Update for confusing language

This commit is contained in:
Katon Minhas
2025-12-11 17:18:37 -06:00
parent a00ffd4b98
commit 57a2907bbd
@@ -238,7 +238,7 @@ You will be shown a Reimbursement Term, and the section of a contract from which
Closely examine the contract text, find the Reimbursement Term, and decide which field value or values apply to the Reimbursement Term.
CRITICAL CONSIDERATIONS:
1. Look for what {field_name} the Program actually *applies* to. This is not the same as the Schedule used as a basis for calculation. For example, many LOBs use Medicaid as a basis for their calculation. The presence of 'Medicaid' as a rate does not on it's own guarantee that the Reimbursement Term is 'Medicaid'.
1. Look for what {field_name} the Service actually *applies to*. This is not the same as the Schedule used as a basis for calculation. For example, many LOBs use Medicaid as a basis for their calculation. The presence of 'Medicaid' as a rate does not on it's own guarantee that the Reimbursement Term is 'Medicaid'.
2. USE THE SERVICE_TERM AS PRIMARY CONTEXT: The Service Term shows which programs are mentioned together. If the Service Term explicitly lists specific programs (e.g., "STAR, CHIP HMO, CHIP PERINATE, and STAR+PLUS"), those are the programs that apply to reimbursement terms in that section. Do NOT assign programs that are mentioned in completely separate sections of the contract.