Provenance and abstention

Every clinical or payer fact the platform serves carries where it came from. Where nothing authoritative answers, it abstains and says so - and that abstention is the product working, not failing.

#Three provenance classes

Class	What it is	Can it be served?
`payer_response`	The payer's own answer about this member, from the eligibility rail. Self-verifying - it cannot go stale because it was asked just now.	Yes, always
`published`	A real document with a followable locator - a Federal Register citation, a payer policy URL.	Only once a named reviewer has confirmed the entry against it
`synthetic`	A harness fixture. Something we wrote.	Never. Not by any configuration.

#Verified and authoritative are different axes

This shipped

Eight knowledge entries carried verified: true with a checked-on date while their own source field read "SYNTHETIC harness fixture". The platform answered "27447 requires prior authorization for Florida Blue" with a verified badge, from a rule nobody had read in any payer document. Everything being unverified would have been the SAFE state - it abstains. Confident assertion of invented clinical rules is the dangerous direction.

The fix was to separate the axes. verified means a human checked the entry against the source it names. provenance means whether that source is a payer document or something we wrote. Service requires both. A reviewer signing off on a fixture does not make it servable - the fixture has to be replaced.

An integrity check runs at load and fails if an entry's flags contradict its source, so the state cannot return quietly.

#Precedence

text

payer response  >  verified published rule  >  abstain

A curated rule may never override a payer's answer about a specific member. Our list describes a payer's general policy; the payer's response describes this person's plan, and where they differ it is the person's plan that gets billed.

#Abstention is three-valued, and it is not silence

The answer to "does this need prior authorization" is required, not_required, or unknown - never a boolean, because a boolean has to invent an answer for the payers that do not say. Not every payer populates the indicator, and inventing "not required" is the expensive direction: the surgery proceeds, nobody filed, and the claim is denied after the fact.

Abstention still raises a task

An earlier version of the triage agent logged its abstentions and moved on. A scheduled surgery whose authorization requirement could not be determined is exactly the case a human must see - quiet abstention is the taxonomy's lost_authorization with better manners.