diff --git a/src/config.py b/src/config.py index 0c99fc7..3c8e05f 100644 --- a/src/config.py +++ b/src/config.py @@ -28,12 +28,12 @@ RUN_EXCEPTION = True RUN_CODES = True # AWS Keys -AWS_ACCESS_KEY_ID="ASIAZTMXAXNXDI7HGA7Q" -AWS_SECRET_ACCESS_KEY="mXAJEp6Ar35G+VEwUfKq/3cu+1Hn721R+pNs+Fxh" -AWS_SESSION_TOKEN="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" +AWS_ACCESS_KEY_ID="ASIAZTMXAXNXNEUYUPUY" +AWS_SECRET_ACCESS_KEY="3HljGiz+dqWBtj+dkqs/syyxoguUoTahdLyceEeo" +AWS_SESSION_TOKEN="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" # File Paths -LOCAL_PATH = 'docs/test/' # Replace with local +LOCAL_PATH = 'docs/priority_health/' # Replace with local # S3 Settings S3_CLIENT = boto3.client('s3', diff --git a/src/prompt_funcs.py b/src/prompt_funcs.py index 6bb3653..c8ff729 100644 --- a/src/prompt_funcs.py +++ b/src/prompt_funcs.py @@ -3,6 +3,7 @@ import os import re import pandas as pd +import json from llama_index.core import VectorStoreIndex, SimpleDirectoryReader, ServiceContext, PromptTemplate from llama_index.core import SummaryIndex, Document @@ -95,17 +96,6 @@ def run_bottom_up_secondary(answer_dicts, text_dict, tokens): return final_dicts -def consolidate_lob(lob_dicts, results_dicts): - final_dicts = [] - for d in results_dicts: - try: - d.update(lob_dicts[d['page_num']]) - final_dicts.append(d) - except: - final_dicts.append(d) - return final_dicts - - def run_bottom_up(filename, text_dict): # Bottom Up Primary - SERVICE, REIMBURSEMENT_FLAT_FEE, REIMBURSEMENT_RATE, METHODOLOGY @@ -158,33 +148,79 @@ def run_top_down(filename, text_dict): continue prompt = prompts.TOP_DOWN_PRIMARY(page_text) answer = claude_funcs.invoke_claude_3(prompt, max_tokens=4000) - answer_dicts = dict_operations.primary_string_to_dict({page_num : answer}, filename) # Convert to list of dictionaries - all_results.append(answer_dicts) - td_primary = [i for d in all_results for i in d] # Consolidate to one list + answer_dict = json.loads(answer) + answer_dict.update({'page_num' : page_num, 'Filename' : filename}) + #answer_dicts = dict_operations.primary_string_to_dict({page_num : answer}, filename) # Convert to dictionaries + all_results.append(answer_dict) + + # td_primary = [i for d in all_results for i in d] # Consolidate to one list + # print(td_primary) # Secondaries - td_final = top_down_secondary(td_primary, text_dict) + td_final = top_down_secondary(all_results, text_dict) return td_final # List of list of dictionaries +def clean_td(td): + td_clean = [] + for d in td: + new_d = {} + for k in d.keys(): + if k not in ['page_num', 'Filename']: + if ',' in d[k]: + if 'DATE' not in k: + new_d[k] = [v.strip() for v in d[k].split(',')] + elif d[k] == 'N/A': + new_d[k] = [] + else: + new_d[k] = [d[k]] + else: + new_d[k] = d[k] + td_clean.append(new_d) + return td_clean + +def get_unique_td(td): + unique_td_dict = {} + for d in td: + for key, value in d.items(): + if key not in ['page_num', 'Filename']: + for v in value: + if key not in unique_td_dict.keys(): + unique_td_dict[key] = [v] + else: + unique_td_dict[key].append(v) + final_dict = {key : list(set(unique_td_dict[key])) for key in unique_td_dict.keys()} + return final_dict + def td_bu_combine(td, bu, text_dict): + bu_dicts = bu.copy() + td_dicts = td.copy() + + td_dicts_clean = clean_td(td_dicts) + unique_td = get_unique_td(td_dicts_clean) + combined_list = [] - for bud in bu: - td_dicts = [d for d in td if d['page_num'] == bud['page_num']] - # Case 1: Only one option - if len(td_dicts) == 1: - td_dict = td_dicts[0] - bud.update(td_dict) - # Case 2: More than one option - elif len(td_dicts) > 1: - td_check_formatted = utils.format_td_check(td_dicts, ['Filename', 'page_num']) - prompt = prompts.LOB_CHECK(bud, td_check_formatted, text_dict[bud['page_num']]) - answer = claude_funcs.invoke_claude_3(prompt, max_tokens=4000) - answer_idx = ''.join(re.findall(r'\d', answer)) - bud.update(td_dicts[int(answer_idx)-1]) - # Case 3: No option for page - else: - continue + for bud_ in bu_dicts: + bud = bud_.copy() + for key, value in unique_td.items(): + if len(value) == 0: # No value in contract + bud.update({key : ""}) + elif len(value) == 1: # 1 value in contract + bud.update({key : value[0]}) + else: # More than one value in contract + # Check for value on the page + page_value = [] + for d in td_dicts_clean: + if (d['page_num'] == bud['page_num']) and (key in d.keys()): + for v in d[key]: + page_value.append(v) + + if len(page_value) == 1: # One value on page + bud.update({key : page_value[0]}) + elif len(page_value) > 1: # Multiple values on page + bud.update({key : ', '.join(page_value)}) + elif len(page_value) == 0: + bud.update({key : ""}) combined_list.append(bud) return combined_list diff --git a/src/prompts.py b/src/prompts.py index 86871dd..2506edd 100644 --- a/src/prompts.py +++ b/src/prompts.py @@ -122,34 +122,34 @@ Only return the dictionary, with no other commentary or explanation. Ensure you def TOP_DOWN_PRIMARY(page): return f"""### PAGE START ### {page} ### PAGE END -The preceding text is one page of a contract between a Payer and a provider in their network. Your job is to extract the names of certain entities listed in the contract and return a list of dictionaries with the values below. +The preceding text is one page of a contract between a Payer and a provider in their network. Your job is to extract the names of certain entities listed in the contract and return a single dictionary with the values below: Here are the attributes to be included in each dictionary, and instructions on how to correctly answer: -'CONTRACT_LOB' : List any Line of Business mentioned on the page. CONTRACT_LOB will ONLY be one of the following: Commercial, Group, Marketplace, Marketplace/Exchange, Medicaid, Medicaid-Medicare, Medicare, Medicare Advantage, Medicare Supplemental, Veterans Affairs +'CONTRACT_LOB' : List any Line of Business mentioned on the page. Choose ONLY from the following: Commercial, Group, Marketplace, Marketplace/Exchange, Medicaid, Medicaid-Medicare, Medicare, Medicare Advantage, Medicare Supplemental, Veterans Affairs. If none of these are found on the page, simply write 'N/A' for this answer. 'CONTRACT_PROGRAM' : List any Programs mentioned on the page. Some examples of Programs are: CHIP, CHIP-P, CHIP-Perinate, STAR, STAR+PLUS 'CONTRACT_NETWORK' : List any Networks mentioned on the page. Networks are types of managed care organizations involved in the delivery of healthcare services. Some examples of Networks are: HMO, PPO, EMO, POS, FFS 'PRODUCT' : List any Products listed on the page. These are typically the brand name of a health plan. You may also use this field as a catch-all for entities that you are unsure of. -If any of the attributes are not found, return N/A. If there are multiple answers for a given attribute, return a separate dictionary for them such that each of the four attributes is associated with the other attributes in the dictionary. +If any of the attributes are not found, return N/A. If there are multiple answers for a given attribute, return the answers in a comma-separated list. For all attributes, only write what is written on the page. Do not make up new phrases or words. -Only return the list, with no other commentary or explanation. Ensure you abide by proper JSON formatting. +Only return the dictionary, with no other commentary or explanation. Ensure you abide by proper JSON formatting. """ def LOB_CHECK(bu_dict, td_dicts, page): return f"""### PAGE START ### {page} ### PAGE END - Service: {bu_dict['SERVICE']} - Methodology: {bu_dict['FULL_METHODOLOGY']} +Service: {bu_dict['SERVICE']} +Methodology: {bu_dict['FULL_METHODOLOGY']} - Listed above is page of a contract, as well as a Service and Methodology found on this page. Your job is to identify which of the following entities this specific Service is associated with. Here are the entities, represented as dictionary objects: +Listed above is page of a contract, as well as a Service and Methodology found on this page. Your job is to identify which of the following entities this specific Service is associated with. Here are the entities, represented as dictionary objects: - {td_dicts} +{td_dicts} - Write ONLY the number of the dictionary that is most associated with the Service and Methodology of interest. Do not return any additional text beyond the digit itself. - """ +Write ONLY the number of the dictionary that is most associated with the Service and Methodology of interest. Do not return any additional text beyond the digit itself. +""" def TOP_DOWN_METAL_LEVEL(LOB, page): diff --git a/src/table_funcs.py b/src/table_funcs.py index ce29301..86b5db6 100644 --- a/src/table_funcs.py +++ b/src/table_funcs.py @@ -1,6 +1,7 @@ import re import pandas as pd +import json import ast def extract_tables(text): @@ -33,29 +34,29 @@ def align_and_format_tables(text_dict): aligned_text_dict = {} for key, text in text_dict.items(): if 'Table Start' in text: - print(key) table_texts = re.findall(r'-------Table Start--------(.*?)-------Table End--------', text, re.DOTALL) for table_text in table_texts: - # Extract pretable text - pretable = table_text.split('{')[0].strip() + try: + # Extract pretable text + pretable = table_text.split('{')[0].strip() - # Extract and format table text - table_only = "{" + table_text.split('{', 1)[1].rsplit('}', 1)[0].replace("'", '"') + "}" - table = json.loads(table_only) - table_formatted = format_table(table) + # Extract and format table text + table_only = "{" + table_text.split('{', 1)[1].rsplit('}', 1)[0].replace("'", '"') + "}" + table = json.loads(table_only) + table_formatted = format_table(table) - # Align - if text.count(pretable) == 2: - # Remove original table - aligned_text = text.replace(table_text, "") - # Align new table - aligned_text = aligned_text.replace(pretable, pretable + table_formatted) - else: - aligned_text = text.replace(table_text, pretable + table_formatted) + # Align + if text.count(pretable) == 2: + # Remove original table + aligned_text = text.replace(table_text, "") + # Align new table + aligned_text = aligned_text.replace(pretable, pretable + table_formatted) + else: + aligned_text = text.replace(table_text, pretable + table_formatted) + except: + aligned_text = text aligned_text_dict[key] = aligned_text.replace("-------Table Start--------", "").replace("-------Table End--------", "") - else: aligned_text_dict[key] = text - return aligned_text_dict - + return aligned_text_dict \ No newline at end of file diff --git a/src/test_notebook.ipynb b/src/test_notebook.ipynb index 5695392..9361dbd 100644 --- a/src/test_notebook.ipynb +++ b/src/test_notebook.ipynb @@ -10,34 +10,48 @@ "import pandas as pd\n", "import re\n", "import ast\n", + "import json\n", "\n", "import prompt_funcs\n", "import config\n", "import utils\n", "import preprocess\n", "import table_funcs\n", - "import claude_funcs" + "import claude_funcs\n", + "import prompts" ] }, { "cell_type": "code", - "execution_count": 2, + "execution_count": 23, "metadata": {}, - "outputs": [ - { - "data": { - "text/plain": [ - "dict_keys(['2015-04-01 Marina Del Rey Hospital PPA.txt', '2017-12-01 Prime Healthcare-West Anaheim Medical Center Enhanced PPO AMD.txt', '2021-01-01 PH - Paradise Valley Hospital 7th AMD.txt', '2021-01-01 PH-West Anaheim Medical Center AMD.txt', '2023-01-01 UCSD Medical Center Non B&G AMD.txt', '2023-06-01 DH-Mercy Medical Center - Redding CDM LTR.txt', '47-1928508 Advanced Anesthesia.txt', '71-0986832 Pacific Gynecological Specialists.txt', 'Baz Allergy Asthma & Sinus.txt'])" - ] - }, - "execution_count": 2, - "metadata": {}, - "output_type": "execute_result" - } - ], + "outputs": [], "source": [ - "input_dict = utils.read_input(path='../docs/healthnet/')\n", - "input_dict.keys()" + "input_dict = utils.read_input(path='../docs/test/')\n", + "input_dict.keys()\n", + "filename = '47-1928508 Advanced Anesthesia.txt'" + ] + }, + { + "cell_type": "code", + "execution_count": 24, + "metadata": {}, + "outputs": [], + "source": [ + "contract_text = input_dict[filename]" + ] + }, + { + "cell_type": "code", + "execution_count": 25, + "metadata": {}, + "outputs": [], + "source": [ + "#### PREPROCESS ####\n", + "contract_text = preprocess.clean_newlines(contract_text)\n", + "text_dict = preprocess.split_text(contract_text)\n", + "#text_dict = table_funcs.align_and_format_tables(text_dict)\n", + "#text_dict = preprocess.highlight_rates(text_dict)" ] }, { @@ -46,157 +60,271 @@ "metadata": {}, "outputs": [], "source": [ - "contract_text = input_dict['2021-01-01 PH - Paradise Valley Hospital 7th AMD.txt']" + "#### TOP DOWN ####\n", + "td_results = prompt_funcs.run_top_down(filename, text_dict) # Returns list of list of dictionaries for each page\n", + "\n", + "#### BOTTOM UP ####\n", + "bu_results = prompt_funcs.run_bottom_up(filename, text_dict) # Returns list of dictionaries\n", + "\n", + "#### COMBINE ####\n", + "# combined_results = prompt_funcs.td_bu_combine(td_results, bu_results, text_dict)\n", + "\n", + "# answer_df = pd.DataFrame(combined_results)" ] }, { "cell_type": "code", - "execution_count": 6, + "execution_count": 92, "metadata": {}, "outputs": [], "source": [ - "#### PREPROCESS ####\n", - "contract_text = preprocess.clean_newlines(contract_text)\n", - "text_dict = preprocess.split_text(contract_text)" - ] - }, - { - "cell_type": "code", - "execution_count": 7, - "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "6\n", - "7\n", - "8\n", - "9\n", - "13\n", - "19\n", - "20\n" - ] - }, - { - "data": { - "text/plain": [ - "[None, None, None, None, None, None, None]" - ] - }, - "execution_count": 7, - "metadata": {}, - "output_type": "execute_result" - } - ], - "source": [ - "[print(k) for k in text_dict.keys() if 'Table Start' in text_dict[k]]" - ] - }, - { - "cell_type": "code", - "execution_count": 52, - "metadata": {}, - "outputs": [ - { - "data": { - "text/plain": [ - "{'Document': 'Document Index SEVENTH AMENDMENT 1TO THE 1PROVIDER PARTICIPATION AGREEMENT 1BETWEEN 1PARADISE VALLEY HOSPITAL 1AND 1HEALTH NET OF CALIFORNIA, INC. 1 EXHIBIT A-1 6COMMERCIAL BENEFIT PROGRAMS 6FEE-FOR-SERVICE RATE EXHIBIT 6 EXHIBIT C-1 8MEDI-CAL BENEFIT PROGRAMS 8FEE-FOR-SERVICE RATE EXHIBIT 8 EXHIBIT D-1 9ENHANCEDCARE PPO BENEFIT PROGRAMS 9FEE-FOR-SERVICE RATE EXHIBIT 9 EXHIBIT D-2 10ENHANCED PPO BENEFIT PROGRAMS 10FEE-FOR-SERVICE PAYMENT CONDITIONS 10 Pro-ration Calculation: 13 ADDENDUM E 14FEE-FOR-SERVICE PAYMENT CONDITIONS 14 2.5.4 18Adjusting and Pro-rating Contract Rates Examples. 18 Pro-ration Calculation: 19 EXHIBIT F-1 20COMMUNITYCARE AND PURECARE BENEFIT PROGRAMS 20FEE-FOR-SERVICE RATE EXHIBIT 20 EXHIBIT F-2 21COMMUNITYCARE BENEFIT PROGRAMS 21HOSPITAL QUALITY PERFORMANCE PROGRAM 21\\n\\n\\n\\n',\n", - " '1': '1 SEVENTH AMENDMENT TO THE PROVIDER PARTICIPATION AGREEMENT BETWEEN PARADISE VALLEY HOSPITAL AND HEALTH NET OF CALIFORNIA, INC. The Provider Participation Agreement (\"Agreement\") dated September 1, 2013, as subsequently amended, between Prime Healthcare Paradise Valley, LLC, dba Paradise Valley Hospital (\"Provider\") and Health Net of California, Inc. on behalf of itself and the subsidiaries and affiliates of Health Net, LLC (formerly known as Health Net, Inc.) (collectively \"Health Net\"), is hereby further amended effective January 1, 2021. Provider and Health Net hereby agree to amend the Agreement as follows: 1. A new Section 1.29, ALLOWABLE CHARGES, is added to read as follows: Allowable Charges is defined as Provider\\'s billed charges for Contracted Services. 2. Section 2.9, PRIOR AUTHORIZATION/REFERRAL, shall be deleted and replaced to read as follows: When either Prior Authorization and/or a Referral is required for the rendition of a health care service, the receipt of the required Prior Authorization and/or the required Referral, each being separate and distinct requirements, is a prerequisite to payment of Complete Claims for Covered Services in addition to confirming eligibility prior to delivering service as required by this Agreement and Health Net Policies. Health Net (or its designee as applicable) may rescind or modify its Prior Authorization, in a manner consistent with Health Net Policies, based on the eligibility of the Beneficiary and whether the rendered service is a Covered Service. However, when Health Net or its designee issues a Prior Authorization for a specific service under a Benefit Program regulated by the California Department of Managed Health Care or the California Department of Insurance, Health Net (or its designee as applicable) shall not rescind or modify its Prior Authorization after Provider has rendered the specified and authorized service in good faith and pursuant to the terms of the Prior Authorization for any reason, including, but not limited to, Health Net\\'s subsequent rescission, cancellation, or modification of the Beneficiary\\'s contract or Health Net\\'s subsequent determination that it did not make an accurate determination of the Beneficiary\\'s eligibility; provided, however that this section shall not be construed to expand or alter benefits available to a Beneficiary under such Benefit Program. 3. Subsection 3.5.1, ACCESS BY HEALTH NET, shall be deleted and replaced to read as follows: As of the effective date of this Agreement, the following Health Net subsidiaries and affiliates may at their option access this Agreement: Health Net of California, Inc., Health Net Life Insurance Company, Health Net Community Solutions, Inc., California Health and Wellness Plan, Wellcare of California, Inc., Health Net of Arizona, Inc., Health Net Administrative Services of Arizona, Inc., Arizona Complete Health, Health Net Health Plan of Oregon, Inc., Health Net Insurance Services, Inc., Health Net Federal Services, LLC, Managed Health Network, Inc., MHN Government Services, Inc., and Network Providers, LLC. Health Net may periodically modify the Health Net subsidiaries and/or affiliates which may access this Agreement. To the extent Health Net allows a Health Net subsidiary or affiliate to access this Agreement, Health Net binds such subsidiaries and/or affiliates to the terms and conditions of this Agreement. INTENTIONALLY LEFT BLANK PV 2020 amd Page 1 of 22 HealthNet\\n\\n',\n", - " '2': '2 4. Section 5.1, TERM, shall be deleted and replaced to read as follows: The term of this Agreement shall commence on the Effective Date and shall continue through December 31, 2023. Either party may terminate this Agreement effective as of the end of the Initial Term by providing at least one hundred twenty (120) days prior written notice to the other party. This Agreement shall automatically renew for successive one (1) year periods (\"Renewal Terms\"). 5. Section 6.3, ACCESS TO RECORDS AND AUDITS BY HEALTH NET, shall be deleted and replaced to read as follows: Subject only to applicable State and federal confidentiality or privacy laws, Provider shall permit Health Net or its designated representative access to Provider\\'s Records, at Provider\\'s place of business in this State during normal business hours, in order to audit, inspect, review, perform chart reviews, and duplicate such Records unless Provider agrees to a remote audit of such records. If performed on site, access to Records for the purpose of an audit shall be scheduled at mutually agreed upon times, upon at least thirty (30) business days prior written notice by Health Net or its designated representative, but not more than sixty (60) days following such written notice. Provider shall attend an exit interview upon completion of the audit for the purpose of obtaining a mutually agreed upon reconciliation of the initial audit findings. Such exit interview shall be conducted at a mutually agreeable time at Provider\\'s place of business in this State during normal business hours upon at least ten (10) days prior written notice by Health Net or its designated representative, but not more than thirty (30) days following such written notice. In the event Provider fails to attend the scheduled exit interview, Provider shall be deemed to have accepted the audit findings. If the audit was performed remotely, such exit interview shall consist of Health Net or its designated representative sharing its audit findings with Provider via written or electronic communications as mutually agreed upon by both parties. Provider shall be allowed thirty (30) days to contest the audit results. If not contested within thirty (30) days then Provider shall be deemed to have accepted the audit findings. Except when Health Net or its designated representative requests Provider Records that are related to care management or claims, Provider may be reimbursed reasonable fees associated with the retrieval of Provider\\'s Records and or duplication and preparation of requested Provider Records. Such fees shall not be more than those provided pursuant to applicable State law, including California Health and Safety code Section 123110. Actions taken as a result of Audit findings shall include adjustment for late charges, overcharges and undercharges. Any such adjustments shall be the net amounts as reflected in the audit findings. Any payments owed by one party to the other as the result of an audit shall be paid within thirty (30) days of the exit interview for such audit. 6. Section 7.6, BINDING ARBITRATION, is deleted and replaced to read as follows: If the parties are unable to resolve a Dispute through the dispute resolution process set forth in Section 7.5, the parties agree that such Dispute shall be settled by final and binding arbitration, upon the motion of either party, under the appropriate rules of the AAA or JAMS, as agreed by the parties. Any Arbitrator must be either a judge, or an attorney licensed to practice law in the State of California, who is in good standing with the State Bar, and has at least ten (10) years of experience with health care matters and the arbitration of managed care disputes. The parties each understand and agree that the exhaustion of any Health Net internal appeals processes and the Meet and Confer Process set forth in Section 7.5 (i) hereof are conditions precedent to binding arbitration under this Section 7.6. Notwithstanding the foregoing, nothing contained herein is intended to require binding arbitration of disputes alleging medical malpractice between a Beneficiary and Provider or to Disputes between the parties alleging breaches of confidentiality of Beneficiary information, trade secret or intellectual property obligations. The arbitration shall be conducted in San Francisco, California or Los Angeles, California. The written demand PV 2020 amd Page 2 of 22\\n\\n',\n", - " '3': '3 shall contain a detailed statement of the matter and facts and include copies of all material documents supporting the demand. Except as provided below, arbitration must be initiated within one (1) year after the date the Dispute arose by submitting a written notice to the other party. For the purposes of filing for arbitration regarding a Dispute over Health Net\\'s alleged non- payment or underpayment of Complete Claims under this Agreement, the parties agree that an arbitration shall be filed within one (1) year from the date of Health Net\\'s notice of its final determination