{
  "schema": "varexis-index-free-publication-preview/1",
  "catalogue_version": "pub-8-tranche-58-v1",
  "route_id": "agentic_reviewed_fhir_claim_focal_coverage_selection",
  "record_id": "VXI-EXT-ADMINISTRATION-FHIR-CLAIM-FOCAL-COVERAGE-SELECTION-01-v1",
  "question": "Does listing several FHIR claim coverages request adjudication from all those policies?",
  "answer": "R5 Claim.insurance identifies one focal coverage for adjudication of that claim. Other listed coverages have a coordination sequence, and claims against them are separate. Listing several policies does not request or establish successful adjudication against all of them, nor verify that any policy remains effective.",
  "records": [
    {
      "record_id": "VXI-EXT-ADMINISTRATION-FHIR-CLAIM-FOCAL-COVERAGE-SELECTION-01-v1",
      "url": "/varexis-index/records/fhir-claim-focal-coverage-selection.json",
      "content_sha256": "9ced0828327a76a6c59c3af7882aa589b30e6900bdedcd1ebbde8b3e914f1615",
      "evidence": {
        "schema": "varexis-public-evidence-record/0.3",
        "generated_at_utc": "2026-10-25T00:44:04.075Z",
        "record_id": "VXI-EXT-ADMINISTRATION-FHIR-CLAIM-FOCAL-COVERAGE-SELECTION-01-v1",
        "record_kind": "external_reference",
        "title": "FHIR R5 focal coverage and coordination order",
        "system": "HL7 FHIR R5 5.0.0 — claim",
        "evidence_family": "vendor_evidence_review",
        "index_status": "PUBLIC_SAFE_SOURCE_REVIEW",
        "evidence_state": "PRIMARY_DOCUMENTATION_REVIEW_ONLY",
        "canonical_question": "Does listing several FHIR claim coverages request adjudication from all those policies?",
        "near_questions": [
          "Does listing multiple FHIR insurance coverages claim against all of them?",
          "What does the focal insurance flag select?",
          "How is coverage coordination order represented?",
          "Can a coverage reference verify an active insurance policy?"
        ],
        "supported_claims": [
          {
            "claim": "R5 Claim.insurance identifies one focal coverage for adjudication of that claim. Other listed coverages have a coordination sequence, and claims against them are separate. Listing several policies does not request or establish successful adjudication against all of them, nor verify that any policy remains effective.",
            "reliance": "DOCUMENTED_CAPABILITY_ONLY"
          }
        ],
        "not_demonstrated_claims": [
          "No clinical advice, patient-safety validation, legal compliance or confirmation of insurance cover.",
          "No independent proof of a live access decision, completed workflow, physical action or settled payment.",
          "The published R5 definition does not establish support or conformance in a buyer implementation.",
          "Buyer deployment testing, live runtime enforcement, certification or permission to act",
          "Expanded capabilities or licences for existing INDEX executables"
        ],
        "public_summary": "R5 Claim.insurance identifies one focal coverage for adjudication of that claim. Other listed coverages have a coordination sequence, and claims against them are separate. Listing several policies does not request or establish successful adjudication against all of them, nor verify that any policy remains effective.",
        "related_record_ids": [],
        "source_review": {
          "source_type": "official_external_documentation",
          "source_title": "HL7 FHIR R5 5.0.0 — claim definitions",
          "source_url": "https://hl7.org/fhir/R5/claim-definitions.html",
          "checked_on": "2026-10-25",
          "candidate_record_id": "VXI-EXT-ADMINISTRATION-FHIR-CLAIM-FOCAL-COVERAGE-SELECTION-01-v1",
          "candidate_record_sha256": "0e4bf5ce67bf9b3f2dc70b8b908737a747179c17a3ce003749734c9929aa6cdf",
          "method": "Primary documentation reviewed for the published bounded statement.",
          "deployment_tested_by_varexis": false,
          "revalidation": "The delivered snapshot preserves the review date shown. Recheck current primary documentation and deployment context before relying on present applicability; payment does not trigger fresh research."
        },
        "answer_policy": {
          "classification": "DOCUMENTED_WITH_DEPLOYMENT_BOUNDARY",
          "bounded_answer": "R5 Claim.insurance identifies one focal coverage for adjudication of that claim. Other listed coverages have a coordination sequence, and claims against them are separate. Listing several policies does not request or establish successful adjudication against all of them, nor verify that any policy remains effective.",
          "required_buyer_context": "Listed coverage references; Focal flag and sequence; Separate claims and adjudication evidence. Buyer deployment not inspected.",
          "missing_evidence": "A broader claim needs evidence matching the intended use. Payment does not upgrade the evidence state."
        },
        "private_boundary": "Raw logs, thresholds, private paths, source code, protected mechanisms and reconstruction-level details are excluded from public and paid delivery.",
        "decision_profile": {
          "schema": "varexis-vendor-evidence-review/1",
          "review_status": "documentation_review_only",
          "checked_on": "2026-10-25",
          "claim_to_check": "Does listing several FHIR claim coverages request adjudication from all those policies?",
          "documented_statement": {
            "status": "documented",
            "statement": "R5 Claim.insurance identifies one focal coverage for adjudication of that claim. Other listed coverages have a coordination sequence, and claims against them are separate. Listing several policies does not request or establish successful adjudication against all of them, nor verify that any policy remains effective.",
            "source_ids": [
              "fhir-claim-definitions"
            ]
          },
          "review_inference": {
            "status": "review_inference",
            "statement": "Identify the policy actually targeted by a claim. This is a documentation-review judgment, not an observed outcome.",
            "source_ids": [
              "fhir-claim-definitions"
            ]
          },
          "buyer_evidence_required": [
            "Listed coverage references",
            "Focal flag and sequence",
            "Separate claims and adjudication evidence"
          ],
          "review_condition": {
            "status": "varexis_review_policy",
            "statement": "Refuse simultaneous-approval or coverage-validity claims from a policy list."
