{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://artifacts.apis.io/backworkhealth-com/json-schema/backworkhealth-com-policy-detail-schema.json",
  "title": "PolicyDetail",
  "x-generated": "2026-11-02",
  "x-method": "derived",
  "x-generator": "derive-json-schema.py",
  "x-source": "openapi/backworkhealth-com-v1-openapi.json#/components/schemas/PolicyDetail",
  "type": "object",
  "properties": {
    "policy_id": {
      "type": "string",
      "description": "Policy identifier (e.g., L33831)"
    },
    "title": {
      "type": "string"
    },
    "policy_type": {
      "type": "string",
      "description": "Policy type; one of `LCD`, `Article`, `NCD`, `PayerPolicy`, `Medical Policy`, `Drug Policy`"
    },
    "jurisdiction": {
      "type": [
        "string",
        "null"
      ]
    },
    "effective_date": {
      "anyOf": [
        {
          "type": "string",
          "format": "date"
        },
        {
          "type": "null"
        }
      ]
    },
    "retire_date": {
      "anyOf": [
        {
          "type": "string",
          "format": "date"
        },
        {
          "type": "null"
        }
      ]
    },
    "last_reviewed_date": {
      "anyOf": [
        {
          "type": "string",
          "format": "date"
        },
        {
          "type": "null"
        }
      ]
    },
    "version": {
      "anyOf": [
        {
          "type": "integer"
        },
        {
          "type": "null"
        }
      ]
    },
    "status": {
      "type": [
        "string",
        "null"
      ]
    },
    "source_url": {
      "type": "string"
    },
    "pdf_url": {
      "type": [
        "string",
        "null"
      ]
    },
    "description": {
      "type": [
        "string",
        "null"
      ]
    },
    "summary": {
      "type": [
        "string",
        "null"
      ]
    },
    "applicability_scope": {
      "type": "string",
      "enum": [
        "shared_markets",
        "document_scoped"
      ]
    },
    "applicability_markets": {
      "description": "Markets whose publisher indexes list this exact document",
      "type": "array",
      "items": {
        "type": "string"
      }
    },
    "applicability_evidence": {
      "anyOf": [
        {
          "type": "object",
          "properties": {
            "document_sha256": {
              "type": "string",
              "pattern": "^[0-9a-f]{64}$"
            },
            "market_index_listings": {
              "maxItems": 16,
              "type": "array",
              "items": {
                "type": "object",
                "properties": {
                  "market": {
                    "type": "string",
                    "pattern": "^[A-Z]{2}$"
                  },
                  "index_url": {
                    "type": "string",
                    "maxLength": 2048,
                    "pattern": "^https:\\/\\/"
                  }
                },
                "required": [
                  "market",
                  "index_url"
                ]
              }
            },
            "document_statements": {
              "maxItems": 16,
              "type": "array",
              "items": {
                "type": "object",
                "properties": {
                  "kind": {
                    "type": "string",
                    "enum": [
                      "non_medicare_disclaimer",
                      "commercial_policy_header",
                      "member_type_branch"
                    ]
                  },
                  "quote": {
                    "type": "string",
                    "minLength": 1,
                    "maxLength": 4000
                  },
                  "page": {
                    "type": "integer",
                    "exclusiveMinimum": 0
                  }
                },
                "required": [
                  "kind",
                  "quote",
                  "page"
                ]
              }
            }
          },
          "required": [
            "document_sha256",
            "market_index_listings",
            "document_statements"
          ]
        },
        {
          "type": "null"
        }
      ]
    },
    "applicability_note": {
      "description": "Explanation when shared or unscoped evidence does not establish a member's plan applicability",
      "type": [
        "string",
        "null"
      ]
    },
    "public_url": {
      "anyOf": [
        {
          "type": "string",
          "format": "uri"
        },
        {
          "type": "null"
        }
      ],
      "description": "Backwork's public page for this policy, or null when it has none. Active Medicare LCDs, Articles and NCDs: `https://backworkhealth.com/policy/{policy_id}`. Active commercial policies: `https://backworkhealth.com/policy/payer/{payer_slug}/{policy_id}`. A retired commercial policy points to its active successor's page when one is known."