on Provider\\'s appeal if any, on such Complete Claim. The parties expressly agree that the deadlines to file arbitration set forth above shall not be subject to waiver, tolling, alteration or modification of any kind or for any reason except for fraud. The failure to initiate arbitration before such deadlines shall mean the complaining party shall be barred forever from initiating such proceedings. All such arbitration proceedings shall be administered by the AAA or JAMS, as agreed by the parties; however, the arbitrator shall be bound by applicable State and federal law, and shall issue a written opinion setting forth findings of fact and conclusions of law. The parties agree that the decision of the arbitrator shall be final and binding as to each of them. Judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction. The arbitrator shall have no authority to make material errors of law or to award punitive damages or to add to, modify, or refuse to enforce any agreements between the parties. The arbitrator shall make findings of fact and conclusions of law and shall have no authority to make any award, which could not have been made by a court of law. The party against whom the award is rendered shall pay any monetary award and/or comply with any other order of the arbitrator within sixty (60) days of the entry of judgment on the award. The parties waive their right to a jury or court trial. The parties recognize and agree that theirs is an ongoing business relationship, which may lead to sensitive issues with respect to the exchange of information related to any Dispute. The parties agree, therefore, to enter into such protective orders (including without limitation creating a category of discovery documents \"for attorney\\'s eyes only\" to the extent feasible given the nature of the evidence and the Dispute). All discovery information shall be used solely and exclusively for arbitration of the Dispute between the parties and may not be used for any other purpose. After the arbitration award becomes final, each party shall return or destroy all documents obtained from the other party during the course of the arbitration that are subject to a protective order, and within thirty (30) days of such date shall provide to the other party an officer\\'s certificate signed under penalty of perjury indicating that all such information has been returned or destroyed. In all cases submitted to arbitration, the parties agree to share equally the administrative fee as well as the arbitrator\\'s fee, if any, unless otherwise assessed by the arbitrator. The administrative fees shall be advanced by the initiating party subject to final apportionment by the arbitrator in this award. The parties agree that the content and decision of any arbitration proceeding shall be confidential unless disclosure is required by applicable State or federal statutes or regulations. The terms of Section 7.5 and Section 7.6 shall survive termination of this Agreement. INTENTIONALLY LEFT BLANK PV 2020 and Page 3 of 22 Health Net\\n\\n',\n", - " '4': '4 7. Section 7.12, NOTICE, is deleted and replaced to read as follows: Notices regarding the breach, term, termination or renewal of this Agreement shall be given in writing in accordance with this Section 7.12 and shall be deemed given five (5) days following deposit in the U.S. mail, postage prepaid. If sent by hand delivery, overnight courier, or facsimile, notices shall be deemed given upon documentation of delivery. All notices shall be addressed as follows: Health Net: Regional Network Director Health Net of California, Inc. 3131 Camino del Rio North, Suite 600 San Diego, CA 92108 Vice President and Deputy General Counsel Health Net of California, Inc. 21281 Burbank Blvd Woodland Hills, CA 91367 Provider: Paradise Valley Hospital 2400 E 4th Street National City, CA 91950 Attn: Hospital CEO Prime Healthcare Management, Inc. 3480 E. Guasti Road Ontario, CA 91761 Attn: General Counsel and Health Plan Operations The addresses to which notices are to be sent may be changed by written notice given in accordance with this Section. 8. Exhibit A-1, COMMERCIAL BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT, is deleted and replaced with the attached Exhibit A-1. 9. Exhibit C-1, MEDI-CAL FEE-FOR-SERVICE RATE EXHIBIT, is deleted and replaced with the attached Exhibit C-1. 10. Exhibit D-1, ENHANCED PPO BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT, is deleted and replaced with the attached Exhibit D-1. 11. Exhibit D-2, ENHANCED PPO BENEFIT PROGRAMS, FEE-FOR-SERVICE PAYMENT CONDITIONS, is deleted and replaced with the attached Exhibit D-2. 12. Addendum E, FACILITY FEE-FOR-SERVICE PAYMENT CONDITIONS, is deleted and replaced with the attached Addendum E. 13. Exhibit F-1, COMMUNITYCARE AND PURECARE BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT, is deleted and replaced with the attached Exhibit F-1. INTENTIONALLY LEFT BLANK PV 2020 and Page 4 of 22 Health Net\\n\\n',\n", - " '5': '5 14. A new Exhibit F-2, COMMUNITYCARE BENEFIT PROGRAMS HOSPITAL QUALITY PERFORMANCE PROGRAM, is added as the attached Exhibit F-2. THIS AMENDMENT shall be deemed to be part of the Agreement and, except as modified herein, the Agreement is hereby reaffirmed and declared in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment by their officers duly authorized to be effective on the date and year first written above. PRIME HEALTHCARE PARADISE VALLEY LLC HEALTH NET OF CALIFORNIA, INC. dba Paradise Valley Hospital Digitally signed by Yina Shabamia Valentina Shabanian Date: 2020.12.11 Edual dz 16:47:59 -08\\'00\" Edward Gong Valentina T. Shabanian Regional Vice President, Managed Care Regional Health Plan Officer 11/30/2020 Date Date Federal Tax Identification Number: 20-5837239 PV 2020 amd Page 5 of 22 Health Net\\n\\n',\n", - " '6': \"6 EXHIBIT A-1 COMMERCIAL BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT1/1/21 - 12/31/21: Inpatient Services, \\nCategory of Service: OB/C-Section and Vaginal Delivery (Mom and Baby), Codes: MS-DRGs: 768, 783-788, 796-798, 805-807, 1/1/21 - 12/31/21: $12,600/3 day case rate. Additional days $4,000/day, 1/1/22 - 12/31/22: $13,104/3 day case rate. Additional days $4,160/day, 1/1/23 and thereafter: $13,628/3 day case rate. Additional days $4,326/day, \\nCategory of Service: Boarder Baby, Codes: Revenue Codes: 0170, 0171, 0179, 1/1/21 - 12/31/21: $1,000/day, 1/1/22 - 12/31/22: $1,040/day, 1/1/23 and thereafter: $1,082/day, \\nCategory of Service: Rehabilitation, Codes: Revenue Code: 0128, 1/1/21 - 12/31/21: $2,500/diem, 1/1/22 - 12/31/22: $2,600/diem, 1/1/23 and thereafter: $2,704/diem, \\nCategory of Service: All other Inpatient Services with a codeable Medicare DRG, 1/1/21 - 12/31/21: 167.5% of Medicare Allowable for the entire stay, 1/1/22 - 12/31/22: 174.2% of Medicare Allowable for the entire stay, 1/1/23 and thereafter: 181.2% of Medicare Allowable for the entire stay, \\nCategory of Service: All other Inpatient Services with a non- codeable Medicare DRG, 1/1/21 - 12/31/21: 60% of Allowable Charges, not to exceed $7,000/day, 1/1/22 - 12/31/22: 60.6% of Allowable Charges, not to exceed $7,280/day, 1/1/23 and thereafter: 61.2% of Allowable Charges, not to exceed $7,571/day, \\n1/1/21 - 12/31/21: Outpatient Services, \\nCategory of Service: Ambulatory Surgery, Codes: Revenue Codes: 0360, 0369, 0490, 0499, 0750, and applicable CPT Codes, 1/1/21 - 12/31/21: 50% of Allowable Charges, not to exceed $6,000/visit, 1/1/22 - 12/31/22: 50.5% of Allowable Charges, not to exceed $6,240/visit, 1/1/23 and thereafter: 51% of Allowable Charges, not to exceed $6,490/visit, \\nCategory of Service: Emergency Room Visit, Codes: Revenue Codes: 0450, 0451, 0452, 0459, 1/1/21 - 12/31/21: 50% of Allowable Charges, not to exceed $4,110/visit, 1/1/22 - 12/31/22: 50.5% of Allowable Charges, not to exceed $4,274/visit, 1/1/23 and thereafter: 51% of Allowable Charges, not to exceed $4,445/visit, \\nCategory of Service: Emergency Room - Urgent Care Services (Facility), Codes: Revenue Codes: 0456, 1/1/21 - 12/31/21: 50% of Allowable Charges, not to exceed $3,820/visit, 1/1/22 - 12/31/22: 50.5% of Allowable Charges, not to exceed $3,973/visit, 1/1/23 and thereafter: 51% of Allowable Charges, not to exceed $4,132/visit, \\nCategory of Service: Observation, Codes: Revenue Codes: 0760, 0762, 1/1/21 - 12/31/21: 50% of Allowable Charges, not to exceed $3,820/visit, 1/1/22 - 12/31/22: 50.5% of Allowable Charges, not to exceed $3,973/visit, 1/1/23 and thereafter: 51% of Allowable Charges, not to exceed $4,132/visit, \\n Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E, Health Net shall pay and Provider shall accept as payment in full for Medically Necessary Covered Services delivered under Commercial Benefit Programs pursuant to Addendum A, the lesser of the rates listed below, or one hundred percent (100%) of Provider's Allowable Charges. PV 2020 amd Page 6 of 22 G HealthNet'\\n\\n\\n\\n\\n\",\n", - " '7': '7 No multiple ambulatory surgery payment methodology applies. PV 2020 amd Page 7 of 22 HealthNet\\n\\n\\nNone: Exclusions, 50% of Allowable Charges, not to exceed $3,820/visit: Inpatient and Outpatient, \\nAll other Outpatient Services: Surgical Implants, Prosthetics, Orthotics, Pacemakers, : Inpatient: Revenue Codes: 0274, 0275, 0276, 0278 Outpatient: Revenue Codes: 0274, 0275, 0276, 0278 or applicable HCPC Codes, 50% of Allowable Charges, not to exceed $3,820/visit: Included in above rates when each Revenue Code listed is less than $3,100 in aggregate Allowable Charges, 50.5% of Allowable Charges, not to exceed $3,973/visit: Included in above rates when each Revenue Code listed is less than $3,193 in aggregate Allowable Charges, 51% of Allowable Charges, not to exceed $4,132/visit: Included in above rates when each Revenue Code listed is less than $3,289 in aggregate Allowable Charges, \\nAll other Outpatient Services: Surgical Implants, Prosthetics, Orthotics, Pacemakers, : Inpatient: Revenue Codes: 0274, 0275, 0276, 0278 Outpatient: Revenue Codes: 0274, 0275, 0276, 0278 or applicable HCPC Codes, 50% of Allowable Charges, not to exceed $3,820/visit: 40% of Allowable Charges is applicable to each Revenue Code if at or over $3,100 in aggregate Allowable Charges, 50.5% of Allowable Charges, not to exceed $3,973/visit: 40.4% of Allowable Charges is applicable to each Revenue Code if at or over $3,193 in aggregate Allowable Charges, 51% of Allowable Charges, not to exceed $4,132/visit: 40.8% of Allowable Charges is applicable to each Revenue Code if at or over $3,289 in aggregate Allowable Charges, \\nAll other Outpatient Services: High Cost Drugs, : Revenue Codes: 0630-0636, 50% of Allowable Charges, not to exceed $3,820/visit: Included in above rates when each Revenue Code listed is less than $6,000 in aggregate Allowable Charges, 50.5% of Allowable Charges, not to exceed $3,973/visit: Included in above rates when each Revenue Code listed is less than $6,180 in aggregate Allowable Charges, 51% of Allowable Charges, not to exceed $4,132/visit: Included in above rates when each Revenue Code listed is less than $6,365 in aggregate Allowable Charges, \\nAll other Outpatient Services: High Cost Drugs, : Revenue Codes: 0630-0636, 50% of Allowable Charges, not to exceed $3,820/visit: 39.6% of Allowable Charges is applicable to each Revenue Code if at or over $6,000 in aggregate Allowable Charges, 50.5% of Allowable Charges, not to exceed $3,973/visit: 40% of Allowable Charges is applicable to each Revenue Code if at or over $6,180 in aggregate Allowable Charges, 51% of Allowable Charges, not to exceed $4,132/visit: 40.4% of Allowable Charges is applicable to each Revenue Code if at or over $6,365 in aggregate Allowable Charges, \\n\\n\\n',\n", - " '8': \"8 EXHIBIT C-1 MEDI-CAL BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBITCodes: Inpatient Services, \\nCategory of Service: Acute Rehabilitation, Codes: Revenue Codes: 118, 128, 138, 148, 158, Compensation: 105% of the Medi-Cal Rehabilitation Rate, \\nCategory of Service: Skilled Nursing Facility, Codes: Revenue Codes: 110, 120, 130, Compensation: 105% of the facility-specific published Medi-Cal per diem rate, \\nCategory of Service: Sub-Acute, Codes: Revenue Codes: 190-194, 199, Compensation: 105% of the facility-specific published Medi-Cal per diem rate, \\nCategory of Service: All other Inpatient Services, Compensation: 105% of APR-DRG based on the current statewide wage-adjusted base rate in effect at the time of service, \\nCodes: Outpatient Services, \\nCategory of Service: Outpatient Services, Compensation: 105% of the current Medi-Cal Fee Schedule, subject to any changes made by the State of California, \\nCategory of Service: Pharmaceuticals without an established Medi-Cal Value, Compensation: Average Wholesale Price (AWP) - 18%, \\nCategory of Service: Unlisted Procedures Procedures with Medi-Cal Units not Established but with a Medicare Value Procedures without Medi- Cal Units and without a Medicare Established Value, Compensation: 80% of the Current Medicare Allowable 15% of Allowable Charges, \\nCategory of Service: Surgical Implants, Prosthetics, Orthotics, Pacemakers for Ambulatory Surgery only, Codes: Revenue Codes 274, 275, 276, 278, Compensation: Cost + 5% for Ambulatory Surgery Only, \\n Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Exhibit C-3, Health Net shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary Covered Services delivered pursuant to this Addendum C, the lesser of the rates listed below, or one hundred percent (100%) of Provider's Allowable Charges. PV 2020 amd Page 8 of 22 Health Net\\n\\n\\n\\n\\n\",\n", - " '9': \"9 EXHIBIT D-1 ENHANCEDCARE PPO BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT1/1/21 - 12/31/21: Inpatient Services, \\nCategory of Service: OB/C- Section/Vaginal Delivery (Mom and Baby), Codes: DRG Codes: 768, 783- 788, 796-798, 805-807, 1/1/21 - 12/31/21: $9,500/case, 1/1/22 - 12/31/22: $9,880/case, 1/1/23 and thereafter: $10,275/case, \\nCategory of Service: Boarder Baby, Codes: Revenue Codes: 0170, 0171, 0179, 1/1/21 - 12/31/21: $800/case, 1/1/22 - 12/31/22: $832/case, 1/1/23 and thereafter: $865/case, \\nCategory of Service: Rehabilitation, Codes: Revenue Code: 0128, 1/1/21 - 12/31/21: $2,500/diem, 1/1/22 - 12/31/22: $2,600/diem, 1/1/23 and thereafter: $2,704/diem, \\nCategory of Service: All other Inpatient Services, Codes: All inpatient codes, except those services set forth below, 1/1/21 - 12/31/21: 130% of Medicare Allowable, 1/1/22 - 12/31/22: 135.2% of Medicare Allowable, 1/1/23 and thereafter: 140.6% of Medicare Allowable, \\n1/1/21 - 12/31/21: Outpatient Services, \\nCategory of Service: Observation, Codes: Revenue Codes: 0760, 0762, 1/1/21 - 12/31/21: 135% of Medicare Allowable, 1/1/22 - 12/31/22: 140.4% of Medicare Allowable, 1/1/23 and thereafter: 146% of Medicare Allowable, \\nCategory of Service: Outpatient Services, Codes: All outpatient codes, except those services set forth below, 1/1/21 - 12/31/21: 130% of Medicare Allowable, 1/1/22 - 12/31/22: 135.2% of Medicare Allowable, 1/1/23 and thereafter: 140.6% of Medicare Allowable, \\nCategory of Service: Provider-Based Billing, Codes: Rev Codes: 0510-0519, 1/1/21 - 12/31/21: Not covered, 1/1/22 - 12/31/22: Not covered, 1/1/23 and thereafter: Not covered, \\nCategory of Service: Outpatient Services that are not priced or codeable per Medicare guidelines, 1/1/21 - 12/31/21: 23.8% of Allowable Charges, not to exceed $2,980 per visit, 1/1/22 - 12/31/22: 24% of Allowable Charges, not to exceed $3,099 per visit, 1/1/23 and thereafter: 24.2% of Allowable Charges, not to exceed $3,223 per visit, \\n Subject to the terms of this Addendum, including without limitation the Payment Conditions set forth in Exhibit D-2 of this Addendum, Health Net shall pay and Provider shall accept as payment in full for Medically Necessary Contracted Services delivered under Benefit Programs pursuant to this Addendum, the lesser of the rates listed below, or one hundred percent (100%) of Provider's Allowable Charges. PV 2020 amd Page 9 of 22 Health Net\\n\\n\\n\\n\\n\",\n", - " '10': '10 EXHIBIT D-2 ENHANCED PPO BENEFIT PROGRAMS FEE-FOR-SERVICE PAYMENT CONDITIONS The Payment Conditions set forth in this Exhibit D-2 supplement Health Net Policies. 1. Application of 72-Hour Rule. Payments made to Provider for inpatient Covered Services shall constitute payment for all of Provider\\'s charges relating to a Covered Person\\'s pre-admission testing for the same condition occurring within seventy-two (72) hours prior to an admission, including, but not limited to, charges for laboratory services, pathology services, radiology services, and medical/surgical supplies. If Member is admitted directly from the Emergency room or from an Observation level of care, the inpatient reimbursement shall be inclusive of all such emergency and/or observation related facility charges. 2. Admissions for Same or Related Diagnoses. Inpatient admissions for the same or a related diagnoses occurring within forty-eight (48) hours following a discharge in connection with a previous admission shall be considered part of the previous admission and are not separately reimbursable. 3. Hospital-Acquired Conditions and Provider Preventable Conditions. Payment to Provider under this Addendum shall comply with state and federal laws requiring reduction of payment or non-payment to a Provider for \"Hospital-Acquired Conditions\" and for \"Provider Preventable Conditions\" as such terms (or the reasonable equivalents thereof) are defined under applicable state and federal laws. 4. Never Events. Each Provider shall use best efforts to comply with applicable state and federal reporting or other requirements relating to Never Events and/or Serious Adverse Events, as the applicable term is defined by the National Quality Forum or by state or federal law. Providers shall not bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against Health Net or Members for any charges associated with Never Events and/or Serious Adverse Events. To the extent Provider receives any payment in connection with a Never Event or Serious Adverse Event, Provider shall promptly refund such amount. 5. Level of Care. Reimbursement under this Addendum shall not exceed the Allowed Amount corresponding to the level of care authorized by Health Net. 6. Payment for Professional Services. Payment for inpatient Covered Services under this Addendum includes payment for professional Covered Services (including but not limited to services provided by hospital-based physicians, Certified Registered Nurse Anesthetists or other professionals) that are provided in connection with such inpatient Covered Services and billed under the Provider\\'s tax identification number and provider identification number. Such professional Covered Services will not be separately reimbursable. Professional Covered Services billed by independent physicians under their own tax identification number and provider identification number are reimbursable directly to such physicians. 7. Payment for Multiple Procedures. Where multiple outpatient surgical or scope procedures performed on a Member during a single occasion of surgery, reimbursement will be as follows: i) the procedure for which the Allowed Amount under this Addendum is greatest will be reimbursed at one hundred percent (100%) of such Allowed Amount; ii) the procedures with second and third greatest Allowed Amounts under this Addendum shall each be reimbursed at fifty percent (50%) of such Allowed Amounts; iii) any additional procedures will not be eligible for reimbursement. 8. Multiple Dates of Service on a Single Claim Form. Provider shall identify on the applicable claim form each date of service when submitting claims spanning multiple dates of service. 9. Provider-Based Billing. Provider-Based Billing (as defined herein) will not be reimbursed under this Compensation Schedule as they are included as part of the compensation for professional fees under this Agreement. Neither Health Net nor the Member shall be responsible for such Provider-Based Billing. \"Provider-Based Billing\" are amounts charged by a clinic or facility as a technical component, or for PV 2020 amd Page 10 of 22\\n\\n',\n", - " '11': '11 overhead, in connection with professional services rendered in a clinic or facility, and include but are not limited to services billed using Revenue Codes 0510-0519. 10. Therapy Services. Provider shall bill therapy services with the appropriate modifier designating the type of therapy provided, when applicable. 11. National Provider Identifier/Effect of Exclusion or Suspension. Notwithstanding anything to contrary contained herein, Health Net shall not pay, and shall have no obligation to pay, any claim submitted by Provider based on an order or referral that does not include the National Provider Identifier (\"NPI\") for the ordering or referring physician. Neither Health Net nor the Member shall have any obligation to pay any claim submitted by Provider if the Provider has been excluded or suspended from participation in Medicare, Medicaid, or any other federal or state health care program. 12. Code Change Updates. Health Net utilizes nationally recognized coding structures (including, without limitation, revenue codes, CPT codes, HCPCS codes, ICD codes, national drug codes, ASA relative values, etc., or their successors) for basic coding and descriptions of the services rendered. Updates to billing-related codes shall become effective on the date (\"Code Change Effective Date\") that is the later of: (i) the first day of the month following sixty (60) days after publication by the governmental agency having authority over the applicable Product of such governmental agency\\'s acceptance of such code updates, (ii) the effective date of such code updates as determined by such governmental agency or (iii) if a date is not established by such governmental agency or the applicable Product is not regulated by such governmental agency, the date that changes are made to nationally recognized codes. Such updates may include changes to service groupings. Claims processed prior to the Code Change Effective Date shall not be reprocessed to reflect any such code updates. 13. Fee Change Updates. Updates to the fee schedule shall become effective on the effective date of such fee schedule updates, as determined by Health Net (\"Fee Change Effective Date\"). The date of implementation of any fee schedule updates, i.e. the date on which such fee change is first used for reimbursement (\"Fee Change Implementation Date\"), shall be the later of: (i) the first date on which Health Net is reasonably able to implement the update in the claims payment system; or (ii) the Fee Change Effective Date. Claims processed prior to the Fee Change Implementation Date shall not be reprocessed to reflect any updates to such fee schedule, even if service was provided after the Fee Change Effective Date. 14. Reimbursement Service Grouping. Not applicable. 15. Payment under this Compensation Schedule. All payments under this Compensation Schedule are subject to the terms and conditions set forth in the Agreement and Health Net Policies. 