Merged in bugfix/multiple_outliers_fixes (pull request #688)
bugfix/multiple_outlier_fixes to main * updated prompts * Merged main into bugfix/multiple_outliers_fixes * updated outlier maximum prompts Approved-by: Katon Minhas
This commit is contained in:
VenkataKrishna Reddy Avula
committed by
Katon Minhas
Katon Minhas
parent
edc48ec3c8
commit
e054f69860
@@ -632,55 +632,55 @@
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"field_name": "OUTLIER_FIRST_DOLLAR_IND",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "Determine whether the outlier payment is calculated on the entire claim amount (first dollar) or only on the portion exceeding the predetermined threshold from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **First Dollar Indicators (Y)**: Language suggesting payment applies to the entire claim when threshold is met:\n - 'X% of total charges when threshold is met'\n - 'X% of entire claim amount'\n - 'X% of all charges upon meeting criteria'\n - 'Full claim paid at X% rate when outlier triggered'\n\n2. **Excess-Only Indicators (N)**: Language suggesting payment applies only to amounts above threshold:\n - 'X% of charges exceeding the threshold'\n - 'X% of costs above the limit'\n - 'X% of excess charges over threshold'\n - 'Payment on amounts in excess of predetermined limit'\n\n3. **Calculation Method**: Contract language describing how the outlier payment amount is determined and what base amount is used for calculation\n\n**Common Indicator Phrases**:\n- **First Dollar (Y)**: 'total charges', 'entire claim', 'full amount', 'complete claim', 'all charges when', 'total cost when threshold met'\n- **Excess Only (N)**: 'exceeding the threshold', 'above the limit', 'excess charges', 'amounts over', 'portion exceeding', 'costs in excess of'\n\n**Decision Logic**:\n- **'Y'** = Outlier payment calculated on entire claim amount when threshold is met\n- **'N'** = Outlier payment calculated only on the portion exceeding the threshold\n- **'UNKNOWN'** = Information should be present but cannot be determined from contract language\n- **'N/A'** = Information is not relevant to this contract\n\n**Instructions**: Analyze the contract language to determine the calculation basis for outlier payments. Return a single indicator based on whether the payment applies to the full claim or only the excess portion.\n\n**Format**: Single character response ('Y', 'N', or 'N/A')"
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"prompt": "Determine whether the outlier payment is calculated on the entire claim amount (first dollar) or only on the portion exceeding the predetermined threshold from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **First Dollar Indicators (Y)**: Language suggesting payment applies to the entire claim when threshold is met:\n - 'X% of total charges when threshold is met'\n - 'X% of entire claim amount'\n - 'X% of all charges upon meeting criteria'\n - 'Full claim paid at X% rate when outlier triggered'\n\n2. **Excess-Only Indicators (N)**: Language suggesting payment applies only to amounts above threshold:\n - 'X% of charges exceeding the threshold'\n - 'X% of costs above the limit'\n - 'X% of excess charges over threshold'\n - 'Payment on amounts in excess of predetermined limit'\n\n3. **Calculation Method**: Contract language describing how the outlier payment amount is determined and what base amount is used for calculation\n\n**Common Indicator Phrases**:\n- **First Dollar (Y)**: 'total charges', 'entire claim', 'full amount', 'complete claim', 'all charges when', 'total cost when threshold met'\n- **Excess Only (N)**: 'exceeding the threshold', 'above the limit', 'excess charges', 'amounts over', 'portion exceeding', 'costs in excess of'\n\n**Decision Logic**:\n- **'Y'** = Outlier payment calculated on entire claim amount when threshold is met\n- **'N'** = Outlier payment calculated only on the portion exceeding the threshold\n- **'UNKNOWN'** = Information should be present but cannot be determined from contract language\n- **'N/A'** = Information is not relevant to this contract\n\n**Instructions**: Analyze the contract language to determine the calculation basis for outlier payments. Return a single indicator based on whether the payment applies to the full claim or only the excess portion.\n\n**Format**: Single character response ('Y', 'N', or 'N/A')"
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},
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{
