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Merged in bugfix/utah_grouper_issues (pull request #730)

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updated grouper reimb method and grouper type prompt

* updated grouper reimb method and grouper type prompt

* updated reimb method prompt


Approved-by: Katon Minhas
This commit is contained in:
VenkataKrishna Reddy Avula
2025-10-09 15:26:59 +00:00
committed by Katon Minhas
parent 6aaa399171
commit bb7404ed62
1 changed files with 2 additions and 2 deletions
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fieldExtraction/src/prompts/investment_prompts.json
+2 -2
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@@ -33,7 +33,7 @@
"field_name": "AARETE_DERIVED_REIMB_METHOD",
"relationship": "one_to_n",
"field_type": "methodology_breakout",
"prompt": "What is the method of reimbursement? Choose only from the following valid values: {valid_values}.\nFollow these mapping rules:\n- If any of Medicare, Medicaid, Average Sales Price (ASP), AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), RBRVS (Resource-Based Relative Value Scale), RVU (Relative Value Unit) or ASA (American Society of Anesthesiology) or any type of Fee Schedule is mentioned, return 'Fee Schedule'\n- In case of MS-DRG, AP-DRG, SDA (Standard Dollar Amount), APR-DRG, APG, EAPG, APC/ OPPS or ASC, return 'Grouper'.\n- In case of Percent of Charge or Percentage of Billed, return 'Billed Charges'.\n- When reimbursement is defined on a per-day basis, the applicable method is Per Diem.\n- For mixed methodologies (e.g., 'cost plus 5% based on AWP'), prioritize the base method (AWP)\n\nImportant exceptions and additional rules:\n- Reimbursements with specific dollar values cannot be 'Fee Schedule'\n- Provider interest rates are not considered 'Flat Rate'.\n- Charge master increase caps or limitations on provider pricing behavior are NOT reimbursement methodologies and should be ignored.\n\nIf no specific rule is matched, map to the most appropriate value from the given valid values.",
"prompt": "What is the method of reimbursement? Choose only from the following valid values: {valid_values}.\nFollow these mapping rules:\n- If any of Medicare, Medicaid, Average Sales Price (ASP), AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), RBRVS (Resource-Based Relative Value Scale), RVU (Relative Value Unit) or ASA (American Society of Anesthesiology) or any type of Fee Schedule is mentioned, return 'Fee Schedule'\n- In case of DRG, MS-DRG, AP-DRG, SDA (Standard Dollar Amount), APR-DRG, APG, EAPG, APC/OPPS(Outpatient Prospective Payment System) or ASC, return 'Grouper'.\n- In case of Percent of Charge or Percentage of Billed, return 'Billed Charges'.\n- When reimbursement is defined on a per-day basis, the applicable method is Per Diem.\n- For mixed methodologies (e.g., 'cost plus 5% based on AWP'), prioritize the base method (AWP)\n\nImportant exceptions and additional rules:\n- Reimbursements with specific dollar values cannot be 'Fee Schedule'\n- Provider interest rates are not considered 'Flat Rate'.\n- Charge master increase caps or limitations on provider pricing behavior are NOT reimbursement methodologies and should be ignored.\n\nIf no specific rule is matched, map to the most appropriate value from the given valid values.",
"valid_values": "VALID_REIMB_TERM_FULL"
},
{
@@ -399,7 +399,7 @@
"field_name": "GROUPER_TYPE",
"relationship": "one_to_n",
"field_type": "grouper_breakout",
"prompt": "Extract all grouper types from the Service and Methodology. Look for MS-DRG, APR-DRG, DRG, APC, APG, EAPG, OPPS and similar grouper methodologies. Follow these rules: 1) Standardize all MS-DRG variations (MSDRG, MS DRG, MSDRGs, etc.) to 'MS-DRG'. 2) Standardize all APR-DRG variations (APRDRG, APR DRG, APRDRGs, etc.) to 'APR-DRG'. 3) For other DRG variants (Ohio Medicaid DRG, Non-weighted DRGs, TDH DRG, etc.), extract only 'DRG' without prefixes. 4) Remove all descriptive prefixes - for 'Surgical MSDRGs' return 'MS-DRG', for 'Enhanced APR-DRG' return 'APR-DRG'. 5) In case of OPPS, return APC as a grouper type. 6) When both MS-DRG/APR-DRG and generic DRG are present in same context, extract only the specific one (MS-DRG or APR-DRG), not both. 7) Extract only abbreviations, not full forms. If multiple different grouper types are found, separate them with commas. Do not return empty arrays, empty strings, or brackets. If no grouper methodology is found, return only N/A."
"prompt": "Extract all grouper types from the Service and Methodology. Look for MS-DRG, APR-DRG, DRG, APC, APG, EAPG, OPPS (Outpatient Prospective Payment System) and similar grouper methodologies. Follow these rules: 1) Standardize all MS-DRG variations (MSDRG, MS DRG, MSDRGs, etc.) to 'MS-DRG'. 2) Standardize all APR-DRG variations (APRDRG, APR DRG, APRDRGs, etc.) to 'APR-DRG'. 3) For other DRG variants (Ohio Medicaid DRG, Non-weighted DRGs, TDH DRG, etc.), extract only 'DRG' without prefixes. 4) Remove all descriptive prefixes - for 'Surgical MSDRGs' return 'MS-DRG', for 'Enhanced APR-DRG' return 'APR-DRG'. 5) In case of OPPS or Outpatient Prospective Payment System of any type, return 'APC'. 6) When both MS-DRG/APR-DRG and generic DRG are present in same context, extract only the specific one ('MS-DRG' or 'APR-DRG'), not both. 7) Extract only abbreviations, not full forms. If multiple different grouper types are found, separate them with commas. Do not return empty arrays, empty strings, or brackets. If no grouper methodology is found, return only N/A."
},
{
"field_name": "GROUPER_CD",