    },
    "source_check": {
      "anyOf": [
        {
          "$ref": "#/$defs/SourceCheck"
        },
        {
          "type": "null"
        }
      ],
      "description": "Source provenance for this policy; null only when the policy is no longer on record."
    },
    "source_shape": {
      "$ref": "#/$defs/SourceShape"
    },
    "source_shape_reason": {
      "type": "string",
      "description": "Human-readable reason for the source_shape classification."
    },
    "specialty": {
      "anyOf": [
        {
          "type": "array",
          "items": {
            "type": "string"
          }
        },
        {
          "type": "null"
        }
      ]
    },
    "keywords": {
      "anyOf": [
        {
          "type": "array",
          "items": {
            "type": "string"
          }
        },
        {
          "type": "null"
        }
      ]
    },
    "created_at": {
      "anyOf": [
        {
          "type": "string",
          "format": "date-time"
        },
        {
          "type": "null"
        }
      ]
    },
    "updated_at": {
      "anyOf": [
        {
          "type": "string",
          "format": "date-time"
        },
        {
          "type": "null"
        }
      ]
    },
    "sections": {
      "description": "Fair-use excerpts (up to ~500 characters) of the policy text sections",
      "type": "object",
      "properties": {
        "indications": {
          "type": [
            "string",
            "null"
          ]
        },
        "limitations": {
          "type": [
            "string",
            "null"
          ]
        },
        "documentation": {
          "type": [
            "string",
            "null"
          ]
        }
      },
      "required": [
        "indications",
        "limitations",
        "documentation"
      ]
    },
    "sections_truncated": {
      "description": "Present and true when any section was excerpted",
      "type": "boolean"
    },
    "sections_notice": {
      "type": "string"
    },
    "mac": {
      "description": "Medicare Administrative Contractor, when the policy has one",
      "type": "object",
      "properties": {
        "name": {
          "type": "string"
        },
        "code": {
          "type": "string"
        },
        "jurisdiction_name": {
          "type": "string"
        },
        "states": {
          "anyOf": [
            {
              "type": "array",
              "items": {
                "type": "string"
              }
            },
            {
              "type": "null"
            }
          ]
        }
      },
      "required": [
        "name",
        "code",
        "jurisdiction_name",
        "states"
      ]
    },
    "payer": {
      "description": "Commercial payer, when the policy has one",
      "type": "object",
      "properties": {
        "name": {
          "type": "string"
        },
        "code": {
          "type": "string"
        },
        "type": {
          "type": "string"
        },
        "slug": {
          "type": "string",
          "pattern": "^[a-z0-9]+(-[a-z0-9]+)*$",
          "description": "URL slug of the payer's public Backwork pages (`/policy/payer/{slug}`). Assigned once; never changes."
        }
      },
      "required": [
        "name",
        "code",
        "type",
        "slug"
      ]
    },
    "criteria": {
      "description": "Criteria blocks grouped by section; included when include=criteria",
      "type": "object",
      "propertyNames": {
        "type": "string"
      },
      "additionalProperties": {
        "type": "array",
        "items": {
          "$ref": "#/$defs/PolicyCriteriaBlock"
        }
      }
    },
    "criteria_count": {
      "type": "integer"
    },
    "codes": {
      "description": "Codes grouped by code system; included when include=codes",
      "type": "object",
      "propertyNames": {
        "type": "string"
      },
      "additionalProperties": {
        "type": "array",
        "items": {
          "$ref": "#/$defs/PolicyCodeEntry"
        }
      }
    },
    "code_count": {
      "type": "integer"
    },
    "attachments": {
      "description": "Included when include=attachments",
      "type": "array",
      "items": {
        "$ref": "#/$defs/PolicyAttachment"
      }
    },
    "versions": {
      "description": "Latest 20 version changes; included when include=versions",
      "type": "array",
      "items": {
        "$ref": "#/$defs/PolicyVersionEntry"
      }
    }
  },
  "required": [
    "policy_id",
    "title",
    "policy_type",
    "jurisdiction",
    "effective_date",
    "retire_date",
    "last_reviewed_date",
    "version",
    "status",
    "source_url",
    "pdf_url",
    "description",
    "summary",
    "public_url",
    "source_check",
    "source_shape",
    "source_shape_reason",
    "specialty",
    "keywords",
    "created_at",
    "updated_at"
  ],
  "$defs": {
    "CodeGrounding": {
      "type": "string",
      "enum": [
        "grounded",
        "not_grounded",
        "no_source_text",
        "not_checked"
      ],
      "description": "Whether Backwork found this code in the source text it retained for the policy. grounded: found in the retained source text. not_grounded: Backwork's document pipeline read the code, but it is not in the retained source text. no_source_text: Backwork retained no source text to check. not_checked: not checked; always the value for codes inferred from the policy title."
