A practice’s standards — “every denial over a million goes past a practice leader”, “no notice deadline passes unsent” — usually live in a procedures manual. In InsightAdvocate they are claim controls: rules a practice leader can read, test against a real claim and publish, which run on every Analyze and write to the decision record.
The eight controls that ship
| Control | When | Outcome |
|---|---|---|
NOTICE_OVERDUE | A policy’s notice deadline has passed with notice unsent | Block until resolved |
NOTICE_DUE_7D | A notice deadline is within seven days | Warn |
UNSUPPORTED_POSITION | A carrier cites wording not in the policy | Warn |
LARGE_DENIAL | A carrier has denied all or part of a claim over $1M | Refer to a lead |
SLA_BREACHES | Two or more carrier SLA clocks breached | Refer to a lead |
SETTLEMENT_GAP | The carrier’s position is more than 25% below the floor | Refer to a lead |
EXCESS_REACH | Exposure reaches half an excess layer’s attachment | Warn |
LARGE_LOSS | A claim over $5M | Refer to a lead |
Each is a sentence over named fields — “when policies whose notice deadline has passed unsent is more than 0, block” — not code. The fields are the engines’ outputs: notices overdue, days to the next deadline, positions weak or not in the policy, missed grants, the gap share, excess reach, documents past due, days open, loss type, state, stage.
Draft, test, publish
A draft is tested against the practice’s open claims before anyone feels it: which would fire,
with what outcome. Publishing creates a new version; the decision record keeps the version that fired
on each claim. Rules can be scoped by loss type or state. The Studio is the platform’s shared
service (insight_broker and insight_rules), the same one InsightPlacement
uses for its placement controls.
What controls do not do
- They don’t change an engine’s figures or the settlement weights.
- They don’t send anything. A fired control prepares a sign-off or shows a banner; people act.
