Compliance Framework & Operational Standards

This page outlines the non-contractual compliance framework governing how evaluations are structured, performed, and interpreted within this professional evaluation framework.

These policies are designed to promote transparency, consistency, independence, and proper alignment between scope, documentation, and analytical outputs.

The content below is operational and normative in nature. It does not replace, modify, or override any Legal Disclaimer, Terms of Use, Privacy Policy, or Jurisdiction provisions published elsewhere on this website.

1. Independence & Non-Decisional Framework

All evaluations are independent, non-binding, and strictly document-based. 

 This evaluation framework:  

• does not provide medical advice,
• does not issue treatment recommendations,
• does not make payer, coverage, or reimbursement determinations, and
• does not replace the judgment of treating providers, insurers, or other decision-makers.

Evaluations are analytical in nature and are intended to support informed decision-making, not to determine outcomes.

For the avoidance of doubt, no element of this evaluation framework relies on automated processes, algorithms, artificial intelligence, or software-based decision engines. All analyses are conducted through human expert review of the documentation provided, and no automated or machine-generated determinations are produced.  

2. Documentation-Based Analysis Standard

All analyses are strictly limited to the documentation submitted and reviewed.

• No assumptions are made beyond the provided records.
• Missing, incomplete, or insufficient documentation is explicitly identified as a limitation.
• The scope and depth of any evaluation are constrained by what the documentation      reasonably supports.

Analytical findings are always attributed to the documentation reviewed, not to any tool, system, or automated process.

3. Non-Binding Evaluation Statement

All evaluation outputs are non-binding. 

They are not:

• medical orders,
• legal opinions,
• coverage decisions, or
• payment authorizations.

Final clinical, administrative, and financial decisions remain the sole responsibility of the relevant professionals, institutions, insurers, or other stakeholders.

4. Scope Adjustment Policy

4.1 Purpose

The Scope Adjustment Policy defines how evaluation scope is determined, adjusted, or escalated based on documentation, analytical needs, and the evaluation level selected at the time of request.

This policy applies across all evaluation types governed by this compliance framework.

4.2 New Execution vs. Re-Labeling Rule

Each evaluation type represents a distinct analytical execution.

• Outputs generated under one evaluation type cannot be converted, reused, re-labeled, or retroactively treated as outputs of another evaluation type.
• Any change in evaluation level requires a new execution under the applicable      governing definition.
• Prior outputs may inform future evaluations but do not substitute for them.

4.3 Documentation Sufficiency

The scope of any evaluation depends on the sufficiency of the documentation submitted.

• Insufficient documentation does not invalidate an evaluation.
• Instead, limitations are explicitly stated in the analysis.
• The absence of documentation may restrict conclusions or prevent escalation to higher      analytical levels.

4.4 Pricing & Scope Alignment (Principle-Based)

Evaluation pricing aligns with the level of analysis requested, not with internal templates or analytical frameworks.

• Entry-level orientation, standard evaluations, and extended evaluations are distinct services.
• Additional analytical layers, when applicable, are treated as add-ons.
• Escalation to a higher level constitutes a new evaluation execution.

4.5 TYPE 1 — Scope Positioning Rule

TYPE 1 is designed exclusively as an entry-level, rapid clinical–economic orientation, based on the documentation submitted at the time of the request.

Based on the documentation reviewed, the preliminary orientation may support:

• confirmation that no further analytical escalation is warranted, or
• recommendation to proceed with a higher-level evaluation under the applicable governing definition.

TYPE 1 outputs:

• do not constitute a clinical–economic evaluation,
• cannot be converted, reused, or re-labeled as standard or extended evaluations, and
• cannot be escalated without a new execution.

Any escalation from TYPE 1 requires:

• a new execution under the applicable evaluation definition, and
• application of the corresponding pricing rules.

4.6 Add-On Analytical Layers

Certain analytical components may be offered as optional add-ons when explicitly requested and when documentation supports their execution.

Add-ons:

• do not replace the core evaluation,
• cannot be executed independently, and
• are performed only on top of the applicable base evaluation level.

5. Competitive & Commercial Conduct

This evaluation framework follows internal standards designed to prevent anti-competitive behavior, inappropriate influence, or misuse of analytical outputs.

• Provider-specific pricing information is not disclosed to competing providers.
• Evaluations are conducted independently of commercial arrangements.
• Analytical integrity takes precedence over commercial considerations.

6. Proprietary & Intellectual Framework (Informational)

Analytical frameworks and methodologies developed by expert evaluators

This statement is informational and does not imply software licensing, automated decision-making, or transfer of intellectual property rights.

7. Updates & Revisions

This Compliance framework may be updated periodically to reflect operational refinements, regulatory considerations, or structural improvements.

Material changes will be reflected on this page.