    },
    "CodeSource": {
      "type": "string",
      "enum": [
        "document",
        "inferred_title_match"
      ],
      "description": "document: listed in the payer's policy document. inferred_title_match: attached because the policy title names the drug; the document itself does not list the code."
    },
    "JsonArray": {
      "type": "array",
      "items": {
        "$ref": "#/$defs/JsonValue"
      }
    },
    "JsonObject": {
      "type": "object",
      "propertyNames": {
        "type": "string"
      },
      "additionalProperties": {
        "$ref": "#/$defs/JsonValue"
      }
    },
    "JsonValue": {
      "anyOf": [
        {
          "type": "string"
        },
        {
          "type": "number"
        },
        {
          "type": "boolean"
        },
        {
          "type": "null"
        },
        {
          "$ref": "#/$defs/JsonArray"
        },
        {
          "$ref": "#/$defs/JsonObject"
        }
      ],
      "description": "Any JSON value."
    },
    "PolicyAttachment": {
      "type": "object",
      "properties": {
        "file_type": {
          "type": "string"
        },
        "url": {
          "type": "string"
        },
        "title": {
          "type": [
            "string",
            "null"
          ]
        },
        "page_number": {
          "anyOf": [
            {
              "type": "integer"
            },
            {
              "type": "null"
            }
          ]
        },
        "file_size_bytes": {
          "anyOf": [
            {
              "type": "integer"
            },
            {
              "type": "null"
            }
          ]
        }
      },
      "required": [
        "file_type",
        "url",
        "title",
        "page_number",
        "file_size_bytes"
      ]
    },
    "PolicyCodeEntry": {
      "type": "object",
      "properties": {
        "code": {
          "type": "string"
        },
        "display": {
          "type": [
            "string",
            "null"
          ]
        },
        "disposition": {
          "type": "string"
        },
        "condition_reference": {
          "type": [
            "string",
            "null"
          ]
        },
        "notes": {
          "type": [
            "string",
            "null"
          ]
        },
        "source": {
          "$ref": "#/$defs/CodeSource"
        },
        "grounding": {
          "$ref": "#/$defs/CodeGrounding"
        }
      },
      "required": [
        "code",
        "display",
        "disposition",
        "condition_reference",
        "notes",
        "source",
        "grounding"
      ]
    },
    "PolicyCriteriaBlock": {
      "type": "object",
      "properties": {
        "block_id": {
          "type": "string"
        },
        "text": {
          "description": "Fair-use excerpt of the criteria text",
          "type": [
            "string",
            "null"
          ]
        },
        "logic_ast": {
          "description": "Structured criteria logic, or null when not extracted",
          "$ref": "#/$defs/JsonValue"
        },
        "tags": {
          "anyOf": [
            {
              "type": "array",
              "items": {
                "type": "string"
              }
            },
            {
              "type": "null"
            }
          ]
        },
        "requires_manual_review": {
          "type": [
            "boolean",
            "null"
          ]
        },
        "confidence_score": {
          "description": "Extraction confidence as a decimal string (e.g. `0.92`)",
          "type": [
            "string",
            "null"
          ]
        }
      },
      "required": [
        "block_id",
        "text",
        "logic_ast",
        "tags",
        "requires_manual_review",
        "confidence_score"
      ]
    },
    "PolicyVersionEntry": {
      "type": "object",
      "properties": {
        "old_version": {
          "type": "integer"
        },
        "new_version": {
          "type": "integer"
        },
        "change_type": {
          "type": "string"
        },
        "change_summary": {
          "type": "string"
        },
        "changed_fields": {
          "$ref": "#/$defs/JsonValue"
        },
        "timestamp": {
          "anyOf": [
            {
              "type": "string",
              "format": "date-time"
            },
            {
              "type": "null"
            }
          ]
        }
      },
      "required": [
        "old_version",
        "new_version",
        "change_type",
        "change_summary",
        "changed_fields",
        "timestamp"
      ]
    },
    "SourceAccuracy": {
      "type": "object",
      "properties": {
        "field": {
          "type": "string",
          "enum": [
            "overall",
            "title",
            "effective_date",
            "codes",
            "link"
          ],
          "description": "What the audit measured: `overall` for the policy record as a whole, or one field of it (`title`, `effective_date`, `codes`, `link`)."