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"field_name": "RANGE_NBR_DAYS",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "Extract the specific period (measured in days) that defines the window of time during which outlier payments are calculated from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **Calculation Period**: Specific number of days that define the outlier payment calculation window (e.g., '30 days', '60 days', '90 days')\n2. **Time Window Language**: Phrases describing the duration for outlier calculation (e.g., 'outlier period of X days', 'calculation window of X days', 'X-day outlier range')\n3. **Range Definitions**: Contract language that establishes the time frame for outlier assessment (e.g., 'days 1-30', 'within 60-day period', 'over 90-day span')\n4. **Unit Conversion**: If expressed in other time units, convert to days (e.g., 'two weeks' = '14 days', 'one month' = '30 days')\n\n**Common Indicator Phrases**: Look for 'number of days', 'days in range', 'days in the window', 'outlier period', 'calculation period', 'outlier range', 'time window', 'day range', 'period of X days', and similar time-based terminology.\n\n**Context**: This represents the specific timeframe during which outlier calculations are performed, distinct from threshold days that trigger eligibility.\n\n**Instructions**: Extract only the numerical value representing the number of days in the outlier calculation period. Convert other time units to days when necessary. If multiple calculation periods exist for different scenarios, return all values separated by commas. If no specific number of days is mentioned, return 'N/A'.\n\n**Format**: Numerical value only (e.g., '30', '60', '30,90' for multiple periods)"
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"prompt": "Extract the specific period (measured in days) that defines the window of time during which outlier payments are calculated from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **Calculation Period**: Specific number of days that define the outlier payment calculation window (e.g., '30 days', '60 days', '90 days')\n2. **Time Window Language**: Phrases describing the duration for outlier calculation (e.g., 'outlier period of X days', 'calculation window of X days', 'X-day outlier range')\n3. **Range Definitions**: Contract language that establishes the time frame for outlier assessment (e.g., 'days 1-30', 'within 60-day period', 'over 90-day span')\n4. **Unit Conversion**: If expressed in other time units, convert to days (e.g., 'two weeks' = '14 days', 'one month' = '30 days')\n\n**Common Indicator Phrases**: Look for 'number of days', 'days in range', 'days in the window', 'outlier period', 'calculation period', 'outlier range', 'time window', 'day range', 'period of X days', and similar time-based terminology.\n\n**Context**: This represents the specific timeframe during which outlier calculations are performed, distinct from threshold days that trigger eligibility.\n\n**Instructions**: Extract only the numerical value representing the number of days in the outlier calculation period. Convert other time units to days when necessary. If multiple calculation periods exist for different scenarios, return all values separated by commas. If no specific number of days is mentioned, return 'N/A'.\n\n**Format**: Numerical value only (e.g., '30', '60', '30,90' for multiple periods)"
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},
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{
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"field_name": "OUTLIER_FIXED_LOSS_NBR_DAYS_THRESHOLD",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "Extract the specific number of days that a patient's length of stay must exceed to qualify for outlier reimbursement from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **Exact Day Count**: Specific numeric values representing the minimum length of stay threshold (e.g., '10 days', '15 days', '30 days', 'exceeds 7 days')\n2. **Threshold Language**: Phrases establishing day-based criteria for outlier payments (e.g., 'length of stay exceeding X days', 'stays longer than X days', 'after X days', 'beyond X day threshold')\n3. **Unit Conversion**: If expressed in other time units, convert to days (e.g., 'three weeks' = '21 days', 'two months' = '60 days')\n4. **Multiple Thresholds**: Different day thresholds for different scenarios - extract all relevant day counts\n\n**Common Indicator Phrases**: Look for 'length of stay requirement', 'minimum stay', 'LOS threshold', 'day outlier threshold', 'length of stay exceeding', 'stays longer than', 'after [number] days', 'beyond [number] days', 'exceeds [number] days', 'over [number] days', 'more than [number] days', and similar day-based terminology.\n\n**Instructions**: Return only the numeric day value(s) that represent the threshold before outlier payments can potentially qualify. If multiple day thresholds exist, return all values separated by commas. If no specific number of days is mentioned, return 'N/A'.\n\n**Format**: Numeric value only (e.g., '10', '15', '7,14' for multiple thresholds)"