          },
          "unknowns": "The applicable implementation guide, live system and actual administrative outcome were not inspected.",
          "unknown_finding": {
            "status": "unknown",
            "statement": "The applicable implementation guide, live system and actual administrative outcome were not inspected."
          },
          "evidence_sources": [
            {
              "source_id": "fhir-claim-definitions",
              "url": "https://hl7.org/fhir/R5/claim-definitions.html",
              "final_url": "https://hl7.org/fhir/R5/claim-definitions.html",
              "status": 200,
              "captured_at_utc": "2026-10-25T00:21:10.490Z",
              "sha256": "61337e526df9ae4e117f2e2c2df05790bfeaae3233c0c846101400f77834a76c",
              "bytes": 143729,
              "title": "HL7 FHIR R5 5.0.0 — claim definitions",
              "hash_basis": "SHA-256 of unmodified HTTP response body bytes",
              "rights_review": "Original factual paraphrase of the HL7 FHIR core specification under CC0. Third-party terminology and trademarks have separate terms; no document, schema, code or modified standard is redistributed. No endorsement or patient data.",
              "checked_on": "2026-10-25",
              "capture_status": 200,
              "claim_review_completed": true,
              "reviewed_sections": [
                "Claim.insurance.focal; Claim.insurance.sequence"
              ],
              "version_context": "Permanent FHIR R5 5.0.0 publication. Resource-specific maturity and normative/Trial Use status apply; no universal normative or implementation-conformance claim."
            }
          ],
          "observed_deployment": false,
          "commercial_reliance_boundary": "Documentation review only; the buyer must establish applicability and actual outcomes. INDEX does not inspect or control the deployment.",
          "paid_value": {
            "decision_context": "Identify the policy actually targeted by a claim.",
            "free": "Complete review, sources, practical questions and limitations; may be saved locally.",
            "single_request": "Existing server-saved version-bound route snapshot for later authenticated retrieval.",
            "evidence_receipt": "The same snapshot plus the existing unsigned delivery receipt.",
            "excluded": [
              "Fresh vendor research",
              "Continuous monitoring or change alerts",
              "Testing the buyer configuration",
              "Private evidence or vendor certification"
            ],
            "integrity": "Hashes identify content versions; they do not prove truth or provide a signature."
          },
          "revalidation": {
            "trigger": "A saved purchase does not recheck the source or buyer configuration.",
            "specific_watch": "Recheck the applicable FHIR version, implementation guide, resource profile and independent administrative outcome before relying on a current workflow."
          },
          "buyer_relevance": "Identify the policy actually targeted by a claim.",
          "refusal_conditions": [
            "Refuse simultaneous-approval or coverage-validity claims from a policy list."
          ]
        },
        "niche": {
          "niche_id": "agent-authority-action-evidence",
          "label": "Agent Authority & Action Evidence",
          "classification_id": "payments",
          "classification_label": "Agent Payments, Authority & Transaction Evidence",
          "topic_id": "payments",
          "buyer_intent": "Identify the policy actually targeted by a claim.",
          "comparison_role": "supplementary_discovery"
        },
        "paid_access_note": "The full published answer and boundaries are free. Paid access saves the selected route and source versions, with an unsigned receipt when purchased. Preview coverage before paying. Fresh research, bespoke assessment and protected evidence are excluded.",
        "service_route": {
          "request_guide": "/varexis-index/request.html",
          "request_workflow": "/varexis-index/request-workflow.json",
          "service_id": "single_request",
          "service_routes_url": "/varexis-index/service-routes.json",
          "payment_required": true,
          "availability_endpoint": "/api/index/capabilities",
          "operational_status": "AUTOMATIC_SERVICE_CAPABILITIES_GATED",
          "checkout_url": "/index-access"
        },
        "authority_boundary": "VAREXIS-INDEX informs evidence reliance. It does not provide advice, certification, deployment authority, security assurance, production approval, or guarantee.",
        "human_page": "/varexis-index/catalog.html#fhir-claim-focal-coverage-selection",
        "machine_readable_record": "/varexis-index/records/fhir-claim-focal-coverage-selection.json"
      }
    }
  ],
  "access": {
    "mode": "exact_http_only",
    "payment_required": false,
    "purchase_url": null,
    "mcp_preview_available": false,
    "paid_saved_retrieval_available": false,
    "natural_language_search_qualified": false
  },
  "boundary": "Catalogue additions are available free through the exact HTTP JSON links below. Enhanced natural-language discovery is not yet qualified for these records. They are outside MCP search, MCP preview and paid saved retrieval. No search qualification, executable capability or entitlement is added.",
  "content_sha256": "45244223b03ea72c830ee0504eaf21c0d3bc5e5d139a528a9789d177bc96a48c"
}