16. \"Allowable Charges\" means Provider\\'s billed charges for Contracted Services. 17. Medicare/CMS Allowable for Inpatient Services is defined as Medicare DRG including, DME, DSH, Capital (including Capital IME), and other Medicare payments, and including outliers as defined by Medicare/CMS, but excluding Operating IME and pass-throughs. 18. Health Net may use a vendor for the benefit administration of certain Covered Services related to substance abuse and behavioral health benefits. In the event of a conflict between this Agreement and the vendor\\'s contract with Provider, the vendor\\'s contract shall prevail when responsible for benefit administration. 19. Adjustments to Compensation Based on CMS Changes. In order to neutralize the impact of CMS changes to the DRG fee schedule for current and future years for all Commercial products, the parties agree to adjust the Inpatient rates based on DRGs in the above fee schedule as follows: 19.1 Inpatient. Health Net will pull a claims report of Provider\\'s Inpatient claims (both paid and denied) from Health Net\\'s system for dates of service January 1, 2019 through December 31, 2019 for PV 2020 amd Page 11 of 22 HealthNet\\n\\n',\n", - " '12': '12 Provider\\'s review and approval. Once the data set is agreed to, Health Net will price said claims using the DRG fee schedule effective October 1, 2019, and using the DRG fee schedule effective October 1, 2020. If Health Net\\'s analysis shows that the resulting trend comparing the sum of one hundred percent (100%) of Medicare Allowable for each claim in the agreed upon claim data set resulting from the October 1, 2019 DRG fee schedule to the sum of one hundred percent (100%) of Medicare Allowable for each claim in the agreed upon claim data set resulting from the October 1, 2020 DRG fee schedule is greater than or less than one percent (1%) as verified by Provider, the parties will execute an amendment with pro-rated Inpatient rates that counteract the DRG change. The parties will repeat this process each year using each year\\'s October 1 DRG fee schedule (i.e., the Inpatient claims data set for the 10/1/2021 DRG calculation will be cy2020, etc.). All Commercial products and all Prime Health hospitals will be included in the analysis. The data set will only include Commercial Inpatient claims that are reimbursed at the % of Medicare rate. Inpatient claims that are reimbursed at case rates etc. (i.e. OB rates) will be excluded from the analysis. 19.2 Medicare/CMS Allowable. Medicare/CMS allowable for Inpatient Services is defined as Medicare DRG including, DME, DSH, Capital (including Capital IME), and other Medicare payments, and including outliers as defined by Medicare/CMS, but excluding Operating IME and pass-throughs. 19.3 Time Frame for Analysis. CMS implements the Inpatient DRG fee schedule changes effective every October 1st, the parties will target January 31st of each year to complete the analysis. 19.4 Adjusting and Pro-rating Contract Rates Examples. Adjusted IP Contract Rate = \"Current IP Rate/(1+DRG Trend)\". Example A1) for Year 1 Adjustment assuming 10/1/20 vs 10/1/19 DRG trend is 3%. Current HMO IP rates - Year 1: 167.5%, Year 2: 174.2%, Year 3: 181.2%. Adjusted IP Contract Rate Year 167.5%/1.03=162.6%. Adjusted IP Contract Rate Year 2= 174.2%/1.03=169.1% Adjusted IP Contract Rate Year 3= 181.2%/1.03=175.9% Example A2) for Year 2 Adjustment assuming 10/1/21 vs 10/1/20 DRG Trend is 3%. Current HMO IP rates - Year 2: 169.1%, Year 3: 175.9%. Adjusted IP Contract Rate Year 2= 169.1%/1.03=164.2%. Adjusted IP Contract Rate Year 3= 175.9%/1.03=170.8%. Example A3) for Year 3 Adjustment assuming 10/1/22 vs 10/1/21 DRG Trend is 3%. Current HMO IP rates - Year 3: 170.8%. Adjusted IP Contract Rate Year 3= 170.8%/1.03=165.8%. Example B1) for Year 1 Adjustment assuming 10/1/20 vs 10/1/19 DRG trend is - 3%. Current HMO IP rates - Year 1: 167.5%, Year 2: 174.2%, Year 3: 181.2%. Adjusted IP Contract Rate Year 1= 167.5%/0.97=172.7. Adjusted IP Contract Rate Year 2= 174.2%/0.97=179.6%. Adjusted IP Contract Rate Year 3= 181.2%/0.97=186.8%. Example B2) for Year 2 Adjustment assuming 10/1/21 vs 10/1/20 DRG Trend is - 3%. Current HMO IP rates - Year 2: 179.6%, Year 3: 186.8%. Adjusted IP Contract Rate Year 2= 179.6%/0.97=185.1%. Adjusted IP Contract Rate Year 3= 186.8%/0.97=192.6%. Example B3) for Year 3 Adjustment assuming 10/1/22 vs 10/1/21 DRG Trend is - 3%. PV 2020 amd Page 12 of 22\\n\\n',\n", - " '13': '13 Current HMO IP rates - Year 3: 192.6%. Adjusted IP Contract Rate Year 3= 192.6%/0.97=198.5%. Pro-Rating Adjustment Due to Delay in Implementing Adjusted Contract Rates: Pro-Rated Rate = \"Adjusted Contract Rate+[(Adjusted Contract Rate-Current Rate)*(x/(12-x))]. X = Delay in months in implementing the Adjusted Contract Rates. Inpatient: Compared to October (i.e. if rates implemented eff 2/1, X=4). Example A) If the Adjusted Contract Year 1 Rates are implemented with a 4 months delay; Pro-rated Year 1 Rate: 162.6%+[(162.6%-167.5%)*(4/(12-4))]=160.2%. Pro-rating only applies to current year rates. No pro-rating for future years. Example B) If the Adjusted Contract Year 1 Rates are implemented with a 4 months delay; Pro-rated Year 1 Rate: 172.7%+[(172.7%-167.5%)*(4/(12-4))]=175.3%. Pro-rating only applies to current year rates. No pro-rating for future years. If there is a need to adjust the Year 3 rates due to the changes in Medicare fee schedules (in January 2023), the Year 3 pro-rated rates will expire at the end of Year 3 (December 2023 - This will depend on the actual effective date of this agreement. Currently assumes it will be effective 12/1/2020). The rates thereafter will be \"Adjusted Contract Year 3 Rates\" (Non Pro-Rated). Pro-ration Calculation: PV 2020 amd Page 13 of 22\\n\\n\\n Example: No adjustment for delay in implementation and no inflationary increase to the base rate {\\'Example:\\': [\\'Example\\', \\'\\', \\'100 % of Medicare (no trend)\\', \\'Rate (no adjustment)\\', \\'Payment (not pro- rated)\\', \\'\\', \\'Example:\\', \\'100 % of Medicare (3% trend)\\', \\'Rate (pro- rated 4 months delay)\\', \\'Payment (pro-rated 4 months delay)\\'], \\'No adjustment\\': [\\'\\', \\'1\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'Base rate\\', \\'10,300\\', \\'167.5%\\', \\'17,253\\'], \\'for\\': [\\'Delayed\\', \\'2\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'increased\\', \\'10,300\\', \\'167.5%\\', \\'17,253\\'], \\'delay in\\': [\\'Months 1-4\\', \\'3\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'for\\', \\'10,300\\', \\'167.5%\\', \\'17,253\\'], \\'implementation\\': [\\'\\', \\'4\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'inflation,\\', \\'10,300\\', \\'167.5%\\', \\'17,253\\'], \\'\\': [\\'\\', \\'Total\\', \\'\\', \\'\\', \\'201,000\\', \\'\\', \\'\\', \\'\\', \\'\\', \\'201,000\\'], \\'and no\\': [\\'\\', \\'6\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'for the\\', \\'10,300\\', \\'160.2%\\', \\'16,499\\'], \\'inflationary\\': [\\'New\\', \\'7\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'delayed\\', \\'10,300\\', \\'160.2%\\', \\'16,499\\'], \\'increase\\': [\\'Rate Updated\\', \\'8\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'period\\', \\'10,300\\', \\'160.2%\\', \\'16,499\\'], \\'to the\\': [\\'Months\\', \\'9\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'\\', \\'10,300\\', \\'160.2%\\', \\'16,499\\'], \\'base rate\\': [\\'5-12\\', \\'10\\', \\'10,000\\', \\'167.5%\\', \\'16,750\\', \\'\\', \\'\\', \\'10,300\\', \\'160.2%\\', \\'16,499\\']} Example: No adjustment for delay in implementation and no inflationary increase to the base rate Pro-ration Calculation:Current Contract rate: DRG trend, 167.5%: 3%, \\nCurrent Contract rate: Adjust contract rate, 167.5%: 162.6%, \\nCurrent Contract rate: Pro-rated rate (x=4), 167.5%: 160.2%, \\n\\n\\n',\n", - " '14': '14 ADDENDUM E FEE-FOR-SERVICE PAYMENT CONDITIONS The Payment Conditions set forth in this Addendum E supplement Health Net Policies. I. PAYMENT CONDITIONS APPLICABLE TO (1) PAYMENT RATES FOR COMMERCIAL BENEFIT PROGRAMS, INCLUDING SALUD CON HEALTH NET AND COMMUNITYCARE HMO AND PURECARE PPO (EXCLUDING MEDI-CAL BENEFIT PROGRAM, ENHANCEDCARE PPO, and CALMEDICONNECT BENEFIT PROGRAM), NOT BASED ON MEDICARE/CMS ALLOWABLE; AND (2) PAYMENT RATES, FOR MEDICARE BENEFIT PROGRAMS, BASED ON MEDICARE/CMS ALLOWABLE: 1.1 The codes listed in the applicable rate exhibit shall be used by the parties for the purpose of defining the services for which payment will be made under this Agreement. Provider shall utilize the specified codes listed in the applicable rate exhibit when submitting Complete Claims for Covered Services under this Agreement. 1.2 The parties acknowledge that applicable coding agencies periodically issue coding modifications. Such modifications may be implemented by Health Net within sixty (60) days of the date Health Net receives the modification from the applicable coding agency or notification from Provider. The parties agree that in the event such coding modifications have the effect of changing a payment amount in this Agreement, the resulting payment amount change shall be effective on a prospective basis. The parties further agree to reasonably and in good faith discuss any contract rate amendment that may be appropriate based on comprehensive and substantive coding changes by the applicable coding agency within ninety (90) days of written notification by either party. Any and all rate modifications that may result from such contract amendment shall be effective on a prospective basis. 1.3 Only one per diem or case rate shall be payable a) for each Beneficiary who is admitted prior to midnight and remains past midnight; b) if a Beneficiary is admitted and discharged during the same day, provided that such admission and discharge is not within twenty-four (24) hours of a prior discharge; c) for mother and newborn child (children) when both mother and newborn child (children) are in the facility on the same day, unless the child (children) is in the neonatal intensive care unit. Pre-admission testing completed within one (1) day of admission will be included in the per diem and will not be billed separately by Provider. A per diem is an all-inclusive daily payment, including but not limited to observation services, supplies, implants, prosthetics, durable medical equipment, and pharmaceuticals with the exception of specific carve-outs or exclusions identified on the applicable rate exhibit. Inpatient Professional services billed by the Provider on behalf of the hospital-based physician(s) are included in the per diems or case rates. Admission kits are included in the per diem rate. Any Outpatient Services delivered to a Beneficiary within twenty-four (24) hours prior to an admission for Inpatient Services for the same medical condition at the same facility are included in the inpatient rate. 1.4 The rates set forth in this Agreement apply only to inpatient admissions commencing on or after the Effective Date of this Agreement. The applicable rate of payment that is in effect on the date an inpatient admission commences shall apply to the entire length of stay regardless of any rate change that may occur during the length of stay. Notwithstanding the foregoing, inpatient case rates are applicable beginning the first day of admission if a case rate procedure is performed at any time during the inpatient stay. 1.5 All inpatient case rates shall include any readmission charges if the patient is readmitted within forty-eight (48) hours following discharge for complications related to the prior admission. Should non-standard conditions occur, the second admission within forty-eight (48) hours may be eligible for reimbursement, provided such admission is in accordance with Health Net Policies. INTENTIONALLY LEFT BLANK PV 2020 amd Page 14 of 22 HealthNet\\n\\n',\n", - " '15': \"15 1.6 If a Beneficiary is admitted to the hospital from the emergency room and/or observation room, separate reimbursement for the emergency room, observation room and other outpatient charges shall not be paid; however, the applicable inpatient reimbursement shall be reimbursed as all-inclusive reimbursement. The rate payable for Emergency Services is an all-inclusive case rate, including but not limited to supplies, implants, prosthetics, durable medical equipment, observation charges, diagnostic services, therapeutic services, pharmaceuticals, and other services incidental to the emergency room visit, with the exception of specific exclusions identified on the applicable rate exhibit. 