{
  "format": "minctrl.process/v1",
  "graph": {
    "edges": [
      {
        "id": "e0___start____intake",
        "source": "__start__",
        "target": "intake"
      },
      {
        "id": "e1_intake__split-checks",
        "source": "intake",
        "target": "split-checks"
      },
      {
        "id": "e2_split-checks__adjudicate",
        "source": "split-checks",
        "target": "adjudicate"
      },
      {
        "id": "e3_split-checks__screen",
        "source": "split-checks",
        "target": "screen"
      },
      {
        "id": "e4_adjudicate__join-checks",
        "source": "adjudicate",
        "target": "join-checks"
      },
      {
        "id": "e5_screen__join-checks",
        "source": "screen",
        "target": "join-checks"
      },
      {
        "id": "e6_join-checks__comp-call",
        "source": "join-checks",
        "target": "comp-call"
      },
      {
        "id": "e7_comp-call__draft-accept",
        "label": "clear / accepted",
        "source": "comp-call",
        "target": "draft-accept"
      },
      {
        "id": "e8_comp-call__build-dossier",
        "label": "contested / denial / red flag",
        "source": "comp-call",
        "target": "build-dossier"
      },
      {
        "id": "e9_draft-accept__schedule-payment",
        "source": "draft-accept",
        "target": "schedule-payment"
      },
      {
        "id": "e10_schedule-payment__signoff",
        "source": "schedule-payment",
        "target": "signoff"
      },
      {
        "id": "e11_build-dossier__signoff",
        "source": "build-dossier",
        "target": "signoff"
      },
      {
        "id": "e12_signoff__sound",
        "source": "signoff",
        "target": "sound"
      },
      {
        "id": "e13_sound__adjudicate",
        "label": "deficient — recompute AWW / pull records",
        "source": "sound",
        "target": "adjudicate"
      },
      {
        "id": "e14_sound__file",
        "label": "sound — proceed to file",
        "source": "sound",
        "target": "file"
      },
      {
        "id": "e15_file__monitor",
        "source": "file",
        "target": "monitor"
      },
      {
        "id": "e16_monitor____end__",
        "source": "monitor",
        "target": "__end__"
      }
    ],
    "nodes": [
      {
        "agent": null,
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "__start__",
        "interrupt_before": false,
        "kind": "terminal",
        "label": "Start",
        "position": {
          "x": 0,
          "y": 0
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "terminal",
        "tools": []
      },
      {
        "agent": "intake",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "intake",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Intake the First Report of Injury (FROI) and the medical records",
        "position": {
          "x": 0,
          "y": 120
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "low",
        "tools": [
          "ocr"
        ]
      },
      {
        "agent": null,
        "confidential": false,
        "gate": null,
        "gateway": "parallel",
        "human": null,
        "id": "split-checks",
        "interrupt_before": false,
        "kind": "gateway",
        "label": "Run compensability computation and treatment/deadline screening concurrently",
        "position": {
          "x": 0,
          "y": 240
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "gateway",
        "tools": []
      },
      {
        "agent": "adjudicator",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "adjudicate",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Determine compensability (AOE/COE) and compute the AWW and TTD/PPD benefits",
        "position": {
          "x": 0,
          "y": 360
        },
        "reversible": true,
        "sla": "21 days from claim intake (state law requires acceptance or denial within 21 calendar days of claim receipt; varies 14–60 days by jurisdiction — IAIABC EDI R3.1; state DOI rules)",
        "sla_spec": null,
        "tier": "low",
        "tools": [
          "comp-rules"
        ]
      },
      {
        "agent": "compliance",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "screen",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Screen utilization review / treatment guidelines and statutory deadlines — apply state-mandated medical treatment guidelines (CA: MTUS per Title 8 §9792.20–9792.27.23; other states: ACOEM, ODG, or jurisdiction-specific schedule) and verify UR compliance with state UR procedures",
        "position": {
          "x": 0,
          "y": 480
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "low",
        "tools": [
          "comp-rules"
        ]
      },
      {
        "agent": null,
        "confidential": false,
        "gate": null,
        "gateway": "parallel",
        "human": null,
        "id": "join-checks",
        "interrupt_before": false,
        "kind": "gateway",
        "label": "Both the benefit computation and the UR / deadline screen are complete",
        "position": {
          "x": 0,
          "y": 600
