Methodology and limits

1. Statement extraction

The extraction service attempts to identify the provider, service date, explicit billing codes, descriptions, quantities, modifiers, and billed amounts in the fictional PDF. The review screen pauses before comparison because extraction can be wrong.

2. Companion EOB

The public demo uses a separate fictional EOB fixture for the same encounter. It contains provider charges, allowed amounts, insurer adjustments, insurer payments, and patient responsibility. It is not inferred from Medicare prices or generated prose.

3. Deterministic reconciliation

All source rows are preserved, including the repeated 85025 line. The interface checks exact-cent arithmetic: charges equal allowed amounts plus adjustments, and allowed amounts equal plan payments plus patient responsibility. Any mismatch makes the case fail instead of producing a confident recommendation.

4. Factual balance inquiry

The prepared inquiry asks whether the insurer adjustment and payment have posted and requests an updated itemized statement. It does not accuse the provider, assert a corrected balance, cite a legal right, or claim savings.

Important limits

• An Explanation of Benefits is not a bill and may not show the provider's current account balance.
• A provider statement may predate adjudication or combine more than one claim.
• A repeated code is not proof of duplicate billing; quantity, modifier, and service detail still need confirmation.
• The demo cannot determine medical necessity, coverage, contract terms, legal liability, or what anyone finally owes.