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A decision-basis contract for auditable LLM-assisted medical billing verification: deterministic rules, verbatim evidence, and fail-closed abstention

arXiv · AI, language, vision and robotics · article · Sep 10, 2026 · UTC

This work presents a proof of concept for auditable LLM-assisted medical billing verification based on a decision-basis contract. The contract separates deterministic checks of versioned fee-catalog rules from LLM-based assessment of free-text documentation. The deterministic layer resolves the applicable catalog release and checks code availability, quantity limits, and exclusions. The semantic layer classifies each claimed item as supported, contradicted, or missing required information. Support and contradiction require a verbatim evidence span; unavailable rule context, unsuccessful assess

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