Merged in bugfix/lesser_of_ind (pull request #551)
bugfix/lesser_of_ind to main * updated lesser_of_ind prompt * Merged main into bugfix/lesser_of_ind Approved-by: Katon Minhas
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Katon Minhas
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4c1b85a2e8
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99f08796fb
@@ -15,7 +15,7 @@
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"field_name": "LESSER_OF_IND",
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"relationship": "one_to_n",
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"field_type": "methodology_breakout",
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"prompt": "If the methodology text explicitly states that the reimbursement shall be the lesser of two or more values, write 'Y' for this field. Do not select 'Y' if the text only includes 'not to exceed' without using 'lesser of' terminology. Otherwise, write 'N'."
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"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 write 'Y' for language that merely sets a maximum limit or cap on a single reimbursement method (such as 'not to exceed', 'up to', 'maximum of', or 'capped at'). \n\nOtherwise, write 'N'."
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},
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{
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"field_name": "GREATER_OF_IND",
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