 835 balance mismatch (arithmetic). Vector 3: 835 interchange control-number mismatch.",
  "vectors": [
    {
      "name": "compliant_837_claims",
      "description": "837 claim transaction, envelope control numbers continuous, two well-formed claims.",
      "policy_parameters": {
        "message_type": "837",
        "envelope": {
          "isa13": "000000001",
          "iea02": "000000001",
          "gs06": "1",
          "ge02": "1",
          "st02": "0001",
          "se02": "0001"
        },
        "claims": [
          {
            "claim_id": "CLM-1001",
            "charge_amount": 250
          },
          {
            "claim_id": "CLM-1002",
            "charge_amount": 75.5
          }
        ]
      },
      "output_payload": {
        "message_type": "837",
        "compliant": true,
        "error_count": 0,
        "warning_count": 0,
        "claim_count": 2,
        "total_charge_amount": 325.5,
        "issues": [],
        "disambiguation": "lint_x12_claim_records checks X12 837/835 ENVELOPE control-number continuity and, for 835, payment-amount balancing (arithmetic only) -- a FORMAT-ONLY validator over identifiers and amounts, never claim content.",
        "phi_note": "This schema is structurally PHI-IMPOSSIBLE: it defines only envelope control numbers, claim/payment identifiers, and monetary amounts -- no patient name, DOB, diagnosis, or any clinical field exists in the input or output. See the HIPAA-Security WATCH row for the separate, un-triggered security-rule surface.",
        "subset_coverage_statement": "This lints X12 837/835 ENVELOPE structure and 835 payment balancing only, from public CMS companion-guide summaries. It does not implement the full licensed X12 implementation guide, and defines no clinical/PHI fields whatsoever.",
        "table_version": "X12-837-835-ENVELOPE-BALANCE-PUBLIC-SUBSET-V1",
        "table_source": "CMS X12 837/835 Companion Guide public summaries (cms.gov); ASC X12 005010 envelope structure (public control-number continuity rules: ISA13/IEA02, GS06/GE02, ST02/SE02).",
        "regulatory_basis": "ASC X12 005010 837/835 transaction sets; CMS companion-guide public summaries; HIPAA Administrative Simplification transaction-standard rule (45 CFR Part 162)."
      },
      "golden_hash": "311fb3fc19abece3ed3f0a85e3c123edf27e7b477cca8a19dd57450e7c35db47"
    },
    {
      "name": "835_balance_mismatch",
      "description": "835 remittance total_paid_amount does not equal sum of claim_payments -- arithmetic balancing failure.",
      "policy_parameters": {
        "message_type": "835",
        "envelope": {
          "isa13": "000000002",
          "iea02": "000000002",
          "gs06": "2",
          "ge02": "2",
          "st02": "0002",
          "se02": "0002"
        },
        "remittance": {
          "total_paid_amount": 300,
          "claim_payments": [
            {
              "claim_id": "CLM-1001",
              "paid_amount": 200
            },
            {
              "claim_id": "CLM-1002",
              "paid_amount": 75
            }
          ]
        }
      },
      "output_payload": {
        "message_type": "835",
        "compliant": false,
        "error_count": 1,
        "warning_count": 0,
        "total_paid_amount": 300,
        "sum_claim_payments": 275,
        "claim_payment_count": 2,
        "balances": false,
        "issues": [
          {
            "code": "REMITTANCE_BALANCE_MISMATCH",
            "severity": "ERROR",
            "field": "remittance",
            "message": "Remittance total_paid_amount (300) does not equal sum of claim_payments (275)."
          }
        ],
        "disambiguation": "lint_x12_claim_records checks X12 837/835 ENVELOPE control-number continuity and, for 835, payment-amount balancing (arithmetic only) -- a FORMAT-ONLY validator over identifiers and amounts, never claim content.",
        "phi_note": "This schema is structurally PHI-IMPOSSIBLE: it defines only envelope control numbers, claim/payment identifiers, and monetary amounts -- no patient name, DOB, diagnosis, or any clinical field exists in the input or output. See the HIPAA-Security WATCH row for the separate, un-triggered security-rule surface.",
        "subset_coverage_statement": "This lints X12 837/835 ENVELOPE structure and 835 payment balancing only, from public CMS companion-guide summaries. It does not implement the full licensed X12 implementation guide, and defines no clinical/PHI fields whatsoever.",
        "table_version": "X12-837-835-ENVELOPE-BALANCE-PUBLIC-SUBSET-V1",
        "table_source": "CMS X12 837/835 Companion Guide public summaries (cms.gov); ASC X12 005010 envelope structure (public control-number continuity rules: ISA13/IEA02, GS06/GE02, ST02/SE02).",
        "regulatory_basis": "ASC X12 005010 837/835 transaction sets; CMS companion-guide public summaries; HIPAA Administrative Simplification transaction-standard rule (45 CFR Part 162)."
      },
      "golden_hash": "0f109ae9693901a536f9e7d0fe94c92f4b8ba63738d9739a0c7ab2f99a103377"
    },
    {
      "name": "835_control_number_mismatch",
      "description": "835 balances arithmetically but ISA13/IEA02 interchange control numbers diverge -- structural continuity failure.",
      "policy_parameters": {
        "message_type": "835",
        "envelope": {
          "isa13": "000000003",
          "iea02": "000000099",
          "gs06": "3",
          "ge02": "3",
          "st02": "0003",
          "se02": "0003"
        },
        "remittance": {
          "total_paid_amount": 100,
          "claim_payments": [
            {
              "claim_id": "CLM-2001",
              "paid_amount": 100
            }
          ]
        }
      },
      "output_payload": {
        "message_type": "835",
        "compliant": false,
        "error_count": 1,
        "warning_count": 0,
        "total_paid_amount": 100,
        "sum_claim_payments": 100,
        "claim_payment_count": 1,
        "balances": true,
        "issues": [
          {
            "code": "INTERCHANGE_CONTROL_MISMATCH",
            "severity": "ERROR",
            "field": "isa13/iea02",
            "message": "ISA13 (000000003) does not match IEA02 (000000099) -- interchange control-number continuity broken."
          }
        ],
        "disambiguation": "lint_x12_claim_records checks X12 837/835 ENVELOPE control-number continuity and, for 835, payment-amount balancing (arithmetic only) -- a FORMAT-ONLY validator over identifiers and amounts, never claim content.",
        "phi_note": "This schema is structurally PHI-IMPOSSIBLE: it defines only envelope control numbers, claim/payment identifiers, and monetary amounts -- no patient name, DOB, diagnosis, or any clinical field exists in the input or output. See the HIPAA-Security WATCH row for the separate, un-triggered security-rule surface.",
        "subset_coverage_statement": "This lints X12 837/835 ENVELOPE structure and 835 payment balancing only, from public CMS companion-guide summaries. It does not implement the full licensed X12 implementation guide, and defines no clinical/PHI fields whatsoever.",
        "table_version": "X12-837-835-ENVELOPE-BALANCE-PUBLIC-SUBSET-V1",
        "table_source": "CMS X12 837/835 Companion Guide public summaries (cms.gov); ASC X12 005010 envelope structure (public control-number continuity rules: ISA13/IEA02, GS06/GE02, ST02/SE02).",
        "regulatory_basis": "ASC X12 005010 837/835 transaction sets; CMS companion-guide public summaries; HIPAA Administrative Simplification transaction-standard rule (45 CFR Part 162)."
      },
      "golden_hash": "a3e33ed4bc176bb5d16c3b6a377ceaf11e048ccde3090a92de814a96972b5720"
    }
  ]
}