diff --git a/src/pipelines/shared/extraction/one_to_n_funcs.py b/src/pipelines/shared/extraction/one_to_n_funcs.py index a692f69..3b6180f 100644 --- a/src/pipelines/shared/extraction/one_to_n_funcs.py +++ b/src/pipelines/shared/extraction/one_to_n_funcs.py @@ -239,7 +239,7 @@ def process_single_carveout( return ("reimbursement", answer_dict) elif reimbursement_categorization in special_case_definitions.keys(): - answer_dict[reimbursement_categorization] = reimb_term + answer_dict[reimbursement_categorization] = f"{service_term} - {reimb_term}" answer_dict.pop("REIMB_TERM", None) answer_dict.pop("SERVICE_TERM", None) return ("special_case", answer_dict) diff --git a/src/prompts/prompt_templates.py b/src/prompts/prompt_templates.py index 3a0d5ca..1caaf89 100644 --- a/src/prompts/prompt_templates.py +++ b/src/prompts/prompt_templates.py @@ -678,6 +678,15 @@ DECISION LOGIC: If nothing applies → return N/A + CONDITIONAL METHODOLOGY RULE: + -If a “lesser of” or “not to exceed” statement: + →Applies only under a specific condition (e.g., “where there is no rate,” “if not listed,” “when no fee schedule exists”), and + →Defines an alternative reimbursement method rather than limiting the base METHODOLOGY, + -Treat it as a separate reimbursement methodology. + -Do NOT apply it as a constraint to the primary METHODOLOGY. + -Do NOT merge it into the output. + -Only include “lesser of” or “not to exceed” language when it operates as an overarching ceiling that applies to the base METHODOLOGY itself. + 3. COMBINE & FORMAT Substitution: