Merged in bugfix/reimb_excess_language_issues (pull request #755)

Bugfix/reimb excess language issues to main

* updated trigger cap def

* updated trigger cap carveout def

* Merged main into bugfix/reimb_excess_language_issues

* updated split reimb prompt

* remove print statements

* Merged main into bugfix/reimb_excess_language_issues

* updated split reimb prompt with complex example


Approved-by: Katon Minhas

fieldExtraction/constants/mappings/valid_carveouts.json

@@ -7,7 +7,7 @@
         "PAYMENT_CARVEOUT": "Describes payments for specific services, procedures, level designations, or specific DRG or codes that are carved out from the base/foundational payment methodology with distinct payment terms. These are exceptions or specialty payments that differ from the standard approach. Examples include 'Radiology covered services', 'Anesthesia covered services', 'Pharmaceuticals' and 'HEMATOCRIT (CPT CODE: 85014)'. Do NOT classify as payment carveout if the service represents a foundational coverage determination (such as primary payer methodologies in dual products) rather than a true exception to standard payment.",
         "UNLISTED_CODE": "Describes payments for codes that are not listed on a fee schedule. This is similar to DEFAULT_TERM. Only populate with Y if the Service or Methodology specifically mentions Codes.",
         "ADDITION": "Describes payments that include a supplemental amount added to or above the base reimbursement rate. Populate with Y if the Methodology describes any additional payments, supplemental amounts, or add-on fees beyond the standard reimbursement.",
-        "TRIGGER_CAP": "Describes the payments that trigger a complete shift to a new payment methodology after a defined quantitative threshold is reached. Unlike supplemental payments, this fundamentally changes how reimbursement is calculated beyond the threshold. Valid thresholds can be based on dollar amounts, number of days, visits, units, or other measurable metrics (but not qualitative thresholds, e.g., 'where there is no Marketplace Medicare Rate'). Look for language indicating a clear change in the payment methodology when a defined quantitative threshold is exceeded, such as 'when charges exceed X, pay Y', or 'after 3 days, payment changes to $1,200 per diem'.",
+        "TRIGGER_CAP": "Describes the payments that trigger a complete shift to a new payment methodology after a defined quantitative threshold is reached. Unlike supplemental payments, this fundamentally changes how reimbursement is calculated beyond the threshold. Valid thresholds can be based on dollar amounts, number of days, visits, units, or other measurable metrics (but not qualitative thresholds, e.g., 'where there is no Marketplace Medicare Rate'). Look for language indicating a clear change in the payment methodology when a defined quantitative threshold is exceeded, such as 'when charges exceed X, pay Y', or 'after 3 days, payment changes to $1,200 per diem'. Do not classify outlier threshold reimbursements or stop-loss provisions as TRIGGER_CAP eventhough they may share similar characteristics.",
         "NEVER_EVENT": "Indicates that Never Events (e.g. sepsis acquired while inpatient) will not be covered. This may be phrased as 'no liability' or 'no payment'.",
         "EXPERIMENTAL_INVESTIGATIONAL": "Describes payments for experimental and investigational procedures.",
         "NOT_MEDICALLY_NECESSARY": "Describes payments for procedures deemed not medically necessary (or medically unnecessary)",

fieldExtraction/src/prompts/prompt_templates.py

@@ -1144,22 +1144,22 @@ INCORRECT: "Fee schedule rate" and "WAC + 5%" (missing "lesser of billed charges
 
 Example of CORRECT service splitting with conditions:
 INPUT: 
-SERVICE: "Covered Services under Medicaid and CHIP"
+SERVICE: "Covered Services provided under the Medicare-Medicaid Program Product which are covered by or are primary to Medicaid"
 REIMBURSEMENT: "Standard rate, except for services where there is no Medicaid Rate, payment is 30% of charges"
 
 CORRECT OUTPUT:
 [
     {{
-        "SERVICE_TERM": "Covered Services under Medicaid and CHIP",
+        "SERVICE_TERM": "Covered Services provided under the Medicare-Medicaid Program Product which are covered by or are primary to Medicaid",
         "REIMB_TERM": "Standard rate"
     }},
     {{
-        "SERVICE_TERM": "Covered Services under Medicaid and CHIP where there is no Medicaid Rate", 
+        "SERVICE_TERM": "Covered Services provided under the Medicare-Medicaid Program Product which are covered by or are primary to Medicaid where there is no Medicaid Rate", 
         "REIMB_TERM": "30% of charges"
     }}
 ]
 
-INCORRECT: "Covered Services where there is no Medicaid Rate" (missing original context)
+INCORRECT: "Covered Services where there is no Medicaid Rate or Medicare Rate" (missing original context)
 
 Return your answer as a JSON array. If no splitting is needed, return the original service and reimbursement as a single entry.