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"prompt": "Extract the specific number of days that a patient's length of stay must exceed to qualify for outlier reimbursement from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **Exact Day Count**: Specific numeric values representing the minimum length of stay threshold (e.g., '10 days', '15 days', '30 days', 'exceeds 7 days')\n2. **Threshold Language**: Phrases establishing day-based criteria for outlier payments (e.g., 'length of stay exceeding X days', 'stays longer than X days', 'after X days', 'beyond X day threshold')\n3. **Unit Conversion**: If expressed in other time units, convert to days (e.g., 'three weeks' = '21 days', 'two months' = '60 days')\n4. **Multiple Thresholds**: Different day thresholds for different scenarios - extract all relevant day counts\n\n**Common Indicator Phrases**: Look for 'length of stay requirement', 'minimum stay', 'LOS threshold', 'day outlier threshold', 'length of stay exceeding', 'stays longer than', 'after [number] days', 'beyond [number] days', 'exceeds [number] days', 'over [number] days', 'more than [number] days', and similar day-based terminology.\n\n**Instructions**: Return only the numeric day value(s) that represent the threshold before outlier payments can potentially qualify. If multiple day thresholds exist, return all values separated by commas. If no specific number of days is mentioned, return 'N/A'.\n\n**Format**: Numeric value only (e.g., '10', '15', '7,14' for multiple thresholds)"
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},
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{
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"field_name": "OUTLIER_FIXED_LOSS_THRESHOLD",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "Extract the specific dollar value or threshold amount that represents the minimum by which claim costs must exceed standard reimbursement to trigger outlier payment eligibility from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **Fixed Dollar Amounts**: Specific monetary values that must be exceeded (e.g., '$25,000', '$50,000', '$100,000')\n2. **Percentage-Based Thresholds**: Percentage values above standard payment (e.g., '150% of DRG rate', '200% of base payment', '120% of allowed amount')\n3. **Excess Amount Calculations**: Language describing how much costs must exceed base payment (e.g., 'costs exceeding payment by $X', 'loss amount above $X')\n4. **Multiple Thresholds**: Different threshold amounts for different scenarios or service types\n\n**Common Indicator Phrases**: Look for 'fixed loss charge threshold', 'outlier charge threshold', 'cost outlier charge threshold', 'stop-loss charge threshold', 'costs exceeding', 'charges above', 'threshold amount', 'loss threshold', 'outlier threshold', 'excess costs over', 'charges in excess of', and similar cost-based terminology.\n\n**Distinguish From**: This field captures cost/charge thresholds (dollar amounts or percentages), NOT day-based thresholds which are captured separately.\n\n**Instructions**: Return the specific threshold value that determines when a claim qualifies for additional outlier reimbursement. Include the unit ($ for dollar amounts, % for percentages). If multiple thresholds exist, return all values separated by commas. If no threshold is specified, return 'N/A'.\n\n**Format**: Include units - '$25000', '150%', '$50000,200%' for multiple thresholds"
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"prompt": "Extract the specific dollar value or threshold amount that represents the minimum by which claim costs must exceed standard reimbursement to trigger outlier payment eligibility from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **Fixed Dollar Amounts**: Specific monetary values that must be exceeded (e.g., '$25,000', '$50,000', '$100,000')\n2. **Percentage-Based Thresholds**: Percentage values above standard payment (e.g., '150% of DRG rate', '200% of base payment', '120% of allowed amount')\n3. **Excess Amount Calculations**: Language describing how much costs must exceed base payment (e.g., 'costs exceeding payment by $X', 'loss amount above $X')\n4. **Multiple Thresholds**: Different threshold amounts for different scenarios or service types\n\n**Common Indicator Phrases**: Look for 'fixed loss charge threshold', 'outlier charge threshold', 'cost outlier charge threshold', 'stop-loss charge threshold', 'costs exceeding', 'charges above', 'threshold amount', 'loss threshold', 'outlier threshold', 'excess costs over', 'charges in excess of', and similar cost-based terminology.\n\n**Distinguish From**: This field captures cost/charge thresholds (dollar amounts or percentages), NOT day-based thresholds which are captured separately.\n\n**Instructions**: Return the specific threshold value that determines when a claim qualifies for additional outlier reimbursement. Include the unit ($ for dollar amounts, % for percentages). If multiple thresholds exist, return all values separated by commas. If no threshold is specified, return 'N/A'.\n\n**Format**: Include units - '$25000', '150%', '$50000,200%' for multiple thresholds"