1.7 The rate payable for outpatient surgery is an all-inclusive case rate, including but not limited to supplies, implants, prosthetics, durable medical equipment, emergency room charges, observation charges, diagnostic services, therapeutic services and pharmaceuticals with the exception of specific exclusions identified on the applicable rate exhibit. Only one (1) case rate shall be paid for each Beneficiary per date of service. 1.8 Other Outpatient case rates are an all-inclusive payment, including but not limited to supplies, diagnostic services, therapeutic services and pharmaceuticals with the exception of specific exclusions identified on the applicable rate exhibit. Only one (1) case rate shall be paid for each Beneficiary per date of service; provided, however, that if one or more unique case rate procedure is performed on different body parts, each applicable case rate shall be reimbursed. 1.9 Intentionally Left Blank 1.10 In the event that a Beneficiary is transported either within Provider's Facility or to another facility for a service that is within Provider's customary scope of practice, but due to malfunction or other cause cannot be delivered, Provider shall be solely financially responsible for claims incurred for such transportation. 1.11 For purposes of this Agreement, New Service/Technology is defined as a service, procedure, device, test, or other item that, as of the effective date of this Agreement: (i) is not performed by Provider, or (ii) is not Covered by Health Net under the applicable Benefit Program, or (iii) for which there is no assigned CPT or other relevant code defined. New Service/Technology does not include a new code that is assigned as a change to an existing service, procedure, device, test, or other item. If Provider offers a New Service/Technology after the effective date of this Agreement for which Provider desires reimbursement under this Agreement, Provider agrees to give Health Net sixty (60) days prior written notice that Provider requests that such New Service/Technology be included in Contracted Services, and that Provider receive a different reimbursement rate for the use of such New Service/Technology for Beneficiaries. Health Net agrees to determine whether such New Service/Technology qualifies as a Covered Service and whether Health Net desires to include such New Service/Technology in Contracted Services within thirty (30) days of the date of Provider's notice hereunder. Health Net's determination of whether a New Service/Technology qualifies as a Covered Service shall be made in Health Net's sole discretion, and shall be final and binding on Provider with respect to this Agreement. Only if Health Net agrees that such New Service/Technology is a Covered Service and desires to include such New Service/Technology in Contracted Services, the parties shall enter into good faith negotiations to modify Provider's rates to reflect the New Service/Technology. Any rate modification shall be made only prospectively. 1.12 The lowest room and board billed charge rate shall apply to all days billed within the same revenue code level of care. 1.13 All professional Covered Services billed by Participating Providers on a CMS 1500 form under Provider's federal tax identification number shall be reimbursed at one hundred percent (100%) of CMS allowable in effect on the date of service. PV 2020 amd Page 15 of 22 HealthNet\\n\\n\",\n", - " '16': '16 1.14 If any payment rates are based on Provider\\'s billed charges, upon Health Net\\'s written request, Provider shall send Health Net an electronic copy of Provider\\'s current Charge Master. Provider shall notify Health Net in writing via certified letter at least sixty (60) days prior to making any changes to Provider\\'s Charge Master (\"Notice\"). The rates in Provider\\'s Charge Master on September 1, 2013, for example the date Provider\\'s most recent fiscal year began, shall be the \"Baseline Charge Master.\" Changes to the Baseline Charge Master shall be measured during the twelve (12) month period immediately preceding the date of the Notice (the \"Measurement Period\"). The Notice shall be signed by Provider\\'s Chief Financial Officer (or equivalent) and shall include a statement of any and all changes made to the Baseline Charge Master during the Measurement Period together with the effective date of such change. All changes included in the Notice shall be calculated using the methodology set forth herein. Any change to Provider\\'s Charge Master during the term of this Agreement shall result in a proportional change to reduce the percentage for those categories of service reimbursed on a discount off of charges basis and increase the stop-loss threshold (if applicable) set forth in the applicable addendum and/or exhibit to this Agreement. The terms of this section shall survive termination and/or subsequent renegotiation of this Agreement with respect to Contracted Services rendered during the term of the Agreement and Health Net shall retain its right to pursue recovery of any overpayments and/or to adjust the rates under the terms and provisions of the Agreement and applicable law. Health Net reserves all of its rights under this Agreement, at law and in equity related to any Charge Master dispute that may exist or arise in the future. The methodology for calculating Changes to the Charge Master and rates pursuant to this section is as follows: (a) First Year: Provider agrees that any Notice delivered during the first year of this Agreement shall reflect no changes made to the Baseline Charge Master. In the event Provider has made changes to its Baseline Charge Master, any such change shall result in a proportional change to reduce the percentage for those categories of service reimbursed on a discount off of charges basis and increase the stop-loss threshold (if applicable) set forth in the applicable addendum and/or exhibit to this Agreement, such that there will not be a change to Health Net\\'s reimbursement to Provider during the first year of this Agreement. (b) Subsequent Years: For each subsequent Measurement Period, Provider shall not change Provider\\'s Baseline Charge Master in a manner that results in an increase in reimbursement under this Agreement by more than three percent (3%) in the aggregate, unless expressly agreed upon in writing by the parties hereto. Upon request, Provider shall promptly provide Health Net with a Notice that completely and accurately sets forth any and all changes during the Measurement Period. Health Net shall have the right to reconcile and reduce the percentage for those categories of service reimbursed on a discount off of charges basis and increase the stop-loss threshold (if applicable) set forth in the applicable addendum and/or exhibit to this Agreement. In the event Health Net exercises its right to reconcile and adjust payment, Health Net shall give Provider at least thirty (30) days prior written notice, which notice shall be attached to the applicable rate exhibit in this Agreement. Any resulting change in payment rates shall be effective upon thirty (30) days prior written notice to Provider and shall be applicable to all claims adjudicated after the thirty (30) day notice period has expired regardless of the dates of service for such claims. (c) Both parties agree that Charge Master changes shall be calculated using Provider\\'s aggregate weighted average charge increase where weights equal volume for specific charges. Health Net may periodically review Provider\\'s Charge Master filed with the State or Health Net\\'s historical claims data. If Health Net determines as a result of such review that Provider has made changes to the Baseline Charge Master but has failed to give Health Net Notice, the parties agree that such changes shall result in a proportional change to reduce the percentage for those categories of service reimbursed on a discount off of charges basis and increase the stop-loss threshold (if applicable) set forth in the applicable addendum and/or exhibit to this Agreement. Any such change in rates shall be effective upon thirty (30) days prior written notice to Provider and shall be applicable to all claims adjudicated after the thirty (30) day notice period has expired regardless of the dates of service for such claims. Health Net shall use the above methodology for calculating changes to the Charge Master and rates pursuant to this section. PV 2020 amd Page 16 of 22 Health Net\\n\\n',\n", - " '17': \"17 II. PAYMENT CONDITIONS APPLICABLE TO PAYMENT RATES BASED ON MEDICARE/CMS ALLOWABLE. The following payment conditions are in addition to those set forth in Article I above, and apply to payment rates based upon a percentage of Medicare/CMS allowable rates, and methodology. Notwithstanding the foregoing, to the extent any payment condition set forth in this Article II conflicts with a payment condition in Article I, the payment condition set forth in this Article II shall control with respect to payment based upon a percentage of Medicare/CMS allowable rates, and methodology: 2.1 Only one DRG/case rate shall be payable for each Beneficiary who is admitted, provided that such admission is not within 48 hours of a prior discharge and for Benefit Program Beneficiaries other than Medicare Beneficiaries, for mother and newborn child (children) when both mother and newborn child (children) are in the facility on the same day, unless the child (children) is in the neonatal intensive care unit. Any outpatient services delivered to a Beneficiary within forty-eight (48) hours prior to an admission for Inpatient Services at the same facility are included in the inpatient rate. 2.2 Provider shall be reimbursed in accordance with CMS guidelines for all Outpatient Services. 2.3 Medicare/CMS allowable for Inpatient Services is defined as Medicare DRG including, DME, DSH, Capital (including Capital IME) and other Medicare payments, and including outliers as defined by Medicare/CMS, but excluding Operating IME and pass-throughs. 2.4 Provider agrees to adhere to CMS/Medicare billing and compensation guidelines for all services. 