The audit trail is the
product.
Verum is not a chatbot. It is five layered subsystems — input modes, probabilistic extraction, deterministic gate, decorative LLM commentary, and four output bridges — connected by a typed audit trail that the medical director can override at any layer.
Probabilistic on top.
Deterministic at the gate.
The single layer that uses no LLM is the layer that produces the verdict. The decorative LLM calls in § 04 are advisory only — they cannot change the answer.
The bridge between
AI image evidence + deterministic policy.
The dictated radiology report often hedges on documentation the gate needs. BRIDGE lets the UM reviewer have Verum · Vision read the image, attest the findings, and promote them into the deterministic gate's fact bank — flipping verdicts on cases where the report missed what the image showed. BRIDGE-extended ontology rules carry a brass “BRIDGE” pill in the cited-rules list so the reader always knows which rules derive from core CMS policy vs the AI-evidence ontology layer. Append-only audit on the Decision; every promotion reversible.
4 procedures × 3 payers × 2 versions.
Two flagship ontologies encoded verbatim from real public policy. Eight synthetic tuples flagged explicitly in their sourceDocument field — no hidden mocks.
| Procedure | Medicare | Commercial | Medicaid |
|---|---|---|---|
| Lumbar MRI | SYN · marked | SYN · marked | SYN · marked |
| Cervical MRI | SYN · marked | SYN · marked | SYN · marked |
| Brain MRI | SYN · marked | SYN · marked | SYN · marked |
| CT Abdomen/Pelvis | SYN · marked | SYN · marked | SYN · marked |
| Procedure | Medicare | Commercial | Medicaid |
|---|---|---|---|
| Lumbar MRI | REAL · LCD L34220 | SYN · marked | SYN · marked |
| Cervical MRI | REAL · LCD L34220 | SYN · marked | SYN · marked |
| Brain MRI | SYN · marked | SYN · marked | SYN · marked |
| CT Abdomen/Pelvis | SYN · marked | SYN · marked | SYN · marked |
Five providers.
Forty-eight curated models.
No vendor lock-in. Click a provider below — the extract agent re-routes live, the latency and cost-per-million-token pills recompute, and the architecture stays identical. Switching a real workspace agent works the same way.
EDI · CDS Hooks · FHIR.
Round-trip fluency in the data formats payers actually use. Generators and parsers for each — proves "we know about EDI" vs "we work with EDI."
EDI · X12N 5010
- 270 · Eligibility request
- 271 · Eligibility response
- 835 · Remittance advice
CDS Hooks · 1.0
- Discovery + invocation (spec-compliant)
- order-sign · prior-auth-prefetch
- order-select · appropriate-use-criteria
FHIR · R4 + CRD-aligned
- PlanDefinition + Library export
- CQL emitter with fact-type bindings
- ValueSet posture via meta.tag
Lumbar Spinal Imaging — Medicare LCD
The federal coverage determination. Read verbatim into the lumbar-Medicare ontology. Source of authority for §-by-§ rule encoding.
Imaging of the Spine — Aetna Clinical Policy Bulletin
The commercial-payer policy used as a triangulation anchor for the lumbar and cervical Medicare ontologies. Where CMS is sparse, Aetna fills with operational criteria.
Imaging of the Spine — Carelon RBM
A third independent source for cross-validation. When all three agreed, the criterion was promoted to flagship REAL.