From 69aebb053eda6526e76af9f92b1dcca80cd98d02 Mon Sep 17 00:00:00 2001 From: VenkataKrishna Reddy Avula Date: Wed, 18 Jun 2025 18:38:43 +0000 Subject: [PATCH] Merged in bugfix/lesser_of_rows_and_pct_rate (pull request #576) bugfix/lesser_of_rows_and_pct_rate -> main * updated reimb term breakout prompt * updated lesser_of_ind prompt * Merged main into bugfix/lesser_of_rows_and_pct_rate * Merged main into bugfix/lesser_of_rows_and_pct_rate Approved-by: Katon Minhas --- fieldExtraction/src/prompts/investment_prompts.json | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/fieldExtraction/src/prompts/investment_prompts.json b/fieldExtraction/src/prompts/investment_prompts.json index 20a8082..240feb2 100644 --- a/fieldExtraction/src/prompts/investment_prompts.json +++ b/fieldExtraction/src/prompts/investment_prompts.json @@ -15,7 +15,7 @@ "field_name": "LESSER_OF_IND", "relationship": "one_to_n", "field_type": "methodology_breakout", - "prompt": "If the methodology text explicitly describes reimbursement as being determined by selecting the smaller/lowest amount from two or more distinct reimbursement calculations or rate structures, write 'Y' for this field. \n\nThis includes language such as 'lesser of', 'lower of', 'minimum of', or equivalent comparative language that establishes multiple reimbursement pathways where the smallest amount is selected. \n\nWrite 'Y' only when there are multiple distinct reimbursement methodologies being compared (e.g., billed charges vs. fee schedule, different percentage calculations, brand vs. generic pricing). \n\nDo NOT select 'Y' for:\n- 'Not to exceed' language (even when it involves comparing to a limit)\n- Cap or ceiling language without explicit comparison terms\n- Payment structures that reference multiple values but use limiting language rather than comparison language\n\nOnly select 'Y' when the text explicitly uses comparison terminology to choose between options.\n\nOtherwise, write 'N'." + "prompt": "If the methodology text explicitly describes reimbursement as being determined by selecting the smaller/lowest amount from two or more distinct reimbursement calculations or rate structures, write 'Y' for this field. \n\nThis includes language such as 'lesser of', 'lower of', 'minimum of', or equivalent comparative language that establishes multiple reimbursement pathways where the smallest amount is selected. \n\nWrite 'Y' only when there are multiple distinct reimbursement methodologies being compared (e.g., billed charges vs. fee schedule, different percentage calculations, brand vs. generic pricing). \n\nSPECIAL CASE: If the methodology contains the phrase 'At no time shall Plan pay an amount that exceeds Provider's billed charges' (or substantially similar language) AND there is at least one other reimbursement calculation present in the methodology, treat this as a 'lesser of' scenario comparing the other reimbursement method against Provider's billed charges. In this case, write 'Y'.\n\nDo NOT select 'Y' for:\n- Standard 'not to exceed' language (even when it involves comparing to a limit)\n- Cap or ceiling language without explicit comparison terms\n- Payment structures that reference multiple values but use limiting language rather than comparison language\n- The special case phrase when it appears alone without other reimbursement calculations\n\nOnly select 'Y' when the text explicitly uses comparison terminology to choose between options OR when the special case condition is met.\n\nOtherwise, write 'N'." }, { "field_name": "GLOBAL_LESSER_OF_STATEMENT",