diff --git a/fieldExtraction/crosswalk/mappings/crosswalk_claim_type.json b/fieldExtraction/crosswalk/mappings/crosswalk_claim_type.json index e325f25..d78bf24 100644 --- a/fieldExtraction/crosswalk/mappings/crosswalk_claim_type.json +++ b/fieldExtraction/crosswalk/mappings/crosswalk_claim_type.json @@ -1,6 +1,6 @@ { "metadata": { - "from_col": "CONTRACT_CLAIM_TYPE_CD", + "from_col": "CLAIM_TYPE_CD", "to_col": "AARETE_DERIVED_CLAIM_TYPE_CD" }, "mapping": { diff --git a/fieldExtraction/crosswalk/mappings/crosswalk_lob.json b/fieldExtraction/crosswalk/mappings/crosswalk_lob.json index 6bb2e52..4e3e4de 100644 --- a/fieldExtraction/crosswalk/mappings/crosswalk_lob.json +++ b/fieldExtraction/crosswalk/mappings/crosswalk_lob.json @@ -1,7 +1,7 @@ { "metadata": { - "from_col": "CONTRACT_LINE_OF_BUSINESS", - "to_col": "AARETE_DERIVED_LINE_OF_BUSINESS" + "from_col": "LOB", + "to_col": "AARETE_DERIVED_LOB" }, "mapping": { "MEDICAID" : "Medicaid", diff --git a/fieldExtraction/crosswalk/mappings/crosswalk_product.json b/fieldExtraction/crosswalk/mappings/crosswalk_product.json index 270ed73..92a2e44 100644 --- a/fieldExtraction/crosswalk/mappings/crosswalk_product.json +++ b/fieldExtraction/crosswalk/mappings/crosswalk_product.json @@ -1,6 +1,6 @@ { "metadata": { - "from_col": "CONTRACT_PRODUCT", + "from_col": "PRODUCT", "to_col": "AARETE_DERIVED_PRODUCT" }, "mapping": { diff --git a/fieldExtraction/crosswalk/mappings/crosswalk_program.json b/fieldExtraction/crosswalk/mappings/crosswalk_program.json index 75e095e..47be1a4 100644 --- a/fieldExtraction/crosswalk/mappings/crosswalk_program.json +++ b/fieldExtraction/crosswalk/mappings/crosswalk_program.json @@ -1,6 +1,6 @@ { "metadata": { - "from_col": "CONTRACT_PROGRAM", + "from_col": "PROGRAM", "to_col": "AARETE_DERIVED_PROGRAM" }, "mapping": { diff --git a/fieldExtraction/crosswalk/mappings/crosswalk_program_lob.json b/fieldExtraction/crosswalk/mappings/crosswalk_program_lob.json index 2ae2396..06437e6 100644 --- a/fieldExtraction/crosswalk/mappings/crosswalk_program_lob.json +++ b/fieldExtraction/crosswalk/mappings/crosswalk_program_lob.json @@ -1,7 +1,7 @@ { "metadata": { "from_col": "MBR_PROGRAM_DESC", - "to_col": "MBR_PRODUCT_LINE_OF_BUSINESS" + "to_col": "MBR_PRODUCT_LOB" }, "mapping": { "Aged, Blind, Disabled (ABD)": "Medicaid", diff --git a/fieldExtraction/crosswalk/mappings/crosswalk_provider_specialty.json b/fieldExtraction/crosswalk/mappings/crosswalk_provider_specialty.json index beab897..ce90bc8 100644 --- a/fieldExtraction/crosswalk/mappings/crosswalk_provider_specialty.json +++ b/fieldExtraction/crosswalk/mappings/crosswalk_provider_specialty.json @@ -1,7 +1,7 @@ { "metadata": { "from_col": "AARETE_DERIVED_PROVIDER_SPECIALTY", - "to_col": "CONTRACT_PROVIDER_SPECIALTY" + "to_col": "PROVIDER_SPECIALTY" }, "mapping": { "GENERAL PRACTICE": "01", diff --git a/fieldExtraction/scripts/investment_field_testing/testing.ipynb b/fieldExtraction/scripts/investment_field_testing/testing.ipynb index bed811e..7202f07 100644 --- a/fieldExtraction/scripts/investment_field_testing/testing.ipynb +++ b/fieldExtraction/scripts/investment_field_testing/testing.ipynb @@ -236,16 +236,16 @@ "# # print(col, df_out[col].nunique())\n", "# one_to_one_fields.append(col)\n", "\n", - "# exclude_list = ['CONTRACT_CARVEOUT_IND', # 1:n\n", - "# \"CONTRACT_GREATER_OF_IND\", # 1:n\n", - "# \"CONTRACT_REIMBURSEMENT_FEE_RATE\", # 1:n\n", - "# \"CONTRACT_NETWORK\", # dynamic\n", - "# \"CONTRACT_CLAIM_TYPE_CD\", # not found in the source spreadsheet\n", + "# exclude_list = ['CARVEOUT_IND', # 1:n\n", + "# \"GREATER_OF_IND\", # 1:n\n", + "# \"REIMB_FEE_RATE\", # 1:n\n", + "# \"NETWORK\", # dynamic\n", + "# \"CLAIM_TYPE_CD\", # not found in the source spreadsheet\n", "# \"CONTRACT_AMENDMENT_NUM\", # not found in the source spreadsheet\n", "# \"PROV_GROUP_NAME_FULL\", # not found in the source spreadsheet\n", - "# \"PROV_FULL_NAME\", # This is called PROV_GROUP_NAME in the source spreadsheet\n", + "# \"PROV_OTHER_NAME_FULL\", # This is called PROV_GROUP_NAME in the source spreadsheet\n", "# \"CONTRACT_FILE_NAME\", # not found in the source spreadsheet\n", - "# \"CONTRACT_CARVEOUT_CD\", # 1:n, also not found in the source spreadsheet\n", + "# \"CARVEOUT_CD\", # 1:n, also not found in the source spreadsheet\n", "# 'PAYER_NAME',\n", "# 'CLIENT_NAME',\n", " \n", @@ -263,7 +263,7 @@ "metadata": {}, "outputs": [], "source": [ - "# mapping_main_to_testbed = {\"CONTRACT_AUTO_RENEWAL_TERM\" : \"CONTRACT_AUTO_RENEWAL_TERM_LENGTH\", \"AARETE_DERIVED_TERMINATION_DATE\" : \"CONTRACT_TERMINATION_DT\"}\n", + "# mapping_main_to_testbed = {\"AUTO_RENEWAL_TERM\" : \"AUTO_RENEWAL_TERM_LENGTH\", \"AARETE_DERIVED_TERMINATION_DT\" : \"TERMINATION_DT\"}\n", "\n", "# def apply_name_mapping(col: str):\n", "# if col in mapping_main_to_testbed:\n", @@ -277,15 +277,15 @@ "metadata": {}, "outputs": [], "source": [ - "# exclude_list = [\"CONTRACT_CLAIM_TYPE_CD\"]\n", + "# exclude_list = [\"CLAIM_TYPE_CD\"]\n", "\n", "# for field in one_to_one_fields:\n", "# field = apply_name_mapping(field)\n", - "# # if field == \"CONTRACT_AUTO_RENEWAL_TERM\":\n", - "# # field = \"CONTRACT_AUTO_RENEWAL_TERM_LENGTH\"\n", - "# # elif field == \"AARETE_DERIVED_TERMINATION_DATE\":\n", - "# # field = \"CONTRACT_TERMINATION_DT\"\n", - "# # elif field == \"CONTRACT_CLAIM_TYPE_CD\":\n", + "# # if field == \"AUTO_RENEWAL_TERM\":\n", + "# # field = \"AUTO_RENEWAL_TERM_LENGTH\"\n", + "# # elif field == \"AARETE_DERIVED_TERMINATION_DT\":\n", + "# # field = \"TERMINATION_DT\"\n", + "# # elif field == \"CLAIM_TYPE_CD\":\n", "# print(df_targets[field].head())" ] }, diff --git a/fieldExtraction/src/constants/investment_columns.py b/fieldExtraction/src/constants/investment_columns.py index 1cebca8..324b637 100644 --- a/fieldExtraction/src/constants/investment_columns.py +++ b/fieldExtraction/src/constants/investment_columns.py @@ -2,9 +2,9 @@ # This is the ONE AND ONLY source of investment column names and order. Do not reference anything else COLUMN_ORDER = [ "CONTRACT_SID", - "CONTRACT_CLASSIFICATION", - "AARETE_DERIVED_CONTRACT_CLASSIFICATION", - "CONTRACT_FILE_NAME", + "CONTRACT_CLASS", + "AARETE_DERIVED_CONTRACT_CLASS", + "FILE_NAME", "CONTRACT_TITLE", "CONTRACT_AMENDMENT_NUM", "CLIENT_NAME", @@ -12,98 +12,103 @@ COLUMN_ORDER = [ "PROV_GROUP_TIN", "PROV_GROUP_NPI", "PROV_GROUP_NAME_FULL", - "PROV_TIN_OTHER", - "PROV_NPI_OTHER", - "PROV_REIMBURSEMENT_TIN", - "PROV_REIMBURSEMENT_NPI", - "PROV_FULL_NAME", - "CONTRACT_EFFECTIVE_DT", - "CONTRACT_TERMINATION_DT", + "PROV_OTHER_TIN", + "PROV_OTHER_NPI", + "PROV_OTHER_NAME_FULL", + "AARETE_DERIVED_EFFECTIVE_DT", + "TERMINATION_DT", "AARETE_DERIVED_TERMINATION_DT", - "CONTRACT_AUTO_RENEWAL_IND", - "CONTRACT_AUTO_RENEWAL_TERM", - "REIMBURSEMENT_EFFECTIVE_DT", - "REIMBURSEMENT_TERMINATION_DT", - "REIMBURSEMENT_PROV_NAME", - "CONTRACT_SIGNATORY_COMPLETE_IND", - "CONTRACT_CLAIM_TYPE_CD", - "AARETE_DERIVED_CLAIM_TYPE_CD", - "EXHIBIT_NAME", + "AUTO_RENEWAL_IND", + "AUTO_RENEWAL_TERM", + "NUM_AVAILABLE_SIGNATORY_LINE_COUNT", + "NUM_SIGNED_SIGNATORY_LINE_COUNT", + "AARETE_DERIVED_SIGNATORY_COMPLETE_IND", + "EXHIBIT_TITLE", "EXHIBIT_PAGE", - "CONTRACT_PRODUCT", + "REIMB_PROV_TIN", + "REIMB_PROV_NPI", + "REIMB_PROV_NAME", + "REIMB_EFFECTIVE_DT", + "REIMB_TERMINATION_DT", + "CLAIM_TYPE_CD", + "AARETE_DERIVED_CLAIM_TYPE_CD", + "PRODUCT", "AARETE_DERIVED_PRODUCT", - "CONTRACT_LINE_OF_BUSINESS", - "AARETE_DERIVED_LINE_OF_BUSINESS", - "CONTRACT_PROGRAM", + "LOB", + "AARETE_DERIVED_LOB", + "PROGRAM", "AARETE_DERIVED_PROGRAM", - "CONTRACT_NETWORK", + "NETWORK", "AARETE_DERIVED_NETWORK", - "CONTRACT_SERVICE_AREA", + "SERVICE_AREA", "AARETE_DERIVED_SERVICE_AREA", - "CONTRACT_PROV_TYPE", + "PROV_TYPE", "AARETE_DERIVED_PROV_TYPE", + "PROV_TAXONOMY_CD", + "PROV_TAXONOMY_CD_DESC", "PROV_SPECIALTY_CD", - "PROV_SPECIALTY_DESC", - "TAXONOMY_CD", - "TAXONOMY_DESC", + "PROV_SPECIALTY_CD_DESC", "PLACE_OF_SERVICE_CD", - "PLACE_OF_SERVICE_DESC", + "PLACE_OF_SERVICE_CD_DESC", "BILL_TYPE_CD", - "BILL_TYPE_DESC", - "PROV_PATIENT_AGE_MIN", - "PROV_PATIENT_AGE_MAX", - "REIMBURSEMENT_ID", - "CONTRACT_SERVICE_CD_OR_DESC", - "CONTRACT_REIMBURSEMENT_METHOD", - "AARETE_DERIVED_REIMBURSEMENT_METHOD", - "CONTRACT_REIMBURSEMENT_FEE_RATE", - "CONTRACT_REIMBURSEMENT_PERCENT_RATE", - "CONTRACT_FEE_SCHEDULE_DESC", - "AARETE_DERIVED_FEE_SCHEDULE", - "CONTRACT_FEE_SCHEDULE_VERSION", - "AARETE_DERIVED_FEE_SCHEDULE_VERSION", - "CONTRACT_LESSER_OF_IND", - "CONTRACT_GREATER_OF_IND", - "CONTRACT_CARVEOUT_IND", - "CONTRACT_CARVEOUT_CD", - "CONTRACT_DEFAULT_IND", + "BILL_TYPE_CD_DESC", + "PATIENT_AGE_MIN", + "PATIENT_AGE_MAX", + "REIMB_TERM", + "REIMB_ID", + "CARVEOUT_IND", + "CARVEOUT_CD", + "LESSER_OF_IND", + "GREATER_OF_IND", + "AARETE_DERIVED_REIMB_METHOD", + "UNIT_OF_MEASURE", + "REIMB_PCT_RATE", + "REIMB_FEE_RATE", "NOT_TO_EXCEED_IND", - "CPT4_PROC_CD" , - "CPT4_PROC_DESC", + "TRIGGER_CAP_THRESHOLD_TYPE", + "TRIGGER_CAP_THRESHOLD_AMT", + "DEFAULT_IND", + "ADDITION_DESC", + "ADDITION_MAX_PCT_RATE_INC", + "ADDITION_MAX_FEE_RATE_INC", + "ADDITION_RATE_CHANGE_TIMELINE", + "AARETE_DERIVED_ADDITION_RATE_CHANGE_TIMELINE", + "FEE_SCHEDULE", + "AARETE_DERIVED_FEE_SCHEDULE", + "FEE_SCHEDULE_VERSION", + "AARETE_DERIVED_FEE_SCHEDULE_VERSION", + "SERVICE_TERM", + "CPT4_PROC_CD", + "CPT4_PROC_CD_DESC", "CPT4_PROC_MOD", "CPT4_PROC_MOD_DESC", "REVENUE_CD", - "REVENUE_DESC", + "REVENUE_CD_DESC", "DIAG_CD", - "DIAG_DESC", - "GROUPER_TYPE", - "FACILITY_GROUPER_CD", - "FACILITY_GROUPER_DESC", - "LINE_NDC_NUM" , - "LINE_NDC_DESC", + "DIAG_CD_DESC", + "NDC_CD", + "NDC_CD_DESC", "CLAIM_ADMIT_TYPE_CD", "AUTH_ADMIT_TYPE_DESC", "CLAIM_STATUS_CD", - "CLAIM_STATUS_DESC", - "CONTRACT_FACILITY_OUTLIER_TERMS", - "FACILITY_OUTLIER_FIXED_LOSS_THRESHOLD", - "FACILITY_OUTLIER_PERCENT_RATE_ON_EXCESS_CHARGES", - "FACILITY_OUTLIER_MAXIMUM", - "FACILITY_OUTLIER_EXCLUSION_CD", - "FACILITY_OUTLIER_EXCLUSION_DESC", - "CONTRACT_FACILITY_STOP_LOSS_TERMS", - "FACILITY_STOP_LOSS_FIXED_LOSS_THRESHOLD", - "FACILITY_STOP_LOSS_PERCENT_RATE_ON_EXCESS_CHARGES", - "FACILITY_STOP_LOSS_DAILY_MAXIMUM", - "FACILITY_STOP_LOSS_EXCLUSION_CD", - "FACILITY_STOP_LOSS_EXCLUSION_DESC", - "CONTRACT_SEQUESTRATION_PERCENT_RATE", - "CONTRACT_SEQUESTRATION_START_DATE", - "CONTRACT_SEQUESTRATION_END_DATE", - "CONTRACT_DISCOUNT_PERCENT_RATE", - "CONTRACT_DISCOUNT_START_DATE", - "CONTRACT_DISCOUNT_END_DATE", - "CONTRACT_PREMIUM_PERCENT_RATE", - "CONTRACT_PREMIUM_START_DATE", - "CONTRACT_PREMIUM_END_DATE" + "CLAIM_STATUS_CD_DESC", + "GROUPER_TYPE", + "GROUPER_CD", + "GROUPER_CD_DESC", + "GROUPER_VERSION", + "GROUPER_ALTERNATIVE_LEVEL_OF_CARE", + "GROUPER_SEVERITY", + "GROUPER_RISK_OF_MORTALITY_SUBCLASS", + "OUTLIER_TERMS", + "OUTLIER_FIXED_LOSS_THRESHOLD", + "OUTLIER_PCT_RATE_ON_EXCESS_CHARGES", + "OUTLIER_MAXIMUM", + "OUTLIER_EXCLUSION_CD", + "OUTLIER_EXCLUSION_DESC", + "STOP_LOSS_TERMS", + "STOP_LOSS_FIXED_LOSS_THRESHOLD", + "STOP_LOSS_PCT_RATE_ON_EXCESS_CHARGES", + "STOP_LOSS_DAILY_MAXIMUM", + "STOP_LOSS_EXCLUSION_CD", + "STOP_LOSS_EXCLUSION_DESC" ] \ No newline at end of file diff --git a/fieldExtraction/src/constants/investment_values.py b/fieldExtraction/src/constants/investment_values.py index d6c56e6..9fcf82e 100644 --- a/fieldExtraction/src/constants/investment_values.py +++ b/fieldExtraction/src/constants/investment_values.py @@ -54,7 +54,7 @@ VALID_PROV_TYPE = [ ] -VALID_CONTRACT_NETWORKS = [ +VALID_NETWORKS = [ "HMO", "HEALTH MAINTENANCE ORGANIZATION", "EPO", @@ -106,14 +106,14 @@ VALID_AARETE_DERIVED_FEE_SCHEDULE = [ "Health Plan", "Proprietary" ] -VALID_CONTRACT_CLAIM_TYPE = [ +VALID_CLAIM_TYPE = [ "Professional", "Institutional", "Ancillary" ] -# AARETE_DERIVED_REIMBURSEMENT_METHOD -VALID_REIMBURSEMENT_METHOD = [ +# AARETE_DERIVED_REIMB_METHOD +VALID_REIMB_TERM = [ "Billed Charges", "Fee Schedule", "Flat Rate", # Per line @@ -157,7 +157,11 @@ VALID_CARVEOUTS = { VALID_SPECIAL = { "OUTLIER" : "Describes additional payments made on amounts over a certain threshold for high-cost facility claims. Look for the term 'Outlier'.", "STOP_LOSS" : "Describes additional payments made on amounts over a certain threshold for high-cost facility claims. Look for the term 'Stop Loss'.", - "SEQUESTRATION" : "Describes a government-mandated reduction in federal spending for a period of time. Look for the term 'Sequestration'." + "SEQUESTRATION" : "Describes a government-mandated reduction in federal spending for a period of time. Look for the term 'Sequestration'.", + "DISCOUNT" : "Describes a discount to the payment. Look for the term 'Discount'.", # placeholder prompt + "PREMIUM" : "Describes a premium to the payment. Look for the term 'Premium'.", # placeholder prompt + "ADDITION" : "Describes an increase in the payment amount over time.", # placeholder prompt + "TRIGGER_CAP" : "Describes if the payment methodology is different if the amount being paid is over or under a given threshold."# placeholder prompt } proc_levels = ["cpt", "hcpcs", "cpt_level3", "cpt_level2", "hcpcs_level2", "cpt_level1", "hcpcs_level1"] diff --git a/fieldExtraction/src/investment/carveout_funcs.py b/fieldExtraction/src/investment/carveout_funcs.py index e2c84c2..76fc833 100644 --- a/fieldExtraction/src/investment/carveout_funcs.py +++ b/fieldExtraction/src/investment/carveout_funcs.py @@ -20,11 +20,11 @@ def get_carveout_fields(answer_dict: dict, """ # Carveout code and indicator - answer_dict['CONTRACT_CARVEOUT_CD'] = carveout_answer - answer_dict['CONTRACT_CARVEOUT_IND'] = 'N' if 'N/A' in carveout_answer else 'Y' + answer_dict['CARVEOUT_CD'] = carveout_answer + answer_dict['CARVEOUT_IND'] = 'N' if 'N/A' in carveout_answer else 'Y' # Default indicator - answer_dict['CONTRACT_DEFAULT_IND'] = 'N' + answer_dict['DEFAULT_IND'] = 'N' # Put Carveout-specific breakouts below diff --git a/fieldExtraction/src/investment/code_funcs.py b/fieldExtraction/src/investment/code_funcs.py index 58fa3d8..476e8af 100644 --- a/fieldExtraction/src/investment/code_funcs.py +++ b/fieldExtraction/src/investment/code_funcs.py @@ -138,7 +138,7 @@ def find_containing_ranges(input_range: str, code_mapping: dict) -> list[dict]: def code_primary(answer_dicts, filename): """ - Breaks down the direct code information from CONTRACT_SERVICE_CD_OR_DESC and CONTRACT_REIMBURSEMENT_METHOD fields + Breaks down the direct code information from SERVICE_TERM and REIMB_TERM fields using an LLM prompt and adds the results to the provided answer dictionaries. Args: @@ -151,7 +151,7 @@ def code_primary(answer_dicts, filename): code_primary_questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="code_primary_breakout").get_prompt_dict() code_breakout_answers = [] for answer_dict in answer_dicts: - service, methodology = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC"), answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") + service, methodology = answer_dict.get("SERVICE_TERM"), answer_dict.get("REIMB_TERM") if service: code_answer_dict = string_utils.universal_json_load( llm_utils.invoke_claude( @@ -301,7 +301,7 @@ def code_indirect(answer_dicts: list[dict], all_dataset: dict) -> list[dict]: results = [] already_seen = {} for answer_dict in answer_dicts: - service = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC", "") + service = answer_dict.get("SERVICE_TERM", "") proc_cd = answer_dict.get("CPT4_PROC_CD") diag_cd = answer_dict.get("DIAG_CD") @@ -326,10 +326,10 @@ def code_indirect(answer_dicts: list[dict], all_dataset: dict) -> list[dict]: if code == 'proc_cd': answer_dict["CPT4_PROC_CD"] = nearest_code - answer_dict["CPT4_PROC_DESC"] = nearest_description + answer_dict["CPT4_PROC_CD_DESC"] = nearest_description elif code == 'diag_cd': answer_dict["DIAG_CD"] = nearest_code - answer_dict["DIAG_DESC"] = nearest_description + answer_dict["DIAG_CD_DESC"] = nearest_description results.append(answer_dict) return results @@ -475,20 +475,20 @@ def code_description_mapping(answer_dicts, all_mappings): proc_mod = answer_dict.get("CPT4_PROC_MOD") diag_code = answer_dict.get("DIAG_CD") rev_code = answer_dict.get("REVENUE_CD") - grouper_code = answer_dict.get("FACILITY_GROUPER_CD") + grouper_code = answer_dict.get("GROUPER_CD") grouper_type = answer_dict.get("GROUPER_TYPE") admit_type_code = answer_dict.get("CLAIM_ADMIT_TYPE_CD") - answer_dict["CPT4_PROC_DESC"] = get_code_description(proc_code, all_mappings['proc_mapping']) + answer_dict["CPT4_PROC_CD_DESC"] = get_code_description(proc_code, all_mappings['proc_mapping']) answer_dict["CPT4_PROC_MOD_DESC"] = get_code_description(proc_mod, all_mappings['proc_mapping']) - answer_dict["DIAG_DESC"] = get_code_description(diag_code, all_mappings['diag_mapping']) - answer_dict["REVENUE_DESC"] = get_code_description(rev_code, all_mappings['rev_mapping']) + answer_dict["DIAG_CD_DESC"] = get_code_description(diag_code, all_mappings['diag_mapping']) + answer_dict["REVENUE_CD_DESC"] = get_code_description(rev_code, all_mappings['rev_mapping']) if grouper_type == 'MS-DRG': - answer_dict["FACILITY_GROUPER_DESC"] = get_code_description(grouper_code, all_mappings['grouper_mapping_ms']) + answer_dict["GROUPER_CD_DESC"] = get_code_description(grouper_code, all_mappings['grouper_mapping_ms']) elif grouper_type == 'APR-DRG': - answer_dict["FACILITY_GROUPER_DESC"] = get_code_description(grouper_code, all_mappings['grouper_mapping_apr']) + answer_dict["GROUPER_CD_DESC"] = get_code_description(grouper_code, all_mappings['grouper_mapping_apr']) else: - answer_dict["FACILITY_GROUPER_DESC"] = "N/A" + answer_dict["GROUPER_CD_DESC"] = "N/A" answer_dict["AUTH_ADMIT_TYPE_DESC"] = get_code_description(admit_type_code, all_mappings['admit_mapping']) return answer_dicts @@ -506,10 +506,10 @@ def get_code_breakout(answer_dicts: list[dict], filename: str, all_dataset: dict dict: A dictionary with primary, indirect/derived, and mapped code descriptions. """ - # Code Primary (Pull codes directly from CONTRACT_SERVICE_CD_OR_DESC and CONTRACT_REIMBURSEMENT_METHOD) + # Code Primary (Pull codes directly from SERVICE_TERM and REIMB_TERM) code_primary_answers = code_primary(answer_dicts, filename) - # Only used for Implicit. Code Indirect (Derive codes indirectly from CONTRACT_SERVICE_CD_OR_DESC and CONTRACT_REIMBURSEMENT_METHOD) + # Only used for Implicit. Code Indirect (Derive codes indirectly from SERVICE_TERM and REIMB_TERM) code_indirect_answers = code_indirect(code_primary_answers, all_dataset) # Code Descriptions (Pull standardized descriptions from codes) diff --git a/fieldExtraction/src/investment/file_processing.py b/fieldExtraction/src/investment/file_processing.py index 8dcf213..0a4143d 100644 --- a/fieldExtraction/src/investment/file_processing.py +++ b/fieldExtraction/src/investment/file_processing.py @@ -31,20 +31,20 @@ def process_file(file_object, all_dataset, run_timestamp): ################## ONE TO N ################## if string_utils.contains_reimbursement(contract_text): one_to_n_results = run_one_to_n_prompts(filename, text_dict, exhibit_pages, exhibit_chunk_mapping, all_dataset) # Return df - one_to_n_results['CONTRACT_FILE_NAME'] = filename + one_to_n_results['FILE_NAME'] = filename print(f"{datetime_str()} One to N Complete - {filename}") else: - one_to_n_results = pd.DataFrame([{'CONTRACT_FILE_NAME' : filename}]) + one_to_n_results = pd.DataFrame([{'FILE_NAME' : filename}]) print(f"{datetime_str()} No One to N Found, Skipping - {filename}") ################## ONE TO ONE ################## one_to_one_results = run_one_to_one_prompts(filename, contract_text, text_dict, top_sheet_dict) # Return df - one_to_one_results['CONTRACT_FILE_NAME'] = filename + one_to_one_results['FILE_NAME'] = filename print(f"{datetime_str()} One to One Complete - {filename}") - # one_to_one_results = {"CONTRACT_FILE_NAME" : filename} + # one_to_one_results = {"FILE_NAME" : filename} ################## MERGE ################## - contract_results = pd.merge(one_to_one_results, one_to_n_results, how='outer', on='CONTRACT_FILE_NAME') + contract_results = pd.merge(one_to_one_results, one_to_n_results, how='outer', on='FILE_NAME') ################## AARETE-DERIVED ################## final_results = aarete_derived.get_crosswalk_and_derived(contract_results, filename) diff --git a/fieldExtraction/src/investment/one_to_n_funcs.py b/fieldExtraction/src/investment/one_to_n_funcs.py index f8d6bd4..ecc1923 100644 --- a/fieldExtraction/src/investment/one_to_n_funcs.py +++ b/fieldExtraction/src/investment/one_to_n_funcs.py @@ -139,7 +139,7 @@ def dynamic_and_exhibit_level(exhibit_text, assign_na=True, exhibit_level_answer_dict=exhibit_level_answer_dict) - exhibit_level_answer_dict['EXHIBIT_NAME'] = exhibit_header + exhibit_level_answer_dict['EXHIBIT_TITLE'] = exhibit_header # exhibit_level_answer_dict should have all exhibit-level fields answers (including the ones that were previously dynamic) # reimbursement_value_dict contains the found values for the dynamic fields that got moved to reimbursement-level return exhibit_level_answer_dict @@ -161,12 +161,12 @@ def get_special_cases(reimbursement_primary_answers: list[dict], filename: str) Returns: list[dict]: Updated list with carveout indicators and default indicators added. - Fields Added: CONTRACT_CARVEOUT_IND, CONTRACT_DEFAULT_IND, CONTRACT_CARVEOUT_CD + Fields Added: CARVEOUT_IND, DEFAULT_IND, CARVEOUT_CD """ special_case_answers = [] for answer_dict in reimbursement_primary_answers: - contract_service_cd, contract_reimbursement_method = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC"), answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") + contract_service_cd, contract_reimbursement_method = answer_dict.get("SERVICE_TERM"), answer_dict.get("REIMB_TERM") if contract_service_cd and contract_reimbursement_method: llm_answer_final = string_utils.extract_text_from_delimiters( llm_utils.invoke_claude( @@ -178,9 +178,9 @@ def get_special_cases(reimbursement_primary_answers: list[dict], filename: str) # Default if "DEFAULT_TERM" in llm_answer_final: - answer_dict["CONTRACT_CARVEOUT_CD"] = "N/A" - answer_dict["CONTRACT_CARVEOUT_IND"] = "N" - answer_dict["CONTRACT_DEFAULT_IND"] = "Y" + answer_dict["CARVEOUT_CD"] = "N/A" + answer_dict["CARVEOUT_IND"] = "N" + answer_dict["DEFAULT_IND"] = "Y" # Carveout elif any([carveout in llm_answer_final for carveout in investment_values.VALID_CARVEOUTS]): answer_dict = carveout_funcs.get_carveout_fields(answer_dict, llm_answer_final, filename) @@ -202,26 +202,27 @@ def get_methodology_breakout(reimbursement_primary_answers: list[dict], filename Returns: list[dict]: Updated list with methodology breakout details and fee schedule information. - Fields Added: AARETE_DERIVED_REIMBURSEMENT_METHOD, - CONTRACT_REIMBURSEMENT_FEE_RATE, - CONTRACT_REIMBURSEMENT_PERCENT_RATE, - CONTRACT_FEE_SCHEDULE_DESC, + Fields Added: AARETE_DERIVED_REIMB_METHOD, + REIMB_FEE_RATE, + REIMB_PCT_RATE, + FEE_SCHEDULE, AARETE_DERIVED_FEE_SCHEDULE, AARETE_DERIVED_FEE_SCHEDULE_VERSION """ - methodology_breakout_questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="methodology_breakout").get_prompt_dict() - fs_breakout_questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="fee_schedule_breakout").get_prompt_dict() + methodology_breakout_questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="methodology_breakout").print_prompt_dict() + fs_breakout_questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="fee_schedule_breakout").print_prompt_dict() + methodology_breakout_answers = [] for answer_dict in reimbursement_primary_answers: - if answer_dict.get("CONTRACT_CARVEOUT_IND") == "Y": # check if there is a CARVEOUT that would require a different methodology breakout + if answer_dict.get("CARVEOUT_IND") == "Y": # check if there is a CARVEOUT that would require a different methodology breakout methodology_breakout_answers.append(answer_dict) else: # If not a carveout, run normal methodology breakout - contract_reimbursement_method = answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") - # Methodology Breakout: AARETE_DERIVED_REIMBURSEMENT_METHOD, CONTRACT_REIMBURSEMENT_FEE_RATE, CONTRACT_REIMBURSEMENT_PERCENT_RATE, CONTRACT_LESSER_OF_IND, CONTRACT_GREATER_OF_IND, AARETE_DERIVED_PROV_TYPE + contract_reimbursement_method = answer_dict.get("REIMB_TERM") + # Methodology Breakout: AARETE_DERIVED_REIMB_METHOD, REIMB_FEE_RATE, REIMB_PCT_RATE, LESSER_OF_IND, GREATER_OF_IND, AARETE_DERIVED_PROV_TYPE if contract_reimbursement_method: llm_response = llm_utils.invoke_claude( - investment_prompts.REIMBURSEMENT_METHODOLOGY_BREAKOUT(contract_reimbursement_method, methodology_breakout_questions), + investment_prompts.REIMB_TERM_BREAKOUT(contract_reimbursement_method, methodology_breakout_questions), config.MODEL_ID_CLAUDE35_SONNET, filename ) @@ -232,16 +233,16 @@ def get_methodology_breakout(reimbursement_primary_answers: list[dict], filename methodology_breakout_answer = [] for methodology_breakout_dict in methodology_breakout_answer: # Fee Schedule Breakout - if contract_reimbursement_method and "Fee Schedule" in methodology_breakout_dict.get("AARETE_DERIVED_REIMBURSEMENT_METHOD", ""): + if contract_reimbursement_method and "Fee Schedule" in methodology_breakout_dict.get("AARETE_DERIVED_REIMB_METHOD", ""): fs_breakout_dict = string_utils.universal_json_load( llm_utils.invoke_claude( - investment_prompts.FEE_SCHEDULE_BREAKOUT(contract_reimbursement_method, methodology_breakout_dict.get("CONTRACT_REIMBURSEMENT_PERCENT_RATE"), fs_breakout_questions), + investment_prompts.FEE_SCHEDULE_BREAKOUT(contract_reimbursement_method, methodology_breakout_dict.get("REIMB_PCT_RATE"), fs_breakout_questions), config.MODEL_ID_CLAUDE35_SONNET, filename ) ) else: - fs_breakout_dict = {"CONTRACT_FEE_SCHEDULE_DESC" : "N/A", + fs_breakout_dict = {"FEE_SCHEDULE" : "N/A", "AARETE_DERIVED_FEE_SCHEDULE" : "N/A", "AARETE_DERIVED_FEE_SCHEDULE_VERSION" : "N/A"} methodology_breakout_answers.append({**answer_dict, **methodology_breakout_dict, **fs_breakout_dict}) @@ -268,7 +269,7 @@ def get_service_breakout(answer_dicts, filename): already_seen = {} service_breakout_answers = [] for answer_dict in answer_dicts: - service, methodology = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC"), answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") + service, methodology = answer_dict.get("SERVICE_TERM"), answer_dict.get("REIMB_TERM") service_methodology = service + methodology if service_methodology not in already_seen: service_breakout_dict = string_utils.universal_json_load( @@ -298,14 +299,14 @@ def reimbursement_tin_npi(exhibit_chunk: str, reimbursement_level_fields: FieldS Returns: tuple[dict, FieldSet]: A dictionary containing extracted TIN and NPI values, and an updated FieldSet with additional fields if multiple values are found. - Fields Added: PROV_REIMBURSEMENT_TIN, - PROV_REIMBURSEMENT_NPI + Fields Added: REIMB_PROV_TIN, + REIMB_PROV_NPI """ answer_dict = {} - fields = [("PROV_REIMBURSEMENT_TIN", r"\b\d{2}-\d{7}\b|\b\d{9}\b"), - ("PROV_REIMBURSEMENT_NPI", r"\b\d{10}\b")] + fields = [("REIMB_PROV_TIN", r"\b\d{2}-\d{7}\b|\b\d{9}\b"), + ("REIMB_PROV_NPI", r"\b\d{10}\b")] for field_tuple in fields: field_name, field_pattern = field_tuple[0], field_tuple[1] @@ -314,7 +315,7 @@ def reimbursement_tin_npi(exhibit_chunk: str, reimbursement_level_fields: FieldS if not field_matches: answer_dict[field_name] = "N/A" elif len(field_matches) == 1: - answer_dict['PROV_REIMBURSEMENT_TIN'] = field_matches[0] + answer_dict['REIMB_PROV_TIN'] = field_matches[0] else: # Multiple tins reimbursement_field = Field.load_from_file(FIELD_JSON_PATH, field_name) reimbursement_field.update_valid_values(field_matches) @@ -381,11 +382,11 @@ def reimbursement_level(exhibit_text, filename, reimbursement_level_fields, all_ # Get service code (or description) and shorten it for the identifier service_identifier = "" - if "CONTRACT_SERVICE_CD_OR_DESC" in row: # This should never be empty but just in case - service_identifier = row["CONTRACT_SERVICE_CD_OR_DESC"].replace(" ", "_")[:10] + if "SERVICE_TERM" in row: # This should never be empty but just in case + service_identifier = row["SERVICE_TERM"].replace(" ", "_")[:10] # Create unique ID - row["REIMBURSEMENT_ID"] = f"{clean_filename}_{exhibit_page}_{service_identifier}_{idx+1:03d}" + row["REIMB_ID"] = f"{clean_filename}_{exhibit_page}_{service_identifier}_{idx+1:03d}" return code_breakout_answers diff --git a/fieldExtraction/src/investment/one_to_one_funcs.py b/fieldExtraction/src/investment/one_to_one_funcs.py index cf9c6ab..f0c6b9f 100644 --- a/fieldExtraction/src/investment/one_to_one_funcs.py +++ b/fieldExtraction/src/investment/one_to_one_funcs.py @@ -31,11 +31,11 @@ def run_regex_fields(contract_text: str, else: # Add answers answer_dict["PROV_GROUP_TIN"] = prov_group_tin - answer_dict["PROV_TIN_OTHER"] = prov_tin_other + answer_dict["PROV_OTHER_TIN"] = prov_tin_other # Remove from questions regex_fields.remove_field("PROV_GROUP_TIN") - regex_fields.remove_field("PROV_TIN_OTHER") + regex_fields.remove_field("PROV_OTHER_TIN") # Add NPI to prompt no matter what regex_fields.update_field_attr(field_name="PROV_GROUP_NPI", diff --git a/fieldExtraction/src/investment/postprocess.py b/fieldExtraction/src/investment/postprocess.py index ce0d5d7..9359eee 100644 --- a/fieldExtraction/src/investment/postprocess.py +++ b/fieldExtraction/src/investment/postprocess.py @@ -26,26 +26,26 @@ def postprocess(df): df[field.field_name] = list(map(postprocessing_funcs.date_postprocessing, df[field.field_name])) # we use `map` to allow memoization to work # Derived termination date - df['AARETE_DERIVED_TERMINATION_DATE'] = list(map(invoke_derived_term_date, df['CONTRACT_EFFECTIVE_DT'], df['CONTRACT_TERMINATION_DT'])) + df['AARETE_DERIVED_TERMINATION_DT'] = list(map(invoke_derived_term_date, df['AARETE_DERIVED_EFFECTIVE_DT'], df['TERMINATION_DT'])) - # Special handling for AARETE_DERIVED_TERMINATION_DATE - # Overwrite AARETE_DERIVED_TERMINATION_DATE "9999/01/01" if CONTRACT_AUTO_RENEWAL_IND is "Y" - if "AARETE_DERIVED_TERMINATION_DATE" in df.columns and "CONTRACT_AUTO_RENEWAL_IND" in df.columns: + # Special handling for AARETE_DERIVED_TERMINATION_DT + # Overwrite AARETE_DERIVED_TERMINATION_DT "9999/01/01" if AUTO_RENEWAL_IND is "Y" + if "AARETE_DERIVED_TERMINATION_DT" in df.columns and "AUTO_RENEWAL_IND" in df.columns: df.loc[ - df["CONTRACT_AUTO_RENEWAL_IND"] == "Y", - "AARETE_DERIVED_TERMINATION_DATE" + df["AUTO_RENEWAL_IND"] == "Y", + "AARETE_DERIVED_TERMINATION_DT" ] = "9999/01/01" - # Remove rows where 'AARETE_DERIVED_REIMBURSEMENT_METHOD' value is "Medicare Member Cost Share" - df = df[df['AARETE_DERIVED_REIMBURSEMENT_METHOD'] != "Medicare Member Cost Share"] + # Remove rows where 'AARETE_DERIVED_REIMB_METHOD' value is "Medicare Member Cost Share" + df = df[df['AARETE_DERIVED_REIMB_METHOD'] != "Medicare Member Cost Share"] - # Standardize 'AARETE_DERIVED_REIMBURSEMENT_METHOD' values + # Standardize 'AARETE_DERIVED_REIMB_METHOD' values # Copy AWP, ASP, WAC to AARETE_DERIVED_FEE_SCHEDULE column for the corresponding row medrx_fee_schedule_values = ['AWP', 'ASP', 'WAC'] - df.loc[df['AARETE_DERIVED_REIMBURSEMENT_METHOD'].isin(medrx_fee_schedule_values), 'AARETE_DERIVED_FEE_SCHEDULE'] = df['AARETE_DERIVED_REIMBURSEMENT_METHOD'] + df.loc[df['AARETE_DERIVED_REIMB_METHOD'].isin(medrx_fee_schedule_values), 'AARETE_DERIVED_FEE_SCHEDULE'] = df['AARETE_DERIVED_REIMB_METHOD'] - # Convert AARETE_DERIVED_REIMBURSEMENT_METHOD values [AWP, ASP, WAC] to 'MedRx' - df['AARETE_DERIVED_REIMBURSEMENT_METHOD'] = df['AARETE_DERIVED_REIMBURSEMENT_METHOD'].replace({'AWP': 'MedRx', 'ASP': 'MedRx', 'WAC': 'MedRx'}) + # Convert AARETE_DERIVED_REIMB_METHOD values [AWP, ASP, WAC] to 'MedRx' + df['AARETE_DERIVED_REIMB_METHOD'] = df['AARETE_DERIVED_REIMB_METHOD'].replace({'AWP': 'MedRx', 'ASP': 'MedRx', 'WAC': 'MedRx'}) # Standardize output column order - this should ALWAYS be the final postprocessing step df = postprocessing_funcs.reorder_columns(df, COLUMN_ORDER) diff --git a/fieldExtraction/src/investment/special_case_funcs.py b/fieldExtraction/src/investment/special_case_funcs.py index f51c455..4638ba5 100644 --- a/fieldExtraction/src/investment/special_case_funcs.py +++ b/fieldExtraction/src/investment/special_case_funcs.py @@ -5,46 +5,41 @@ import src.prompts.investment_prompts as investment_prompts import src.config as config from src.prompts.investment_prompts import Field, FieldSet -# These functions are virtually identical currently - TODO: explore combining them to one function -def get_outlier_fields(answer_dict, filename): - service, methodology = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC"), answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") - answer_dict["CONTRACT_FACILITY_OUTLIER_TERMS"] = methodology - questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="outlier") - llm_answer_raw = llm_utils.invoke_claude( - investment_prompts.SERVICE_METHODOLOGY_BREAKOUT(service, methodology, questions), - config.MODEL_ID_CLAUDE35_SONNET, - filename - ) - llm_answer_final = string_utils.universal_json_load(llm_answer_raw) - return {**answer_dict, **llm_answer_final} +def run_special_case_prompts(answer_dict, filename, field_type, additional_key=None): + """ + Generic function to retrieve special case fields based on the field type. -def get_stop_loss_fields(answer_dict, filename): - service, methodology = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC"), answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") - answer_dict["CONTRACT_FACILITY_STOP_LOSS_TERMS"] = methodology - questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="stop_loss") - llm_answer_raw = llm_utils.invoke_claude( - investment_prompts.SERVICE_METHODOLOGY_BREAKOUT(service, methodology, questions), - config.MODEL_ID_CLAUDE35_SONNET, - filename - ) - llm_answer_final = string_utils.universal_json_load(llm_answer_raw) - return {**answer_dict, **llm_answer_final} + Args: + answer_dict (dict): Dictionary of answers to update. + filename (str): The name of the file being processed. + field_type (str): The type of special case field (e.g., "outlier", "stop_loss", "sequestration"). + additional_key (str, optional): Key to add to the answer_dict for specific field types (e.g., "OUTLIER_TERMS"). -def get_sequestration_fields(answer_dict, filename): - service, methodology = answer_dict.get("CONTRACT_SERVICE_CD_OR_DESC"), answer_dict.get("CONTRACT_REIMBURSEMENT_METHOD") - questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type="sequestration") + Returns: + dict: The updated answer dictionary with special case fields populated. + """ + service, methodology = answer_dict.get("SERVICE_TERM"), answer_dict.get("REIMB_TERM") + + # Duplicate methodology into the _DESC column if needed + if additional_key: + answer_dict[additional_key] = methodology + + # Load the questions for the given field type + questions = FieldSet(file_path=config.FIELD_JSON_PATH, field_type=field_type) + + # Invoke the LLM to get the answers llm_answer_raw = llm_utils.invoke_claude( - investment_prompts.SERVICE_METHODOLOGY_BREAKOUT(service, methodology, questions), - config.MODEL_ID_CLAUDE35_SONNET, - filename - ) + investment_prompts.SERVICE_METHODOLOGY_BREAKOUT(service, methodology, questions), + config.MODEL_ID_CLAUDE35_SONNET, + filename + ) + + # Parse the LLM response and update the answer dictionary llm_answer_final = string_utils.universal_json_load(llm_answer_raw) return {**answer_dict, **llm_answer_final} -def get_special_case(answer_dict: dict, - special_answer: str, - filename: str): +def get_special_case(answer_dict: dict, special_answer: str, filename: str): """ Processes special case answers by setting default carveout and default indicators, then populates additional fields based on the special answer type. @@ -59,22 +54,26 @@ def get_special_case(answer_dict: dict, """ # Carveouts - answer_dict["CONTRACT_CARVEOUT_CD"] = "N/A" - answer_dict["CONTRACT_CARVEOUT_IND"] = "N" + answer_dict["CARVEOUT_CD"] = "N/A" + answer_dict["CARVEOUT_IND"] = "N" # Default - answer_dict["CONTRACT_DEFAULT_IND"] = "N" + answer_dict["DEFAULT_IND"] = "N" # Individual if "OUTLIER" in special_answer: - answer_dict = get_outlier_fields(answer_dict, filename) + answer_dict = run_special_case_prompts(answer_dict, filename, "outlier", additional_key="OUTLIER_TERMS") elif "STOP_LOSS" in special_answer: - answer_dict = get_stop_loss_fields(answer_dict, filename) + answer_dict = run_special_case_prompts(answer_dict, filename, "stop_loss", additional_key="STOP_LOSS_TERMS") elif "SEQUESTRATION" in special_answer: - answer_dict = get_sequestration_fields(answer_dict, filename) - - # TODO: Note that currently - for Outlier and Stop-Loss, there is FACILITY_OUTLIER_EXCLUSION_DESC and FACILITY_STOP_LOSS_EXCLUSION_DESC. - # As of now, these are being pulled in the prompts. In the future, change these fields to be mapped using the PROC code mapping system - # They should map from FACILITY_OUTLIER_EXCLUSION_CD or FACILITY_STOP_LOSS_EXCLUSION_CD - return answer_dict + answer_dict = run_special_case_prompts(answer_dict, filename, "sequestration") + elif "DISCOUNT" in special_answer: + answer_dict = run_special_case_prompts(answer_dict, filename, "discount") + elif "PREMIUM" in special_answer: + answer_dict = run_special_case_prompts(answer_dict, filename, "premium") + elif "ADDITION" in special_answer: + answer_dict = run_special_case_prompts(answer_dict, filename, "addition") + elif "TRIGGER_CAP" in special_answer: + answer_dict = run_special_case_prompts(answer_dict, filename, "trigger_cap") + return answer_dict \ No newline at end of file diff --git a/fieldExtraction/src/investment/tin_npi_funcs.py b/fieldExtraction/src/investment/tin_npi_funcs.py index 15ca468..d0d3e88 100644 --- a/fieldExtraction/src/investment/tin_npi_funcs.py +++ b/fieldExtraction/src/investment/tin_npi_funcs.py @@ -56,10 +56,10 @@ def clean_tin_npi(dict_): new_dict = {} new_dict["PROV_GROUP_TIN"] = clean_str(dict_.get("PROV_GROUP_TIN", "")) - new_dict["PROV_TIN_OTHER"] = ", ".join(list(set([clean_str(s) for s in dict_.get("PROV_TIN_OTHER", "") if clean_str(s) != new_dict['PROV_GROUP_TIN']]))) + new_dict["PROV_OTHER_TIN"] = ", ".join(list(set([clean_str(s) for s in dict_.get("PROV_OTHER_TIN", "") if clean_str(s) != new_dict['PROV_GROUP_TIN']]))) new_dict["PROV_GROUP_NPI"] = clean_str(dict_.get("PROV_GROUP_NPI", "")) - new_dict["PROV_NPI_OTHER"] = ", ".join(list(set([clean_str(s) for s in dict_.get("PROV_NPI_OTHER", "") if clean_str(s) != new_dict['PROV_GROUP_NPI']]))) + new_dict["PROV_OTHER_NPI"] = ", ".join(list(set([clean_str(s) for s in dict_.get("PROV_OTHER_NPI", "") if clean_str(s) != new_dict['PROV_GROUP_NPI']]))) return new_dict diff --git a/fieldExtraction/src/postprocessing_funcs.py b/fieldExtraction/src/postprocessing_funcs.py index fc56c32..f62ec53 100644 --- a/fieldExtraction/src/postprocessing_funcs.py +++ b/fieldExtraction/src/postprocessing_funcs.py @@ -1134,9 +1134,31 @@ def