stoploss fix
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@@ -209,6 +209,7 @@ def prompt_carveout_check(
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instruction=prompt_templates.CARVEOUT_CHECK_INSTRUCTION(),
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usage_label="CARVEOUT_CHECK",
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)
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logging.debug(f"Carveout/ special case check for {filename}: {llm_answer_raw}")
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carveout_answer = string_utils.extract_text_from_delimiters(
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llm_answer_raw, Delimiter.PIPE
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@@ -996,6 +996,7 @@ VALID entries - return YES:
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- "Lesser of" or "greater of" statements with clear and specific rates
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- Capitation rates (PMPM, PMPY, per member costs)
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- Flat rates per service or episode
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- These Special cases: OUTLIER, STOP_LOSS, SEQUESTRATION, DISCOUNT, PREMIUM, RATE_ESCALATOR, FACILITY_ADJUSTMENT
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INVALID entries - return NO unless there is VALID language as well:
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- 'Empty' Reimbursements - have the same structure as a valid reimbursement but doesn't actually reference any specific rate or fee schedule (e.g. "Covered Services will be paid at the rates stated in the next section")
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