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Merged in bugfix/carveout_ind (pull request #635)

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fixed non-default cases

* fixed non-default cases

* prompt fix

* prompt fix

* Merge branch 'main' into bugfix/carveout_ind

* prompt fix

* Merged main into bugfix/carveout_ind

* Merge branch 'main' into bugfix/carveout_ind

* prompt fix

* Merged main into bugfix/carveout_ind

* update Default term definition

* Merged main into bugfix/carveout_ind


Approved-by: Alex Galarce
This commit is contained in:
Mayank Aamseek
2025-07-31 21:51:44 +00:00
committed by Katon Minhas
parent db4daa3f55
commit 0f80c1f16d
1 changed files with 1 additions and 1 deletions
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fieldExtraction/src/constants/investment_values.py
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@@ -136,7 +136,7 @@ VALID_CARVEOUTS = {
"PREADMISSION" : None,
"POST_DISCHARGE" : None,
"READMISSIONS" : "Describes payment for subsequent admission with the same diagnostic category of codes as the initial admission.",
"DEFAULT_TERM" : "Indicates whether this service/methodology serves as a default/fallback payment rate when no other payment methods apply. The default/fallback payment rate is typically a low rate and based on billed charges. This is an 'end-of-the-line' reimbursement when no other methodologies apply.\n\nThe service/methodology should meet BOTH these criteria:\n1. Contains language indicating it applies to services not covered elsewhere, such as:\n - 'services not listed in the fee schedule'\n - 'services for which no other payment method is specified'\n - 'all other services'\n - 'services not otherwise specified'\n2. Is clearly a secondary/fallback option, NOT the primary/base reimbursement method, as indicated by:\n - Position in the contract (appears after primary methodology is defined)\n - Lower reimbursement rate than the base methodology (typically 50-60% of charges)\n - Explicit 'default' or 'fallback' terminology\n - Applies to a minor subset of services (not the majority of contract services)\n\nIt should not indicate ANY of these:\n- The methodology is the primary/base reimbursement approach, even if defined by exclusion\n- The methodology applies to specific listed services/procedures\n- The methodology offers standard rates comparable to other contract methodologies\n- No default/fallback language is present\n\nExample: 'For any services not specifically listed in Exhibits A-D, reimbursement shall be 50% of billed charges.'",
"DEFAULT_TERM" : "Indicates whether this service/methodology serves as a default/fallback payment rate when no other payment methods mentioned anywhere in the contract apply. The default/fallback/'end-of-the-line' payment rate may be a lower rate, often based on billed charges. Do not classify as default if:\n- The methodology is the primary/base reimbursement approach, even if defined by exclusion\n- The methodology applies to specific listed services/procedures \n- No default/fallback language is present\n\nExample: 'For any services not specifically listed in Exhibits A-D, reimbursement shall be 50% of billed charges.'",
# + Any Reimbursement Carveouts (Codes, Services, etc)
}