remove_unnamed_columns(df): # postprocessing_funcs.py return df[[col for col in df.columns if "Unnamed" not in col]] -def reorder_columns(df: pd.DataFrame, column_order: list[str]): - # Return each valid column first, in order, then add invalid columns to the end - return df[[col for col in column_order if col in df.columns] + [col for col in df.columns if col not in column_order]] +def reorder_columns(df: pd.DataFrame, column_order: list[str]) -> pd.DataFrame: + """ + Reorders the columns of the DataFrame based on the given column order. + Steps: + 1. Adds any missing columns from `column_order` to the DataFrame, filled with empty strings. + 2. Reorders the columns of the DataFrame to match `column_order`. + 3. Appends any columns in the DataFrame that are not in `column_order` to the end. + Args: + df (pd.DataFrame): The input DataFrame. + column_order (list[str]): The desired column order. + Returns: + pd.DataFrame: The reordered DataFrame. + """ + # Add missing columns from column_order to the DataFrame, filled with empty strings + for col in column_order: + if col not in df.columns: + df[col] = "" + # Reorder columns to match column_order + ordered_columns = [col for col in column_order if col in df.columns] + # Add columns in df that are not in column_order to the end + remaining_columns = [col for col in df.columns if col not in column_order] + # Combine the ordered columns and remaining columns + final_column_order = ordered_columns + remaining_columns + # Return the DataFrame with reordered columns + return df[final_column_order] @cache # memoize repeated calls to this function diff --git a/fieldExtraction/src/prompts/investment_prompts.json b/fieldExtraction/src/prompts/investment_prompts.json index 6224df5..5124886 100644 --- a/fieldExtraction/src/prompts/investment_prompts.json +++ b/fieldExtraction/src/prompts/investment_prompts.json @@ -1,34 +1,34 @@ [ { - "field_name" :"CONTRACT_SERVICE_CD_OR_DESC", + "field_name" :"SERVICE_TERM", "relationship" : "one_to_n", "field_type" : "reimbursement_level", "prompt" : "What is the Service that is being reimbursed? Include the full Service, including any distinguishing context. Include any codes that are part of the service, including revenue codes and procedure codes. Use only exact text from the document. Do not leave this field N/A." }, { - "field_name" : "CONTRACT_REIMBURSEMENT_METHOD", + "field_name" : "REIMB_TERM", "relationship" : "one_to_n", "field_type" : "reimbursement_level", "prompt" : "Write the full sentence or paragraph in the text describing the reimbursement methodology, including any lesser of language, rates, or other important information." }, { - "field_name": "CONTRACT_LESSER_OF_IND", + "field_name": "LESSER_OF_IND", "relationship": "one_to_n", "field_type": "methodology_breakout", "prompt": "If the methodology text indicates that the reimbursement shall be the lesser of two or more values, write 'Y' for this field. Otherwise, write 'N'." }, { - "field_name": "CONTRACT_GREATER_OF_IND", + "field_name": "GREATER_OF_IND", "relationship": "one_to_n", "field_type": "methodology_breakout", "prompt": "If the methodology text indicates that the reimbursement shall be the greater of two or more values, write 'Y' for this field. Otherwise, write 'N'." }, { - "field_name": "AARETE_DERIVED_REIMBURSEMENT_METHOD", + "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}. Note that if the reimbursement is a dollar value, the AARETE_DERIVED_REIMBURSEMENT_METHOD cannot be 'Fee Schedule'.if Average Sales Price (ASP) is present in the methodology, then return 'ASP' value. In cases Where we have 'cost plus 5% based on AWP' it should be AWP not Cost Plus. Answer DOFR only when the word 'DOFR' is specifically mentioned. Answer 'Medicare Member Cost Share' only when the phrase 'Medicare Member Cost Share' is specifically mentioned.", - "valid_values": "VALID_REIMBURSEMENT_METHOD" + "prompt": "What is the method of reimbursement? Choose only from the following: {valid_values}. Note that if the reimbursement is a dollar value, the AARETE_DERIVED_REIMB_METHOD cannot be 'Fee Schedule'.if Average Sales Price (ASP) is present in the methodology, then return 'ASP' value. In cases Where we have 'cost plus 5% based on AWP' it should be AWP not Cost Plus. Answer DOFR only when the word 'DOFR' is specifically mentioned. Answer 'Medicare Member Cost Share' only when the phrase 'Medicare Member Cost Share' is specifically mentioned.", + "valid_values": "VALID_REIMB_TERM" }, { "field_name": "UNIT_OF_MEASURE", @@ -36,33 +36,32 @@ "field_type": "methodology_breakout", "prompt": "If the reimbursement rate is flat rate, what is its unit of measure. some examples are Per Minute, Per Hour, Per Unit, Per mg, ml etc." }, - { - "field_name": "CONTRACT_REIMBURSEMENT_FEE_RATE", + "field_name": "REIMB_FEE_RATE", "relationship": "one_to_n", "field_type": "methodology_breakout", "prompt": "If the reimbursement rate is a dollar amount, what is that dollar amount?" }, { - "field_name": "CONTRACT_REIMBURSEMENT_PERCENT_RATE", + "field_name": "REIMB_PCT_RATE", "relationship": "one_to_n", "field_type": "methodology_breakout", "prompt": "If the reimbursement rate is a percentage of something, what is that percentage?. If no specific percentage is explicitly mentioned, return 100 as the default value. Extract only the final percentage value from the text." }, { - "field_name": "REIMBURSEMENT_EFFECTIVE_DT", + "field_name": "REIMB_EFFECTIVE_DT", "relationship": "one_to_n", "field_type": "dynamic", "prompt": "Identify the effective date for reimbursement rates:\n- Look for dates associated with:\n • 'Effective' or 'effective date'\n • 'In effect' or 'in effect on'\n • Date ranges with 'from/through' or 'start/end'\n- Dates may appear as:\n • Full dates (12/1/17, December 1, 2017)\n • Month and year (December 2017)\n • Year only (2017)" }, { - "field_name": "REIMBURSEMENT_TERMINATION_DT", + "field_name": "REIMB_TERMINATION_DT", "relationship": "one_to_n", "field_type": "dynamic", "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)" }, { - "field_name": "REIMBURSEMENT_PROV_NAME", + "field_name": "REIMB_PROV_NAME", "relationship": "one_to_n", "field_type": "dynamic", "prompt": "Identify any Provider Names present that apply to the text. Do NOT return the name of a payer or insurance plan, only the names of specific providers (doctors, hospitals, clinics, etc) listed. Do not return the word 'Provider'." @@ -74,7 +73,7 @@ "prompt": "Identify if there is a 'not to exceed' limitation:\n- Look for phrases like:\n • 'not to exceed' or 'NTE'\n • 'shall not exceed'\n • 'maximum of' or 'max'\n- These may apply to:\n • Dollar amounts\n • Percentages\n • Per-service limits\nReturn 'Y' if any such limitation is found, 'N' if not." }, { - "field_name": "CONTRACT_FEE_SCHEDULE_DESC", + "field_name": "FEE_SCHEDULE", "relationship": "one_to_n", "field_type": "fee_schedule_breakout", "prompt": "Write the full name of the Fee Schedule here. Only use exact text from the methodology." @@ -87,7 +86,7 @@ "valid_values" : "VALID_AARETE_DERIVED_FEE_SCHEDULE" }, { - "field_name": "CONTRACT_FEE_SCHEDULE_VERSION", + "field_name": "FEE_SCHEDULE_VERSION", "relationship": "one_to_n", "field_type": "fee_schedule_breakout", "prompt": "What version of the fee schedule is it? Look for a version number, a year, a date, or the words 'prevailing', 'current', or similar. Only use exact text from the methodology." @@ -99,26 +98,26 @@ "prompt": "What version of the fee schedule is it? Look for a version number, a year, a date, or the words 'prevailing', 'current', or similar." }, { - "field_name" : "CONTRACT_LINE_OF_BUSINESS", + "field_name" : "LOB", "relationship" : "one_to_n", "field_type" : "dynamic", "prompt" : "What is the Line of Business? Choose ONLY from the following: {valid_values}", "valid_values" : "VALID_LOBS" }, { - "field_name": "AARETE_DERIVED_LINE_OF_BUSINESS", + "field_name": "AARETE_DERIVED_LOB", "relationship": "one_to_n", "field_type": "crosswalk", "prompt": "TBD", "crosswalk" : "crosswalk_lob.json", - "base_field" : "CONTRACT_LINE_OF_BUSINESS" + "base_field" : "LOB" }, { - "field_name" : "CONTRACT_NETWORK", + "field_name" : "NETWORK", "relationship" : "one_to_n", "field_type" : "dynamic", "prompt" : "What is the Network? Choose ONLY from the following: {valid_values}", - "valid_values" : "VALID_CONTRACT_NETWORKS" + "valid_values" : "VALID_NETWORKS" }, { "field_name": "AARETE_DERIVED_NETWORK", @@ -126,10 +125,10 @@ "field_type": "crosswalk", "prompt": "TBD", "crosswalk" : "crosswalk_network.json", - "base_field" : "CONTRACT_NETWORK" + "base_field" : "NETWORK" }, { - "field_name" : "CONTRACT_PRODUCT", + "field_name" : "PRODUCT", "relationship" : "one_to_n", "field_type" : "dynamic", "prompt" : "List any Products found in the Exhibit. Look for the brand name of a health plan or product. Do not include the name of the entire healthplan (such as 'Molina', 'Centene' etc) - rather, look for the Product that these healthplans offer. This field should also not include generic healthcare terms like 'Medicare', 'Medicaid', etc, unless the contract explicitely labels these terms as a Product. Return the exact text from the contract." @@ -140,10 +139,10 @@ "field_type": "TBD", "prompt": "TBD", "crosswalk" : "crosswalk_product.json", - "base_field" : "CONTRACT_PRODUCT" + "base_field" : "PRODUCT" }, { - "field_name" : "CONTRACT_PROGRAM", + "field_name" : "PROGRAM", "relationship" : "one_to_n", "field_type" : "dynamic", "prompt" : "What is the Program? Choose ONLY from the following: {valid_values}. Note that 'Medicare' does NOT mean 'Medicare Advantage'. If only 'Medicare' is seen, do not write 'Medicare Advantage'.", @@ -155,14 +154,14 @@ "field_type": "crosswalk", "prompt": "TBD", "crosswalk" : "crosswalk_program.json", - "base_field" : "CONTRACT_PROGRAM" + "base_field" : "PROGRAM" }, { - "field_name" : "CONTRACT_CLAIM_TYPE_CD", + "field_name" : "CLAIM_TYPE_CD", "relationship" : "one_to_one", "field_type" : "full_context", "prompt" : "Is the contract related to a professional, instututional, facility or ancillary provider? It may be deduced based on contract title. If the contract is with Hospital or Facility, the answer would be Institutional. If contract is directly with doctor or physician services, the answer would be Professional. If contract is with providers which only provides services like Audiology, Cardiac Monitoring, Diagnostic Imaging, Genetic Testing, Laboratory/Blood Testing, Radiology, Sleep Lab Services, Telemedicine, Allergy Services, Behavioral & Mental Health Services, answer would be Ancillary.", - "valid_values" : "VALID_CONTRACT_CLAIM_TYPE", + "valid_values" : "VALID_CLAIM_TYPE", "keywords" : [], "smart_chunking_methodology" : "TBD" }, @@ -220,7 +219,7 @@ "prompt": "What is the Provider Group's (as opposed to an individual provider's) TIN? Choose ONLY from the following: {valid_values}. If there is no clear Group TIN, write N/A. If there are multiple numbers that appear to be the Group TIN, or multiple Groups that each have a TIN, return number in a comma-separated list." }, { - "field_name": "PROV_TIN_OTHER", + "field_name": "PROV_OTHER_TIN", "relationship": "regex", "field_type": "regex", "prompt": "List any TINs found in the contract other than the Group TIN. Choose from the same list of TINs provided for PROV_GROUP_TIN. Some of the numbers in the list may not be TINs, but are instead Medicaid IDs, TPIs, Fax/Phone numbers, or other numbers that were mistaken as TINs due to having a similar format. Do not include any numbers that are not labeled as something other than a TIN or Tax ID Number. If there are no valid TINs, return an empty list." @@ -232,19 +231,19 @@ "prompt": "What is the Provider Group's NPI? This will be the NPI that corresponds with the PROV_GROUP_TIN value. Choose ONLY from the following: {valid_values}. If there is no clear Group NPI, write N/A. If there are multiple numbers that appear to be the Group NPI, return them in a comma-separated list." }, { - "field_name": "PROV_NPI_OTHER", + "field_name": "PROV_OTHER_NPI", "relationship": "regex", "field_type": "regex", "prompt": "List any NPIs found in the contract other than the Group NPI. Choose from the same list of NPIs provided for PROV_GROUP_NPI. Some of the numbers in the list may not be NPIs, but are instead Medicaid IDs, TPIs, Fax/Phone numbers, or other numbers that were mistaken as NPIs due to having a similar format. These should not be included in the list. If there are no valid NPIs, return an empty list." }, { - "field_name": "PROV_REIMBURSEMENT_TIN", + "field_name": "REIMB_PROV_TIN", "relationship": "one_to_n", "field_type": "TBD", "prompt": "What TIN (Tax ID Number) does the reimbursement term apply to? Choose only from the following: {valid_values}." }, { - "field_name": "PROV_REIMBURSEMENT_NPI", + "field_name": "REIMB_PROV_NPI", "relationship": "one_to_n", "field_type": "TBD", "prompt": "What NPI (National Provider Identifier) does the reimbursement term apply to? Choose only from the following: {valid_values}." @@ -256,13 +255,13 @@ "prompt": "What is the name of the Group provider that is a party to the contract? If a group provider is explicitly mentioned, return it exactly as written. If no group provider is stated, return the individual provider’s full name, including credentials (e.g., MD, LPCMH). If the document does not clearly distinguish between a group or an individual, search for a provider name near keywords such as 'Provider', 'Group Name', 'Physician', 'Doctor', 'DBA', 'Medical Group', 'This Agreement is made and entered between', or 'Contracted Provider'. Only return the extracted name without additional text or descriptions." }, { - "field_name": "PROV_FULL_NAME", + "field_name": "PROV_OTHER_NAME_FULL", "relationship": "one_to_one", "field_type": "full_context", "prompt": "What is the name of the Provider?" }, { - "field_name": "CONTRACT_EFFECTIVE_DT", + "field_name": "AARETE_DERIVED_EFFECTIVE_DT", "relationship": "one_to_one", "field_type": "smart_chunked", "prompt": "Please analyze the following contract and extract ONLY the effective date of the CURRENT contract or CURRENT amendment. THE DATE MAY OR MAY NOT BE EXPLICITLY LABELED AS AN EFFECTIVE DATE. Follow these retrieval rules in order:\n[RETRIEVAL RULES]\nLOOK FOR dates that appear after these common phrases but not limited to (case-insensitive matching):\n'Effective Date:' FOLLOWED BY a date\n'is entered into as of' FOLLOWED BY a date\n'is made and entered into as of the' FOLLOWED BY a date\n'effective as of' FOLLOWED BY a date\n'shall begin on' FOLLOWED BY a date\n'Effective Date of Agreement:' FOLLOWED BY a date\n'Effective Date of Amendment' FOLLOWED BY a date\n'made this' FOLLOWED BY a date\n'made and entered into' FOLLOWED BY a date\n\nALSO LOOK FOR dates in phrases that semantically indicate an effective date (may or may not be explictly labelled as effective date), even if they do not exactly match the phrases above.\nExamples include but ARE NOT LIMITED TO:\nPhrases indicating when an contract or amendment begins or takes effect, Phrases specifying the start date of the contract or amendment, Phrases defining when the contract or amendment becomes operational, or Any phrase indicating contract or amendment creation or execution date.