        },
        "sampled_at": {
          "type": "string",
          "format": "date-time",
          "description": "When the audit drew its sample."
        },
        "sample_size": {
          "type": "integer",
          "exclusiveMinimum": 0,
          "description": "How many of this source's policy records the audit sampled."
        },
        "accuracy": {
          "type": "number",
          "minimum": 0,
          "maximum": 1,
          "description": "Share of the sampled records whose `field` matched the source document, from 0 to 1: the records that matched divided by `sample_size`."
        },
        "ci_low": {
          "type": "number",
          "minimum": 0,
          "maximum": 1,
          "description": "Lower bound of the 95% Wilson score confidence interval for `accuracy`."
        },
        "ci_high": {
          "type": "number",
          "minimum": 0,
          "maximum": 1,
          "description": "Upper bound of the 95% Wilson score confidence interval for `accuracy`."
        },
        "method": {
          "type": "string",
          "description": "How the audit decided whether a sampled record matched its source, as Backwork names the method."
        }
      },
      "required": [
        "field",
        "sampled_at",
        "sample_size",
        "accuracy",
        "ci_low",
        "ci_high",
        "method"
      ],
      "description": "The most recent audit of one field for the policy's source. It measures a sample of the source's policy records, not this policy alone."
    },
    "SourceCheck": {
      "type": "object",
      "properties": {
        "source_url": {
          "type": "string",
          "description": "The URL Backwork fetches this policy from."
        },
        "last_fetched_at": {
          "anyOf": [
            {
              "type": "string",
              "format": "date-time"
            },
            {
              "type": "null"
            }
          ],
          "description": "When Backwork last fetched the policy from `source_url`; null when no fetch time is recorded. The payer may have changed the document since."
        },
        "content_sha256": {
          "anyOf": [
            {
              "type": "string",
              "pattern": "^[0-9a-f]{64}$"
            },
            {
              "type": "null"
            }
          ],
          "description": "SHA-256 of the content Backwork fetched, as 64 lowercase hex characters; null when the loader did not record one. Compare it across responses to see whether the fetched content changed."
        },
        "source_accuracy": {
          "anyOf": [
            {
              "type": "array",
              "items": {
                "$ref": "#/$defs/SourceAccuracy"
              }
            },
            {
              "type": "null"
            }
          ],
          "description": "The latest audit for each field Backwork has audited for this policy's source, `overall` first. null when the policy has no recorded source or its source has no audit yet."
        }
      },
      "required": [
        "source_url",
        "last_fetched_at",
        "content_sha256",
        "source_accuracy"
      ],
      "description": "Where and when Backwork last fetched this policy, a hash of the fetched content, and the sampled accuracy that audits measured for its source."
    },
    "SourceShape": {
      "type": "string",
      "enum": [
        "criteria_backed",
        "criteria_enrichment_gap",
        "code_list_only",
        "metadata_only_pending_batch"
      ],
      "description": "Policy source data shape. Use this to distinguish criteria-backed policies from delegated code-list sources and policies without structured criteria blocks."
    }
  }
}