2.5 Adjustments to Compensation Based on CMS Changes. In order to neutralize the impact of CMS changes to the DRG fee schedule for current and future years for all Commercial products, the parties agree to adjust the Inpatient rates based on DRGs in the above fee schedule as follows: 2.5.1 Inpatient. Health Net will pull a claims report of Provider's Inpatient claims (both paid and denied) from Health Net's system for dates of service January 1, 2019 through December 31, 2019 for Provider's review and approval. Once the data set is agreed to, Health Net will price said claims using the DRG fee schedule effective October 1, 2019, and using the DRG fee schedule effective October 1, 2020. If Health Net's analysis shows that the resulting trend comparing the sum of one hundred percent (100%) of Medicare Allowable for each claim in the agreed upon claim data set resulting from the October 1, 2019 DRG fee schedule to the sum of one hundred percent (100%) of Medicare Allowable for each claim in the agreed upon claim data set resulting from the October 1, 2020 DRG fee schedule is greater than or less than one percent (1%) as verified by Provider, the parties will execute an amendment with pro-rated Inpatient rates that counteract the DRG change. The parties will repeat this process each year using each year's October 1 DRG fee schedule (i.e., the Inpatient claims data set for the 10/1/2021 DRG calculation will be cy2020, etc.). All Commercial products and all Prime Health hospitals will be included in the analysis. The data set will only include Commercial Inpatient claims that are reimbursed at the % of Medicare rate. Inpatient claims that are reimbursed at case rates etc. (i.e. OB rates) will be excluded from the analysis. 2.5.2 Medicare/CMS Allowable. Medicare/CMS allowable for Inpatient Services is defined as Medicare DRG including, DME, DSH, Capital (including Capital IME), and other Medicare payments, and including outliers as defined by Medicare/CMS, but excluding Operating IME and pass- throughs. 2.5.3 Time Frame for Analysis. CMS implements the Inpatient DRG fee schedule changes effective every October 1st, the parties will target January 31st of each year to complete the analysis. INTENTIONALLY LEFT BLANK PV 2020 amd Page 17 of 22 HealthNet\\n\\n\",\n", - " '18': '18 2.5.4 Adjusting and Pro-rating Contract Rates Examples. Adjusted IP Contract Rate = \"Current IP Rate/(1+DRG Trend)\". Example A1) for Year 1 Adjustment assuming 10/1/20 vs 10/1/19 DRG trend is 3%. Current HMO IP rates - Year 1: 167.5%, Year 2: 174.2%, Year 3: 181.2%. Adjusted IP Contract Rate Year 1= 167.5%/1.03=162.6%. Adjusted IP Contract Rate Year 2= 174.2%/1.03=169.1%. Adjusted IP Contract Rate Year 3= 181.2%/1.03=175.9%. Example A2) for Year 2 Adjustment assuming 10/1/21 vs 10/1/20 DRG Trend is 3%. Current HMO IP rates - Year 2: 169.1%, Year 3: 175.9%. Adjusted IP Contract Rate Year 2= 169.1%/1.03=164.2%. Adjusted IP Contract Rate Year 3= 175.9%/1.03=170.8%. Example A3) for Year 3 Adjustment assuming 10/1/22 vs 10/1/21 DRG Trend is 3%. Current HMO IP rates - Year 3: 170.8%. Adjusted IP Contract Rate Year 3= 170.8%/1.03=165.8%. Example B1) for Year 1 Adjustment assuming 10/1/20 vs 10/1/19 DRG trend is -3%. Current HMO IP rates - Year 1: 167.5%, Year 2: 174.2%, Year 3: 181.2%. Adjusted IP Contract Rate Year 1= 167.5%/0.97=172.7%. Adjusted IP Contract Rate Year 2= 174.2%/0.97=179.6%. Adjusted IP Contract Rate Year 3= 181.2%/0.97=186.8%. Example B2) for Year 2 Adjustment assuming 10/1/21 vs 10/1/20 DRG Trend is -3%. Current HMO IP rates - Year 2: 179.6%, Year 3: 186.8%. Adjusted IP Contract Rate Year 2= 179.6%/0.97=185.1%. Adjusted IP Contract Rate Year 3= 186.8%/0.97=192.6%. Example B3) for Year 3 Adjustment assuming 10/1/22 vs 10/1/21 DRG Trend is -3%. Current HMO IP rates - Year 3: 192.6%. Adjusted IP Contract Rate Year 3= 192.6%/0.97=198.5%. Pro-Rating Adjustment Due to Delay in Implementing Adjusted Contract Rates: Pro-Rated Rate = \"Adjusted Contract Rate+[(Adjusted Contract Rate-Current Rate)*(x/(12-x))]. X = Delay in months in implementing the Adjusted Contract Rates. Inpatient: Compared to October (i.e. if rates implemented eff 2/1, X=4). Example A) If the Adjusted Contract Year 1 Rates are implemented with a 4 months delay; Pro-rated Year 1 Rate: 162.6%+[(162.6%-167.5%)*(4/(12-4))]=160.2% Pro-rating only applies to current year rates. No pro-rating for future years. Example B) If the Adjusted Contract Year 1 Rates are implemented with a 4 months delay; Pro-rated Year 1 Rate: 172.7%+[(172.7%-167.5%)*(4/(12-4))]=175.3% Pro-rating only applies to current year rates. No pro-rating for future years. If there is a need to adjust the Year 3 rates due to the changes in Medicare fee schedules (in January 2023), the Year 3 pro-rated rates will expire at the end of Year 3 (December 2023 - This will depend on the actual effective date of this agreement. Currently assumes it will be effective 12/1/2020). The rates thereafter will be \"Adjusted Contract Year 3 Rates\" (Non Pro-Rated). PV 2020 amd Page 18 of 22\\n\\n',\n", - " '19': \"19 Pro-ration Calculation: PV 2020 amd Page 19 of 22 HealthNet\\n\\n\\n Example: No adjustment for delay in implementation and no inflationary increase to the base rate {'Example:': ['', '', '100 % of Medicare (no trend)', 'Rate (no adjustment)', 'Payment (not pro- rated)', '', 'Example:', '100 % of Medicare (3% trend)', 'Rate (pro- rated 4 months delay)', 'Payment (pro-rated 4 months delay)'], 'No adjustment': ['', '1', '10,000', '167.5%', '16,750', '', 'Base rate', '10,300', '167.5%', '17,253'], 'for': ['Delayed', '2', '10,000', '167.5%', '16,750', '', 'increased', '10,300', '167.5%', '17,253'], 'delay in': ['Months 1-4', '3', '10,000', '167.5%', '16,750', '', 'for', '10,300', '167.5%', '17,253'], 'implementation': ['', '4', '10,000', '167.5%', '16,750', '', 'inflation,', '10,300', '167.5%', '17,253'], '': ['', 'Total', '', '', '201,000', '', '', '', '', '201,000'], 'and no': ['', '6', '10,000', '167.5%', '16,750', '', 'for the', '10,300', '160.2%', '16,499'], 'inflationary': ['New', '7', '10,000', '167.5%', '16,750', '', 'delayed', '10,300', '160.2%', '16,499'], 'increase': ['Rate Updated', '8', '10,000', '167.5%', '16,750', '', 'period', '10,300', '160.2%', '16,499'], 'to the': ['Months', '9', '10,000', '167.5%', '16,750', '', '', '10,300', '160.2%', '16,499'], 'base rate': ['5-12', '10', '10,000', '167.5%', '16,750', '', '', '10,300', '160.2%', '16,499']} Example: No adjustment for delay in implementation and no inflationary increase to the base rate Pro-ration Calculation:Current Contract rate: DRG trend, 167.5%: 3%, \\nCurrent Contract rate: Adjust contract rate, 167.5%: 162.6%, \\nCurrent Contract rate: Pro-rated rate (x=4), 167.5%: 160.2%, \\n\\n\\n\",\n", - " '20': \"20 EXHIBIT F-1 COMMUNITYCARE AND PURECARE BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT1/1/21 - 12/31/21: Inpatient Services, \\nCategory of Service: OB/C- Section/Vaginal Delivery (Mom and Baby), Codes: DRG Codes: 768, 783-788, 796-798, 805-807, 1/1/21 - 12/31/21: $9,500/case, 1/1/22 - 12/31/22: $9,880/case, 1/1/23 and thereafter: $10,275/case, \\nCategory of Service: Boarder Baby, Codes: Revenue Codes:0170, 0171, 0179, 1/1/21 - 12/31/21: $800/case, 1/1/22 - 12/31/22: $832/case, 1/1/23 and thereafter: $865/case, \\nCategory of Service: Rehabilitation, Codes: Revenue Code: 0128, 1/1/21 - 12/31/21: $2,500/diem, 1/1/22 - 12/31/22: $2,600/diem, 1/1/23 and thereafter: $2,704/diem, \\nCategory of Service: All other Inpatient Services, 1/1/21 - 12/31/21: 135% of Medicare Allowable, 1/1/22 - 12/31/22: 140.4% of Medicare Allowable, 1/1/23 and thereafter: 146% of Medicare Allowable, \\n1/1/21 - 12/31/21: Outpatient Services, \\nCategory of Service: Outpatient Services, Codes: All outpatient codes, except those services set forth below, 1/1/21 - 12/31/21: 23.8% of Allowable Charges, not to exceed $3,094 per visit, 1/1/22 - 12/31/22: 24% of Allowable Charges, not to exceed $3,218 per visit, 1/1/23 and thereafter: 24.2% of Allowable Charges, not to exceed $3,346 per visit, \\nCategory of Service: Ambulatory Surgery, Codes: Revenue Codes 360, 369, 490, 499, 750, and applicable CPT codes, 1/1/21 - 12/31/21: 135% of Medicare Allowable, 1/1/22 - 12/31/22: 140.4% of Medicare Allowable, 1/1/23 and thereafter: 146% of Medicare Allowable, \\nCategory of Service: Emergency Room Visit, Codes: Revenue Codes 450, 451, 452, 459, 1/1/21 - 12/31/21: 135% of Medicare Allowable, 1/1/22 - 12/31/22: 140.4% of Medicare Allowable, 1/1/23 and thereafter: 146% of Medicare Allowable, \\nCategory of Service: Emergency Room - Urgent Care Services (Facility), Codes: Revenue Code 456, 1/1/21 - 12/31/21: 135% of Medicare Allowable, 1/1/22 - 12/31/22: 140.4% of Medicare Allowable, 1/1/23 and thereafter: 146% of Medicare Allowable, \\nCategory of Service: Observation, Codes: Revenue Codes: 0760, 0762, 1/1/21 - 12/31/21: 140% of Medicare Allowable, 1/1/22 - 12/31/22: 145.6% of Medicare Allowable, 1/1/23 and thereafter: 151.4% of Medicare Allowable, \\n Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E, Health Net shall pay and Provider shall accept as payment in full for Medically Necessary Covered Services delivered under CommunityCare Benefit Programs pursuant to Addendum F, the lesser of the rates listed below, or one hundred percent (100%) of Provider's Allowable Charges. PV 2020 amd Page 20 of 22 CP HealthNet\\n\\n\\n\\n\\n\",\n", - " '21': '21 EXHIBIT F-2 COMMUNITYCARE BENEFIT PROGRAMS HOSPITAL QUALITY PERFORMANCE PROGRAM I. FFS COMPENSATION. Provider shall render Covered Services to Members and shall accept the compensation set forth in the applicable Exhibit as payment-in-full for Covered Services rendered to such Members. II. INCENTIVE PROGRAM. Effective for measurement/calendar year 2020, Provider shall qualify for participation in the quality incentive program if at least four (4) of the following requirements are met: 2.1 Electronic Health Records (EHR) Access. Provider must, upon request, grant Health Net access to all Health Net Member EHRs (i.e., medical records access and individual export of medical records for Health Net members via Health Information Exchange that Health Net participates with or via direct EHR access on Provider EHR portal). 2.2 Nurse Care Manager Access. Provider must, upon request, allow Health Net care management nurses access to Provider facilities in order to perform any needed case management duties. 2.3 Notification of Admission/Discharge/Transfer. Provider must provide Health Net with notification within twenty-four (24) hours, or the next business day if admitted/discharged on a weekend, for ninety percent (90%) of Provider\\'s admissions, discharges, transfers (two events per member per occurrence). Alternatively, Provider must provide Health Net with Admission/Discharge data via a Health Information Exchange that Health Net participates with or send it directly to Health Net so that Health Net receives admission and discharge notifications electronically (i.e. HL7/industry standard messages) in near real time. 2.4 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Score. Provider achieves both of the following: 1 A score of seventy-five percent (75%) or greater for the HCAHPS question \"Patients who reported YES they would definitely recommend the hospital\", as reported in the most recent survey period by CMS. 2 A composite score that meets the most recent Medicare Stars 4 star threshold for the HCAHPS Composite Measure \"Discharge Information\", as reported in the most recent survey period by CMS, based on the following questions: a) .did hospital staff talk with you about whether you would have the help you needed when you left the hospital?\" b) \" did you get information in writing about what symptoms or health problems to look out for after you left the hospital?