ADM.7:1 - Problem frame

A handler, deciding person or provider is about to rely on a claim. The claim concerns an identified participant, event, relation, amount or condition at a relevant time. The governing service rule supplies the criterion where one is needed.

A check can establish different things: that a document came from its stated issuer, that a receipt concerns this expense, that a condition holds under a policy, or that a provider effect occurred. A successful check of one thing cannot silently answer another. An authentic assignment record can describe a future appointment; a successful credential operation can leave the person’s eligibility unestablished.

The handler specifies and uses the needed result. The person or mechanism competent to perform the check supplies its evidence or judgment. Administrative responsibility for the case does not confer every specialist competence.