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:
committed by
Alex Galarce
parent
c55e8a30cd
commit
a3df2f3e15
@@ -69,7 +69,6 @@ COLUMN_ORDER = [
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"REIMB_PCT_RATE",
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"REIMB_FEE_RATE",
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"REIMB_CONVERSION_FACTOR",
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"NOT_TO_EXCEED_IND",
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"TRIGGER_CAP_THRESHOLD_AMT",
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"TRIGGER_BASE_THRESHOLD",
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"DEFAULT_IND",
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@@ -88,12 +88,6 @@
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"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.",
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"format": "date"
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},
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{
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"field_name": "NOT_TO_EXCEED_IND",
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"relationship": "one_to_n",
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"field_type": "methodology_breakout",
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"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'."
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},
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{
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"field_name": "FEE_SCHEDULE",
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"relationship": "one_to_n",
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