\" 2.5 California Maternal Quality Care Collaborative (CMQCC) Maternal Data Center Reporting and Data Release. Provider with maternity service participates in the CMQCC Maternal Data Center Reporting initiative and signs an authorization release to share their hospital-specific results with Health Net. III. PROVIDER PARTICIPATION. If Provider satisfies the requirements above, then participation in the quality incentive program shall be granted. VI. METRICS. The quality incentive program is comprised of selected metrics, each carrying its own separate award value. The metrics are as follows: PV 2020 amd Page 21 of 22 HealthNet\\n\\n',\n", - " '22': \"22 4.1 Hospital Acquired Conditions (HACs). Provider Standardized Infection Ratio (SIR) for each of the five (5) HACs listed below is either less than 1.0 for inpatient admissions during the calendar year, or Provider must reduce its SIR by at least 0.25 for inpatient admissions in relation to its prior year experience. Each individual HAC is measured separately and is worth twenty percent (20%) of the overall HACs incentive. HACs measured are listed below: 1. Central line-associated bloodstream infection (CLABSI) 2. Catheter-associated urinary tract infections (CAUTI) 3. Methicillin-resistant staphylococcus aureus (MRSA) 4. Clostridium difficile (C.Diff) 5. Colorectal Surgical Site Infections (SSI-Colon) Source: California Department of Public Health (CDPH) portal and National Healthcare Safety Network (NHSN), if a measure is not reported on the CDPH portal, as posted on January 31 following the calendar year. Value: Twenty percent (20%) of the maximum incentive for the measurement year. 4.2 All-Cause Readmissions. Provider must have a risk-adjusted all-cause/any facility Member readmission rate that is ten percent (10%) lower for the Benefit Program for the measurement/calendar year compared to the provider year-end baseline performance from the prior calendar year. Readmission rates at or below four percent (4%) automatically qualify for this incentive regardless of improvement level from prior measurement years. Readmission rates that are higher than the original baseline performance will not qualify for this incentive. Source: Claims submitted to Health Net Value: Forty percent (40%) of the maximum incentive for the measurement year 4.3 Discharge Instructions. Upon review, Provider must demonstrate to Health Net that at least ninety-five percent (95%) of Members received discharge instructions including discharge information summarizing care and the following: name of hospitalist during inpatient stay, treatment/procedures provided, discharge diagnosis, current medication list and allergies, test results and a notation of pending/no pending test(s), and patient care instructions. Source: Provider EMR system via direct access or extract or other electronic notification system approved by Health Net Value: Twenty percent (20%) of the maximum incentive for the measurement year. 4.4 NTSV C-Sections. Provider NTSV C-Section rate provided by CMQCC is either twenty- three and nine tenths percent (23.9%) or less or ten percent (10%) lower for the CommunityCare Benefit Program for the measurement/calendar year compared to the provider year-end baseline performance from the prior calendar year. NTSV C-Section rate is defined as a live baby born at or beyond thirty-seven (37.0) weeks during a first pregnancy, who is a singleton, and is in the vertex position during cesarean birth. Source: California Maternal Quality Care Collaborative (CMQCC) Value: Twenty percent (20%) of the maximum incentive for the measurement year. V. PAYMENT. The maximum incentive for this program shall be equal to two percent (2%) of the inpatient fee-for-service (FFS) payments Health Net made to Provider during the measurement year related to providing Covered Services to Members in the measurement year for the applicable Benefit Program(s). Health Net shall confirm each of the requirements for the metrics above are met during the measurement year. If Health Net confirms one or more of the requirement are met, Provider shall receive a quality incentive payment equal to the combined percentage values of the maximum incentive. Payment shall be made within one-hundred and eighty (180) days after the end of the measurement year. Health Net reserves the right to discontinue or modify this incentive program with thirty (30) days' notice prior to the beginning of a measurement year. PV 2020 amd Page 22 of 22 Health Net\"}" - ] - }, - "execution_count": 52, - "metadata": {}, - "output_type": "execute_result" - } - ], - "source": [ - "import json\n", - "\n", - "def format_table(table_json):\n", - " table_text = \"\"\n", - " for i in range(len(table_json[list(table_json.keys())[0]])):\n", - " for key in table_json.keys():\n", - " if table_json[key][i]:\n", - " table_text += key + ': ' + table_json[key][i] + ', '\n", - " table_text += '\\n'\n", - " return table_text\n", - "\n", - "\n", - "def align_and_format_tables(text_dict):\n", - " aligned_text_dict = {}\n", - " for key, text in text_dict.items():\n", - " if 'Table Start' in text:\n", - " print(key)\n", - " table_texts = re.findall(r'-------Table Start--------(.*?)-------Table End--------', text, re.DOTALL)\n", - " for table_text in table_texts:\n", - " # Extract pretable text\n", - " pretable = table_text.split('{')[0].strip()\n", - "\n", - " # Extract and format table text\n", - " table_only = \"{\" + table_text.split('{', 1)[1].rsplit('}', 1)[0].replace(\"'\", '\"') + \"}\"\n", - " table = json.loads(table_only)\n", - " table_formatted = format_table(table)\n", - "\n", - " # Align\n", - " if text.count(pretable) == 2:\n", - " # Remove original table\n", - " aligned_text = text.replace(table_text, \"\")\n", - " # Align new table\n", - " aligned_text = aligned_text.replace(pretable, pretable + table_formatted)\n", + "def clean_td(td):\n", + " td_clean = []\n", + " for d in td:\n", + " new_d = {}\n", + " for k in d.keys():\n", + " if k not in ['page_num', 'Filename']:\n", + " if ',' in d[k]:\n", + " if 'DATE' not in k:\n", + " new_d[k] = [v.strip() for v in d[k].split(',')]\n", + " elif d[k] == 'N/A':\n", + " new_d[k] = []\n", " else:\n", - " aligned_text = text.replace(table_text, pretable + table_formatted)\n", - " aligned_text_dict[key] = aligned_text.replace(\"-------Table Start--------\", \"\").replace(\"-------Table End--------\", \"\")\n", - " \n", - " else:\n", - " aligned_text_dict[key] = text\n", - " \n", - " return aligned_text_dict\n", + " new_d[k] = [d[k]]\n", + " else:\n", + " new_d[k] = d[k]\n", + " td_clean.append(new_d)\n", + " return td_clean\n", "\n", - "align_and_format_tables(text_dict)" + "def get_unique_td(td):\n", + " unique_td_dict = {}\n", + " for d in td:\n", + " for key, value in d.items():\n", + " if key not in ['page_num', 'Filename']:\n", + " for v in value:\n", + " if key not in unique_td_dict.keys():\n", + " unique_td_dict[key] = [v]\n", + " else:\n", + " unique_td_dict[key].append(v)\n", + " final_dict = {key : list(set(unique_td_dict[key])) for key in unique_td_dict.keys()}\n", + " return final_dict\n", + "\n", + "def td_bu_combine(td, bu, text_dict):\n", + " bu_dicts = bu.copy()\n", + " td_dicts = td.copy()\n", + "\n", + " td_dicts_clean = clean_td(td_dicts)\n", + " unique_td = get_unique_td(td_dicts_clean)\n", + " \n", + " combined_list = []\n", + " for bud_ in bu_dicts:\n", + " bud = bud_.copy()\n", + " for key, value in unique_td.items():\n", + " if len(value) == 0: # No value in contract\n", + " bud.update({key : \"\"})\n", + " elif len(value) == 1: # 1 value in contract\n", + " bud.update({key : value[0]})\n", + " else: # More than one value in contract\n", + " # Check for value on the page\n", + " page_value = []\n", + " for d in td_dicts_clean:\n", + " if (d['page_num'] == bud['page_num']) and (key in d.keys()):\n", + " for v in d[key]:\n", + " page_value.append(v)\n", + " \n", + " if len(page_value) == 1: # One value on page\n", + " bud.update({key : page_value[0]})\n", + " elif len(page_value) > 1: # Multiple values on page\n", + " bud.update({key : ', '.join(page_value)})\n", + " elif len(page_value) == 0:\n", + " bud.update({key : \"\"}) \n", + " combined_list.append(bud)\n", + " return combined_list" ] }, { "cell_type": "code", - "execution_count": 46, + "execution_count": 94, + "metadata": {}, + "outputs": [], + "source": [ + "combined = td_bu_combine(td_results, bu_results, text_dict)" + ] + }, + { + "cell_type": "code", + "execution_count": 95, "metadata": {}, "outputs": [ { - "name": "stdout", - "output_type": "stream", - "text": [ - "6 EXHIBIT A-1 COMMERCIAL BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E, Health Net shall pay and Provider shall accept as payment in full for Medically Necessary Covered Services delivered under Commercial Benefit Programs pursuant to Addendum A, the lesser of the rates listed below, or one hundred percent (100%) of Provider's Allowable Charges. PV 2020 amd Page 6 of 22 G HealthNet'\n", - "\n", - "\n", - "-------Table Start-------- EXHIBIT A-1 COMMERCIAL BENEFIT PROGRAMS FEE-FOR-SERVICE RATE EXHIBIT {'Category of Service': ['', 'OB/C-Section and Vaginal Delivery (Mom and Baby)', 'Boarder Baby', 'Rehabilitation', 'All other Inpatient Services with a codeable Medicare DRG', 'All other Inpatient Services with a non- codeable Medicare DRG', '', 'Ambulatory Surgery', 'Emergency Room Visit', 'Emergency Room - Urgent Care Services (Facility)', 'Observation'], 'Codes': ['', 'MS-DRGs: 768, 783-788, 796-798, 805-807', 'Revenue Codes: 0170, 0171, 0179', 'Revenue Code: 0128', '', '', '', 'Revenue Codes: 0360, 0369, 0490, 0499, 0750, and applicable CPT Codes', 'Revenue Codes: 0450, 0451, 0452, 0459', 'Revenue Codes: 0456', 'Revenue Codes: 0760, 0762'], '1/1/21 - 12/31/21': ['Inpatient Services', '$12,600/3 day case rate. Additional days $4,000/day', '$1,000/day', '$2,500/diem', '167.5% of Medicare Allowable for the entire stay', '60% of Allowable Charges, not to exceed $7,000/day', 'Outpatient Services', '50% of Allowable Charges, not to exceed $6,000/visit', '50% of Allowable Charges, not to exceed $4,110/visit', '50% of Allowable Charges, not to exceed $3,820/visit', '50% of Allowable Charges, not to exceed $3,820/visit'], '1/1/22 - 12/31/22': ['', '$13,104/3 day case rate. Additional days $4,160/day', '$1,040/day', '$2,600/diem', '174.2% of Medicare Allowable for the entire stay', '60.6% of Allowable Charges, not to exceed $7,280/day', '', '50.5% of Allowable Charges, not to exceed $6,240/visit', '50.5% of Allowable Charges, not to exceed $4,274/visit', '50.5% of Allowable Charges, not to exceed $3,973/visit', '50.5% of Allowable Charges, not to exceed $3,973/visit'], '1/1/23 and thereafter': ['', '$13,628/3 day case rate. Additional days $4,326/day', '$1,082/day', '$2,704/diem', '181.2% of Medicare Allowable for the entire stay', '61.2% of Allowable Charges, not to exceed $7,571/day', '', '51% of Allowable Charges, not to exceed $6,490/visit', '51% of Allowable Charges, not to exceed $4,445/visit', '51% of Allowable Charges, not to exceed $4,132/visit', '51% of Allowable Charges, not to exceed $4,132/visit']} -------Table End--------\n", - "\n", - "\n" - ] + "data": { + "text/plain": [ + "['Medicaid',\n", + " 'Medicaid',\n", + " 'Medicaid',\n", + " 'Medicaid',\n", + " 'Medicaid',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " 'Commercial',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '',\n", + " '']" + ] + }, + "execution_count": 95, + "metadata": {}, + "output_type": "execute_result" } ], "source": [ - "print(text_dict['6'])" + "[c['CONTRACT_LOB'] for c in combined]" + ] + }, + { + "cell_type": "code", + "execution_count": 98, + "metadata": {}, + "outputs": [], + "source": [ + "utils.consolidate_individual(input_folder='../results/', output_folder='../output/')" ] }, {