Merged in feature/remove-nte (pull request #653)

Feature/remove nte

* Revert prompts

* Remove qa_qc tests

* Remove valid lines

* Update crosswalk path

* remove extra argument from split compound reimbursement

* model aliasing

* Haiku alias

* remove erroneous import

* Merge branch 'refactor/update-claude-models' into bugfix/aug-5-issue-fixes

* Convert all matching codes to strings

* Exit if service is empty

* Merged main into bugfix/aug-5-issue-fixes

* global lesser of fix

* Merge branch 'main' into feature/remove-nte

* Remove NTE


Approved-by: Alex Galarce
This commit is contained in:
Katon Minhas
2025-08-06 17:18:12 +00:00
committed by Alex Galarce
parent c55e8a30cd
commit a3df2f3e15
2 changed files with 0 additions and 7 deletions
@@ -69,7 +69,6 @@ COLUMN_ORDER = [
"REIMB_PCT_RATE",
"REIMB_FEE_RATE",
"REIMB_CONVERSION_FACTOR",
"NOT_TO_EXCEED_IND",
"TRIGGER_CAP_THRESHOLD_AMT",
"TRIGGER_BASE_THRESHOLD",
"DEFAULT_IND",
@@ -88,12 +88,6 @@
"prompt": "Identify the termination date for reimbursement rates:\n- Look for dates associated with:\n • 'Termination' or 'termination date'\n • 'Expires' or 'expiration date'\n • 'Through' or 'until'\n- Dates may appear as:\n • Full dates (12/1/17, December 1, 2017)\n • Month and year (December 2017)\n • Year only (2017). Do NOT include dates written in the footer of the page.",
"format": "date"
},
{
"field_name": "NOT_TO_EXCEED_IND",
"relationship": "one_to_n",
"field_type": "methodology_breakout",
"prompt": "Determine if this reimbursement component contains or is subject to a monetary payment limitation:\n\n**EXPLICIT LIMITATION PHRASES:**\n• 'not to exceed', 'NTE', 'shall not exceed', 'cannot exceed'\n• 'maximum of', 'max of', 'up to', 'capped at', 'ceiling of'\n• 'limited to', 'subject to a limit of'\n\n**IMPLICIT LIMITATIONS:**\n• Percentage calculations with explicit caps (e.g. '80% up to $500')\n• Payment formulas combined with ceiling amounts\n• Any reimbursement rate with a defined upper monetary boundary\n\n**COMPONENT ANALYSIS RULES:**\n• If ANY component in the methodology has a limitation, ALL components get 'Y'\n• If this component IS a cap/ceiling/maximum amount: Return 'Y'\n• If this component is SUBJECT TO a limitation: Return 'Y'\n• Consider only monetary payment limitations\n\n**EXCLUSIONS:**\n• Do not include administrative restrictions, eligibility limits, or service quantity limitations\n• Do not include payment timing constraints\n\n**EXAMPLES:**\n• '30% of charges, not to exceed $75' → Both components get 'Y'\n• '$75 maximum payment' → Gets 'Y' (is itself a limitation)\n• '80% of Medicare rates' → Gets 'N' (exact payment, not a limitation)\n\nReturn 'Y' if any monetary payment limitation exists in the methodology or if this component represents a monetary limitation itself, otherwise 'N'."
},
{
"field_name": "FEE_SCHEDULE",
"relationship": "one_to_n",