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},
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{
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"field_name": "OUTLIER_PCT_RATE_ON_EXCESS_CHARGES",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "Extract the percentage rate applied to the portion of charges or costs that exceed the outlier threshold for calculating additional reimbursement from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **Percentage Rates**: Specific percentage values applied to excess amounts (e.g., '80%', '75%', '90%')\n2. **Rate Application Language**: Phrases describing how the rate applies to excess costs (e.g., '80% of charges exceeding threshold', '75% of costs above limit', '90% of excess charges')\n3. **Decimal Conversions**: Convert decimal rates to whole percentages (e.g., '0.75' becomes '75', '0.80' becomes '80')\n4. **Multiple Rates**: Different percentage rates for different threshold levels or scenarios\n\n**Common Indicator Phrases**: Look for 'percentage of charges', 'percent of costs', 'rate applied to excess', '% of charges exceeding', '% of costs above', 'percent of excess charges', 'rate on excess costs', 'percentage applied to', 'reimbursement rate of', and similar percentage-based terminology.\n\n**Calculation Context**: This rate is specifically applied to the amount that exceeds the outlier threshold, not to the total claim amount.\n\n**Instructions**: Extract only the numerical percentage value that represents the rate applied to excess charges or costs above the outlier threshold. If multiple rates exist for different scenarios, return all values separated by commas. Convert decimals to whole percentages. If no percentage rate is specified, return 'N/A'.\n\n**Format**: Numerical value only without % symbol (e.g., '75', '80', '75,90' for multiple rates)"
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"prompt": "Extract the percentage rate applied to the portion of charges or costs that exceed the outlier threshold for calculating additional reimbursement from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **Percentage Rates**: Specific percentage values applied to excess amounts (e.g., '80%', '75%', '90%')\n2. **Rate Application Language**: Phrases describing how the rate applies to excess costs (e.g., '80% of charges exceeding threshold', '75% of costs above limit', '90% of excess charges')\n3. **Decimal Conversions**: Convert decimal rates to whole percentages (e.g., '0.75' becomes '75', '0.80' becomes '80')\n4. **Multiple Rates**: Different percentage rates for different threshold levels or scenarios\n\n**Common Indicator Phrases**: Look for 'percentage of charges', 'percent of costs', 'rate applied to excess', '% of charges exceeding', '% of costs above', 'percent of excess charges', 'rate on excess costs', 'percentage applied to', 'reimbursement rate of', and similar percentage-based terminology.\n\n**Calculation Context**: This rate is specifically applied to the amount that exceeds the outlier threshold, not to the total claim amount.\n\n**Instructions**: Extract only the numerical percentage value that represents the rate applied to excess charges or costs above the outlier threshold. If multiple rates exist for different scenarios, return all values separated by commas. Convert decimals to whole percentages. If no percentage rate is specified, return 'N/A'.\n\n**Format**: Numerical value only without % symbol (e.g., '75', '80', '75,90' for multiple rates)"
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},
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{
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"field_name": "OUTLIER_MAXIMUM",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "What is the maximum dollar amount that can be reimbursed for an outlier claim, regardless of actual costs incurred? Extract any outlier terms or reimbursement methodology language that sets a reimbursement cap or maximum limit specifically for qualifying outlier claims. Look for 'maximum outlier payment', 'outlier payment shall not exceed', 'outlier cap', 'outlier reimbursement limited to', 'outlier payment capped at'. IMPORTANT: Do NOT include general payment caps like 'shall not exceed billed charges' or overall reimbursement limits - only extract maximums that specifically apply to the outlier payment portion. Return dollar amount only (e.g. '$500000') or 'N/A'."
