Grade one coverage line's five documentation items on two separated axes the
old code conflated: required_state (from plan_type + payer_rules.json) and
input_state (SUPPLIED | ABSENT). A line is "Clear to Ship" only when EVERY
required item is satisfied by positive evidence — a required item with no data
is NOT_EVALUATED and blocks green, never granted by absence of contradiction.
- plan_type never guessed: None / unmapped / casing-variant -> "Plan Type Needed",
structurally cannot be green; PECOS/PA sit NOT_EVALUATED while universal items
(SWO/visit/diagnosis per LCD L33822) still grade.
- Required-ness reads from payer_rules.json (single source of truth), removing
the latent Python-set-vs-JSON divergence.
- Config-surface fail-safe: a known plan missing/partial in config cannot grade
green (NOT_EVALUATED), and the green gate checks every item.
- Diagnosis accepts a real ICD-10 code as on-file; only explicit negatives gap.
Additive only: not wired into the live pipeline. 27 tests green (full suite 73),
code-auditor reviewed (H1/H2/M1/M2/M3/M4/L1 fixed).
PROVISIONAL, flagged for Pi/Kisa: gap->label mapping (At Risk/Action Needed/
On Track) and the visit-recency scope boundary (timing layer, not readiness).
Spec: docs/readiness-model-brief-2026-06-23.md section 4
Co-Authored-By: Claude Opus 4.8 (1M context) <noreply@anthropic.com>
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