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Merged in feature/filter-out-clean-claims (pull request #609)

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Enhance INVALID entries examples in reimbursement guidelines for clean claims

* Enhance INVALID entries examples in reimbursement guidelines for clean claims


Approved-by: Katon Minhas
This commit is contained in:
Alex Galarce
2025-07-10 18:20:21 +00:00
parent 45db295d17
commit de2e7291d1
1 changed files with 3 additions and 0 deletions
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fieldExtraction/src/prompts/investment_prompts.py
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@@ -340,12 +340,15 @@ INVALID entries (return NO):
- Coverage limitations without payment rates
- General benefit descriptions
- Exclusions or non-covered statements
- Processing instructions that reference external methodologies without specific rates
- Claims processing procedures that don't specify actual payment amounts
Examples:
✅ "reimbursed at 100% of DMAP fee schedule" → YES (clear payment method)
✅ "flat rate of $20.00 per frame" → YES (specific rate)
❌ "Standard eyeglass lenses as defined by DMAP are CR39 lenses..." → NO (definition only)
❌ "Contact lenses must be prior authorized" → NO (authorization only)
❌ "Community shall process Clean Claims based on the then current Medicare or Medicaid Fee Schedule cost index as applicable to services rendered and according to Medicare reimbursement methodology, Including the geographic practice (GPCI), or Medicaid reimbursement methodology as applicable." → NO (definition only)
Briefly explain your reasoning, then return YES or NO in |pipes|."""