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"prompt": "What is the maximum dollar amount that can be reimbursed for an outlier claim, regardless of actual costs incurred? Extract any outlier terms or reimbursement methodology language that sets a reimbursement cap or maximum limit specifically for qualifying outlier claims. This can be either a fixed dollar amount or a payment per unit in excess maximum. Look for 'maximum outlier payment', 'outlier payment shall not exceed', 'outlier cap', 'outlier reimbursement limited to', 'outlier payment capped at'. IMPORTANT: Do NOT include general payment caps like 'shall not exceed billed charges' or overall reimbursement limits - only extract maximums that specifically apply to the outlier payment portion.\n\nExamples:\n- '$6,049 per diem for Obstetrical Services Days in Excess of 8 day Threshold' → Extract: $6049\n- '$6,368 for Cardiac Services Days in Excess of 12 days threshold' → Extract: $6368\n\nReturn dollar amount only (e.g. '$500000') or 'N/A'."
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},
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{
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"field_name": "OUTLIER_MAXIMUM_FREQUENCY",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "If there is a cap on the total amount to be paid for outlier claims, what is the frequency of that cap? This may be per claim, per day (per diem), or per admission. Look for terms like 'maximum outlier payment per claim', 'outlier payment shall not exceed per day', or similar phrasing. Return the exact phrase used in the contract (e.g., 'per admission', 'per claim', 'per day', 'per case', 'per stay'). If not specified, write 'N/A'."
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"prompt": "If there is a cap on the total amount to be paid for outlier claims, what is the frequency of that cap? This may be per claim, per day (per diem), or per admission. The outlier maximum can be either a fixed dollar amount or a payment per unit in excess maximum. Look for terms like 'maximum outlier payment per claim', 'outlier payment shall not exceed per day', or similar phrasing.\n\nExamples:\n- '$6,049 per diem for Obstetrical Services Days in Excess of 8 day Threshold' → Extract: per diem\n- '$6,368 for Cardiac Services Days in Excess of 12 days threshold' → Extract: per day (inferred from 'days in excess')\n\nNote: When frequency is not explicitly mentioned but can be inferred from context (e.g., 'days in excess of threshold' implies 'per day'), extract the inferred frequency.\n\nReturn the exact phrase used in the contract (e.g., 'per admission', 'per claim', 'per day', 'per case', 'per stay'). If not specified, write 'N/A'."
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},
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{
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"field_name": "OUTLIER_EXCLUSION_CD",
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"relationship": "one_to_n",
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"field_type": "outlier",
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"prompt": "Extract specific codes listed in the contract that are excluded from outlier reimbursement eligibility, even if cost or length thresholds are met, from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **Code Types**: CPT codes, HCPCS codes, DRG codes, revenue codes, ICD diagnosis codes, or procedure codes that are explicitly excluded\n2. **Exclusion Lists**: Specific code numbers or ranges that are not eligible for outlier payments (e.g., 'CPT 12345', 'DRG 470-472', 'Revenue Code 0370')\n3. **Code Categories**: Groups of codes excluded by category (e.g., 'all psychiatric DRGs', 'experimental procedure codes', 'rehabilitation revenue codes')\n4. **Individual vs Range**: Both single codes and code ranges that are excluded from outlier calculations\n\n**Common Indicator Phrases**: Look for 'excluding the following codes', 'codes not eligible for outlier payments', 'outlier exclusions', 'excluded from outlier calculation', 'not applicable to codes', 'codes exempt from outlier', 'outlier payments do not apply to', and similar exclusion terminology.\n\n**Instructions**: Extract only the specific codes that are explicitly excluded from outlier reimbursement. Include code prefixes (CPT, DRG, etc.) when specified. If multiple codes are excluded, list all codes separated by commas. If the contract excludes codes but doesn't specify the actual code numbers, describe the exclusion category. If no codes are specifically excluded, return 'N/A'.\n\n**Format**: Include code type when specified (e.g., 'CPT 12345, DRG 470, Revenue Code 0370' or 'All psychiatric DRGs')"
