Time of Service Pre-Funding
def auth_payment(patient_id, amount):
account = get_account(patient_id)
limit = calculate_limit(funding)
return card.auth(min(amount, limit))
Exclusion-Free Gap Coverage
def reconcile(claim_id, insurer_paid):
owed = total_billed - insurer_paid
amount = owed - pre_paid
return gap(claim_id, amount)
Auto Adjudication
async def process_claim:
oop = cop + ded + coins
await gap.coverage(oop)
await card.settle(claim_id)