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "gateway",
        "tools": []
      },
      {
        "agent": null,
        "confidential": false,
        "gate": null,
        "gateway": "exclusive",
        "human": null,
        "id": "comp-call",
        "interrupt_before": false,
        "kind": "gateway",
        "label": "Compensability clear and accepted, or contested / denial?",
        "position": {
          "x": 0,
          "y": 720
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "gateway",
        "tools": []
      },
      {
        "agent": "adjudicator",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "draft-accept",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Auto-draft the acceptance and benefit-payment notice with the computed AWW / TTD",
        "position": {
          "x": 0,
          "y": 840
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "low",
        "tools": [
          "comp-rules"
        ]
      },
      {
        "agent": "adjudicator",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "schedule-payment",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Schedule the first benefit payment to meet state timeliness requirements (e.g., within 14 days of first disability in CA; failure to pay within 30 days triggers 10% penalty — CA Labor Code § 5814). Record the scheduled payment date on the acceptance notice.",
        "position": {
          "x": 0,
          "y": 960
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "low",
        "tools": [
          "comp-rules"
        ]
      },
      {
        "agent": "compliance",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "build-dossier",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Build the contested / denial dossier — AOE/COE dispute, fraud or red-flag indicators, missing-records gaps",
        "position": {
          "x": 0,
          "y": 1080
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "medium",
        "tools": [
          "comp-rules"
        ]
      },
      {
        "agent": null,
        "confidential": false,
        "gate": "gate:claims-adjuster-signoff",
        "gateway": null,
        "human": "Licensed claims adjuster",
        "id": "signoff",
        "interrupt_before": true,
        "kind": "gate",
        "label": "A licensed claims adjuster signs the compensability determination before state filing. Note: pre-filing adjuster signoff requirements are jurisdiction-specific (e.g., mandatory for some self-insured employers in AZ; carrier/TPA policy in CA; check state DOI rules).",
        "position": {
          "x": 0,
          "y": 1200
        },
        "reversible": false,
        "sla": null,
        "sla_spec": null,
        "tier": "high",
        "tools": []
      },
      {
        "agent": null,
        "confidential": false,
        "gate": null,
        "gateway": "exclusive",
        "human": null,
        "id": "sound",
        "interrupt_before": false,
        "kind": "gateway",
        "label": "Determination sound and defensible — or send back for rework? For denials: confirm the decision has a reasonably debatable basis to avoid bad-faith liability (penalties up to 200% of withheld benefits — CA Labor Code § 5814; state bad-faith statutes). For acceptances: confirm AWW/TTD computation and payment schedule are complete.",
        "position": {
          "x": 0,
          "y": 1320
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "gateway",
        "tools": []
      },
      {
        "agent": "submit",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "file",
        "interrupt_before": false,
        "kind": "agent",
        "label": "File the FROI/SROI to the state via IAIABC EDI Claims Release R3.1 (electronic submission to the state workers-comp authority per state DOI EDI requirements)",
        "position": {
          "x": 0,
          "y": 1440
        },
        "reversible": false,
        "sla": null,
        "sla_spec": null,
        "tier": "high",
        "tools": [
          "claim-edi"
        ]
      },
      {
        "agent": "monitor",
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "monitor",
        "interrupt_before": false,
        "kind": "agent",
        "label": "Monitor the claim status, benefit-payment timeliness and reserves",
        "position": {
          "x": 0,
          "y": 1560
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "low",
        "tools": [
          "claim-edi:check-status"
        ]
      },
      {
        "agent": null,
        "confidential": false,
        "gate": null,
        "gateway": null,
        "human": null,
        "id": "__end__",
        "interrupt_before": false,
        "kind": "terminal",
        "label": "Done",
        "position": {
          "x": 0,
          "y": 1680
        },
        "reversible": true,
        "sla": null,
        "sla_spec": null,
        "tier": "terminal",
        "tools": []
      }
    ]
  },
  "hash": "ce0723e588919706eeb245d9634e63f8266a69d637b362814cc11accbff2316c",
  "name": "Workers'-comp claims autopilot",
  "slug": "workers-comp",
  "source": "example",
  "version": null,
  "violations": []
}