Merged in bugfix/ut-carveout-fixes (pull request #746)

Bugfix/ut carveout fixes

* carveout definition change

* carveout definition change

* chargemaster removed

* Merged main into bugfix/ut-carveout-fixes

* chargemaster removed

* Merge branch 'bugfix/ut-carveout-fixes' of https://bitbucket.org/aarete/doczy.ai into bugfix/ut-carveout-fixes


Approved-by: Katon Minhas

fieldExtraction/constants/mappings/valid_carveouts.json

@@ -4,7 +4,7 @@
     },
     "mapping": {
         "BASE_COVERED_SERVICES": "Describes foundational payment methodologies for standard covered services, including primary coverage determinations. This refers to payment methodologies that establish the fundamental reimbursement structure, not exceptions or adjustments to it. Examples:\n- 'covered services'\n- 'Covered Services not included in the Service Categories in Table 1 shall be reimbursed at 100% of the Medicare fee schedule'\n- Primary coverage methodologies in dual products (e.g., 'services primary to Medicare', 'services primary to Medicaid')\n- Base reimbursement rates that form the foundation of the payment structure",
-        "PAYMENT_CARVEOUT": "Describes payments for specific services, procedures, level designations, or specific codes that are carved out from the base/foundational payment methodology with distinct payment terms. These are exceptions or specialty payments that differ from the standard approach. Examples include 'Radiology covered services', 'Anesthesia covered services', 'Pharmaceuticals' and 'HEMATOCRIT (CPT CODE: 85014)'. Do NOT classify as payment carveout if the service represents a foundational coverage determination (such as primary payer methodologies in dual products) rather than a true exception to standard payment.",
+        "PAYMENT_CARVEOUT": "Describes payments for specific services, procedures, level designations, or specific DRG or codes that are carved out from the base/foundational payment methodology with distinct payment terms. These are exceptions or specialty payments that differ from the standard approach. Examples include 'Radiology covered services', 'Anesthesia covered services', 'Pharmaceuticals' and 'HEMATOCRIT (CPT CODE: 85014)'. Do NOT classify as payment carveout if the service represents a foundational coverage determination (such as primary payer methodologies in dual products) rather than a true exception to standard payment.",
         "UNLISTED_CODE": "Describes payments for codes that are not listed on a fee schedule. This is similar to DEFAULT_TERM. Only populate with Y if the Service or Methodology specifically mentions Codes.",
         "ADDITION": "Describes payments that include a supplemental amount added to or above the base reimbursement rate. Populate with Y if the Methodology describes any additional payments, supplemental amounts, or add-on fees beyond the standard reimbursement.",
         "TRIGGER_CAP": "Describes the payments that trigger a complete shift to a new payment methodology after a defined quantitative threshold is reached. Unlike supplemental payments, this fundamentally changes how reimbursement is calculated beyond the threshold. Valid thresholds can be based on dollar amounts, number of days, visits, units, or other measurable metrics (but not qualitative thresholds, e.g., 'where there is no Marketplace Medicare Rate'). Look for language indicating a clear change in the payment methodology when a defined quantitative threshold is exceeded, such as 'when charges exceed X, pay Y', or 'after 3 days, payment changes to $1,200 per diem'.",

fieldExtraction/src/prompts/prompt_templates.py

@@ -1053,6 +1053,7 @@ INVALID entries - return NO unless there is VALID language as well:
 - Authorization/coverage requirements only
 - Processing instructions, funding arrangements, and administrative statements without specific rates
 - Member cost responsibilities (including Medicare Member Cost Share)
+- Charge Description Master (CDM) or "chargemaster" language.
 
 HARD INVALID entries - return NO even if there is VALID reimbursement language present as well:
 - Any reference to Coordination of Benefits or general benefit descriptions