Upstream-Intelligence/specialty-clinic-synthetic-claims

Specialty Clinic Synthetic Claims Sample

This sample contains 1000 generated-from-scratch synthetic healthcare claim rows.

Use case: Model specialty clinic procedure authorization, documentation, and payer coverage friction across multi-specialty outpatient settings.

Synthetic-Only Boundary

• —No PHI.
• —No customer data.
• —No patient-level source records.
• —Generated from public healthcare references, explicit modeling assumptions, and deterministic synthesis code.

Dataset Files

• —Sample data: specialty-clinic.csv
• —Manifest: public_sample_manifest.json
• —Public source manifest: public_source_manifest.json
• —Synthetic-only attestation: synthetic_only_attestation.json

Schema

• —Schema version: 0.4.0
• —Total columns: 58
• —Specialty context columns: specialtyserviceline, procedureauthorizationstatus, documentationcompletenessband, siteofservicecategory, followupvisitindicator

Source Coverage

• —Public sources: 56
• —Source stewards: 18
• —Source categories: Appeals, Authorization, Claims Standard, Coding Edit, Coverage Policy, Enrollment Demographics, Fee Schedule, Interoperability

Public Sample Artifacts

• —specialty-clinic.csv
• —public_sample_manifest.json
• —public_source_manifest.json
• —synthetic_only_attestation.json
• —LICENSE.md

Paywalled Delivery Artifacts

The following artifacts exist in paid delivery bundles and are intentionally omitted from public sample publication:

• —validation_report.json
• —benchmark_report.json
• —payer_behavior_report.json
• —cash_flow_forecast.json
• —scenario_report.json
• —training_corpus.jsonl
• —claim_realism_report.json
• —claim_edit_simulation_report.json
• —adjudication_trace.jsonl
• —adjudication_trace_summary.json
• —claim_envelopes.jsonl
• —remittance_advices.jsonl
• —transaction_bundle_manifest.json
• —transaction_validation_report.json
• —synthetic_edi_transactions.jsonl
• —claim_status_276_277.jsonl
• —attachment_275_workflows.jsonl
• —fhir_claim_eob_bundle.jsonl
• —transaction_surface_manifest.json
• —transaction_surface_validation_report.json
• —world_entities.jsonl
• —payer_policy_rules.jsonl
• —contract_terms.jsonl
• —operations_states.jsonl
• —world_model_manifest.json
• —world_validation_report.json
• —economy_operating_timeline.jsonl
• —economy_claim_intents.jsonl
• —economy_impact_report.json
• —economy_kernel_manifest.json
• —economy_kernel_validation.json
• —payer_policy_decisions.jsonl
• —payer_policy_decision_summary.json
• —contract_fee_schedule_lines.jsonl
• —contract_fee_schedule_manifest.json
• —contract_fee_schedule_report.json
• —payer_contract_simulator_config.json
• —payer_contract_simulation_manifest.json
• —payer_contract_simulation_report.json
• —revenue_cycle_events.jsonl
• —agent_evaluation_tasks.jsonl
• —event_simulation_manifest.json
• —event_validation_report.json
• —episode_journeys.jsonl
• —episode_manifest.json
• —episode_validation_report.json
• —operating_timeline.jsonl
• —synthetic_documents.jsonl
• —artifact_trace_graph.jsonl
• —operating_artifact_graph_manifest.json
• —operating_artifact_graph_validation.json
• —workflow_replays.jsonl
• —workflow_replay_public_index.json
• —workflow_replay_engine_manifest.json
• —workflow_replay_engine_validation.json
• —evaluation_suite_manifest.json
• —evaluation_harness_report.json
• —population_control_report.json
• —synthetic_twin_aggregate_config.json
• —synthetic_twin_calibration_report.json
• —synthetic_twin_reproducibility_packet.json
• —dataset.lock.json
• —release_ledger.jsonl

Limitations

• —Synthetic datasets are for software testing, model training, workflow benchmarking, and scenario planning.
• —The data should not be treated as observed payer behavior, reimbursement truth, or legal billing advice.
• —Public sources support structure, constraints, and calibration targets; they do not expose proprietary payer distributions.
• —Code presence is authoritative, but frequency and payer-specific usage are not provided.
• —Explains remittance context but does not expose payer frequency distributions.

License

Dataset usage is governed by upstream-data-synthetic-dataset-eula-v0. Review terms before production use.