CDM_AUTOMATION_FLOW.md

⚡ AI-Driven CDM Auto-Sync: Automation Flow

This document details how the AI identifies, audits, and patches Temple Health's Chargemaster (CDM) in response to CMS regulatory shifts.

1. Trigger: Regulatory Ingestion

The process begins when the Regulatory Specialist Agent retrieves a rule from the FAISS vector database.

• Example: Rule R2025_BUND_01 states that Orthopedic supply costs (HCPCS C1713) are now "packaged" into the APC 5114 flat fee.

2. Detection: Conflict Identification

The CDM Specialist Agent receives the regulatory insight and performs a semantic audit:

• It scans for keywords like "Bundling", "APC", "Packaged", or "Pass-Through".
• If a bundling rule is detected, it queries the local chargemaster.csv (Temple's Digital Twin).
• Conflict Found: It identifies that HCPCS_C1713 is currently marked as Pass-Through in Temple's system, which contradicts the new CMS mandate.

3. Quantification: Revenue at Risk

If the CDM is not updated, the claim will be submitted as "Pass-Through".

• Old Expected: $7,000 (Pass-Through).
• Reality: CMS will auto-deny the claim because the item is now packaged.
• Result: $0 reimbursement (Total Denial).
• AI Solution: By syncing to the "Packaged" status, the facility secures the $5,500 APC fee, preventing a 100% revenue loss.

4. Automation: The Auto-Sync Patch

The agent generates a cdm_patch instruction:

• Action: Update Status: Pass-Through -> Packaged APC 5114.
• Target: HCPCS_C1713.
• System Impact: Triggers an automated update to the CDM database to ensure all future claims for this service line are billed correctly from Day 1 of the rule change.

5. Persistence: Post-Patch Reconciliation

The sync process is tracked in a permanent audit trail:

• Detailed Table: Captures the transition from Legacy Risk ($0) to Target Value.
• Detection Logic: Every correction includes the specific AI reasoning (e.g., Rule R2025_BUND_01 match).
• Billing Asset: Generates a multi-sheet Excel workbook with audit trails, savings summaries, and a data dictionary.

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Temple Health RCM Automation | Project Antigravity