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"prompt": "Extract specific codes listed in the contract that are excluded from outlier reimbursement eligibility, even if cost or length thresholds are met, from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **Code Types**: CPT codes, HCPCS codes, DRG codes, revenue codes, ICD diagnosis codes, or procedure codes that are explicitly excluded\n2. **Exclusion Lists**: Specific code numbers or ranges that are not eligible for outlier payments (e.g., 'CPT 12345', 'DRG 470-472', 'Revenue Code 0370')\n3. **Code Categories**: Groups of codes excluded by category (e.g., 'all psychiatric DRGs', 'experimental procedure codes', 'rehabilitation revenue codes')\n4. **Individual vs Range**: Both single codes and code ranges that are excluded from outlier calculations\n\n**Common Indicator Phrases**: Look for 'excluding the following codes', 'codes not eligible for outlier payments', 'outlier exclusions', 'excluded from outlier calculation', 'not applicable to codes', 'codes exempt from outlier', 'outlier payments do not apply to', and similar exclusion terminology.\n\n**Instructions**: Extract only the specific codes that are explicitly excluded from outlier reimbursement. Include code prefixes (CPT, DRG, etc.) when specified. If multiple codes are excluded, list all codes separated by commas. If the contract excludes codes but doesn't specify the actual code numbers, describe the exclusion category. If no codes are specifically excluded, return 'N/A'.\n\n**Format**: Include code type when specified (e.g., 'CPT 12345, DRG 470, Revenue Code 0370' or 'All psychiatric DRGs')"
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},
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{
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"field_name": "OUTLIER_EXCLUSION_CD_DESC",
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"relationship": "TBD",
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"field_type": "TBD",
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"prompt": "Extract the description of the specific codes listed in the contract that are excluded from outlier reimbursement eligibility, providing the explanatory text associated with each excluded code from the service description and reimbursement methodology. Focus on identifying:\n\n**What to Look For:**\n1. **Code Descriptions**: Specific explanations provided for each excluded code (e.g., 'Experimental surgical procedure', 'Routine laboratory tests', 'Rehabilitation services')\n2. **Service Categories**: Descriptive text explaining the type of services represented by excluded codes (e.g., 'Physical therapy services', 'Diagnostic imaging', 'Outpatient procedures')\n3. **Exclusion Rationale**: Contract language explaining why certain codes are excluded (e.g., 'Non-acute care services', 'Elective procedures', 'Preventive care services')\n4. **Associated Descriptions**: Text that directly correlates with the codes identified in OUTLIER_EXCLUSION_CD\n\n**Common Description Types**: Look for service descriptions, procedure explanations, diagnostic categories, treatment types, or administrative reasons provided alongside excluded codes.\n\n**Instructions**: For each code identified in OUTLIER_EXCLUSION_CD, extract the specific description of that code as provided in the contract. Only include descriptions that are directly associated with excluded codes. Match descriptions to their corresponding codes when possible. If the contract lists excluded codes without descriptions, return 'N/A'.\n\n**Format**: Provide descriptions in the same order as codes listed in OUTLIER_EXCLUSION_CD, separated by commas (e.g., 'Experimental surgical procedure, Routine diagnostic tests, Rehabilitation services')"
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"prompt": "Extract the description of the specific codes listed in the contract that are excluded from outlier reimbursement eligibility, providing the explanatory text associated with each excluded code from the service description and reimbursement methodology or outlier terms. Focus on identifying:\n\n**What to Look For:**\n1. **Code Descriptions**: Specific explanations provided for each excluded code (e.g., 'Experimental surgical procedure', 'Routine laboratory tests', 'Rehabilitation services')\n2. **Service Categories**: Descriptive text explaining the type of services represented by excluded codes (e.g., 'Physical therapy services', 'Diagnostic imaging', 'Outpatient procedures')\n3. **Exclusion Rationale**: Contract language explaining why certain codes are excluded (e.g., 'Non-acute care services', 'Elective procedures', 'Preventive care services')\n4. **Associated Descriptions**: Text that directly correlates with the codes identified in OUTLIER_EXCLUSION_CD\n\n**Common Description Types**: Look for service descriptions, procedure explanations, diagnostic categories, treatment types, or administrative reasons provided alongside excluded codes.\n\n**Instructions**: For each code identified in OUTLIER_EXCLUSION_CD, extract the specific description of that code as provided in the contract. Only include descriptions that are directly associated with excluded codes. Match descriptions to their corresponding codes when possible. If the contract lists excluded codes without descriptions, return 'N/A'.\n\n**Format**: Provide descriptions in the same order as codes listed in OUTLIER_EXCLUSION_CD, separated by commas (e.g., 'Experimental surgical procedure, Routine diagnostic tests, Rehabilitation services')"
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},
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{
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"field_name": "STOP_LOSS_TERMS",
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