\nIt is possible that the contract will specify that the effective date is derived from elsewhere in the contract. One specific case is outlined: SIGNATURE DATE HANDLING:\nPRIMARY RULE: DO NOT USE signature dates unless STRICTLY meeting the criteria below\nWHEN TO USE a signature date: ONLY IF that SPECIFIC signature date has an EXPLICIT statement marking IT as the effective date\nHere are some example scenarios:\n✓ USE: 'Effective Date: 1/13/2024' + 'Date: [blank]' below\n✓ USE: 'Effective Date of Agreement: 2/15/2016' + 'Date: [blank]' below\nWHEN NOT TO USE a signature date:\n- Even if there is an empty effective date section or field nearby\nHere are some example scenarios but not limited to:\n✗ DO NOT USE: 'Date: 1/1/2024' + 'Effective Date: [blank]' below\n✗ DO NOT USE: 'Effective Date: [blank]' + 'Date: 1/1/2024' below\n\n\n[OUTPUT DATE HANDLING]\nCRITICAL - DATE FORMAT PRESERVATION:\n- You MUST preserve the EXACT format of the date AS IT APPEARS in the document\n- DO NOT modify, standardize, or reformat the date in ANY way\n- Preserve ALL original: Spacing (including multiple spaces), punctuation, separators (commas, hyphens, forward slashes, etc.), leading/trailing spaces, or partial or incomplete dates\n\nExamples of EXACT DATE preservation:\n✓ If document shows: '3-1 , , 03' → return |3-1 , , 03|\n✓ If document shows: 'June 1st,2010' → return |June 1st,2010|\n✓ If document shows: 'Feb 1st day of , 10' → return |Feb 1st day of , 10|\n✓ If document shows: '6 /1/ 2010' → return |6 /1/ 2010|\n✓ If document shows: '12-1-20' → return |12-1-20|\n✓ If document shows: 'made this day of Jan, 2009' → return |day of Jan, 2009|\n✓ If document shows: 'to be effective as of , 20 ( the 'Effective Date').' → return |, 20|\n\nIt is POSSIBLE that the intended effective date could be blank (left blank, not filled), empty, incomplete, or partial. This is still acceptable as the ANSWER. DO NOT ASSUME/INFER anything about the date or its components.\nReturn N/A only if NO valid effective date is found (excluding blank/empty/incomplete dates)\n\nIF MULTIPLE matches are retrieved:\n - VERIFY that you have PRECISELY followed the retrieval rules\n - If multiple matches are present, PRIORITIZE and SELECT the LATEST date as the answer\n - MAINTAIN the EXACT FORMAT of the selected date as it appears in the document\n\nBefore providing the final answer, SHOW your reasoning:\n - LIST ALL dates found that match patterns in the retrieval rules\n- For EACH date found:\n* EXPLAIN why it is considered for effective date or not\n* Include the EXACT text snippet where the date was found\n- JUSTIFY your final date selection or why N/A is being returned\n\nFinal Answer Format:\n - Your answer MUST be ENCLOSED in |pipes|\n - The text between the pipes MUST be an EXACT COPY of how the date appears in the document\n - DO NOT add or remove ANY characters, spaces, or formatting", @@ -270,7 +269,7 @@ "format": "date" }, { - "field_name": "CONTRACT_TERMINATION_DT", + "field_name": "TERMINATION_DT", "relationship": "one_to_one", "field_type": "smart_chunked", "prompt": "What is the initial contract termination date? Look within the Term or Term and Termination section. Extract the specific end date of the initial term before any renewals or extensions. \nOutput Format Rules: \n- If an exact specific date is mentioned: Output the date (e.g., '12/31/2024') \n- If described using terminology like duration or recurring period: Output the exact terminology (e.g., 'three years from the contract effective date', 'year to year') \n- If multiple dates or conditions are mentioned, prioritize the initial termination date before any automatic renewals. \n - Do not modify, transform, or calculate dates. Example Outputs: - For specific date: '12/31/2014' - For duration: 'three years from the contract effective date' - For recurring period: 'year to year' - For conditional termination: 'upon execution of new FPA or 12/31/2014, whichever is earlier'", @@ -279,7 +278,7 @@ }, { "field_name": "AARETE_DERIVED_TERMINATION_DT", - "base_field": "CONTRACT_TERMINATION_DT", + "base_field": "TERMINATION_DT", "relationship": "one_to_one", "field_type": "date_inferred", "prompt": "TBD", @@ -288,7 +287,7 @@ "case_sensitive" : "True" }, { - "field_name": "CONTRACT_AUTO_RENEWAL_IND", + "field_name": "AUTO_RENEWAL_IND", "relationship": "one_to_one", "field_type": "smart_chunked", "prompt": "If this contract automatically renews, answer Y. If this contract will remain in effect unless terminated, answer Y. Otherwise, answer N.", @@ -297,7 +296,7 @@ "case_sensitive" : "True" }, { - "field_name": "CONTRACT_AUTO_RENEWAL_TERM", + "field_name": "AUTO_RENEWAL_TERM", "relationship": "one_to_one", "field_type": "smart_chunked", "prompt": "If contract automatically renews, then what is the length of the renewal term? This is related to the term and termination agreement section of the contract. This should be a one or two word statement, typically around renewal, automatic renewal, or auto-renewal. Only return the length of time for the renewal, do not provide any context.", @@ -306,22 +305,22 @@ "case_sensitive" : "True" }, { - "field_name": "CONTRACT_SIGNATORY_COMPLETE_IND", + "field_name": "SIGNATORY_COMPLETE_IND", "relationship": "one_to_one", "field_type": "TBD", "prompt": "TBD" }, { "field_name": "AARETE_DERIVED_CLAIM_TYPE_CD", - "base_field": "CONTRACT_CLAIM_TYPE_CD", + "base_field": "CLAIM_TYPE_CD", "relationship": "one_to_one", "field_type": "crosswalk", "valid_values":"VALID_AARETE_DERIVED_CLAIM_TYPE_CD", - "prompt": "Convert the claim type value to appropriate code: Return H for 'facility' or 'hospital' or 'Institutional'. Return M for 'ancillary' or 'professional'. Claim type: {CONTRACT_CLAIM_TYPE_CD}. Return only 'H' or 'M' without any additional text.", + "prompt": "Convert the claim type value to appropriate code: Return H for 'facility' or 'hospital' or 'Institutional'. Return M for 'ancillary' or 'professional'. Claim type: {CLAIM_TYPE_CD}. Return only 'H' or 'M' without any additional text.", "crosswalk": "crosswalk_claim_type.json" }, { - "field_name": "CONTRACT_SERVICE_AREA", + "field_name": "SERVICE_AREA", "relationship": "one_to_one", "field_type": "TBD", "prompt": "TBD" @@ -333,7 +332,7 @@ "prompt": "TBD" }, { - "field_name": "CONTRACT_PROV_TYPE", + "field_name": "PROV_TYPE", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" @@ -353,8 +352,8 @@ "valid_values": "VALID_PROV_SPECIALTY" }, { - "field_name": "PROV_SPECIALTY_DESC", - "base_field": "CONTRACT_PROV_SPECIALTY", + "field_name": "PROV_SPECIALTY_CD_DESC", + "base_field": "PROV_SPECIALTY_CD", "relationship": "one_to_n", "field_type": "crosswalk", "prompt": "TBD", @@ -367,7 +366,7 @@ "prompt": "Identify all Bill Type codes in the text: - 4 alphanumeric characters - First character is often a leading zero, it may or may not be included - If no code is listed, but the phrase 'Bill Type' appears, write the exact text from the contract that describes the Bill Type." }, { - "field_name": "BILL_TYPE_DESC", + "field_name": "BILL_TYPE_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" @@ -385,19 +384,19 @@ "prompt": "TBD" }, { - "field_name": "CONTRACT_CARVEOUT_IND", + "field_name": "CARVEOUT_IND", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" }, { - "field_name": "CONTRACT_CARVEOUT_CD", + "field_name": "CARVEOUT_CD", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" }, { - "field_name": "CONTRACT_DEFAULT_IND", + "field_name": "DEFAULT_IND", "relationship": "one_to_n", "field_type": "methodology_breakout", "prompt": "DEFAULT_INDICATOR:\nIndicates whether this methodology serves as a default/fallback payment rate when no other payment methods apply. The default/fallback payment rate is typically a low rate and based on billed charges.\nOutput 'Y' if ANY of these conditions are met in the methodology:\n1. Specifies a rate that applies to:\nservices not listed in the fee schedule\nservices for which no other payment method is specified\nall other services\nservices not otherwise specified\n2. Explicitly labeled as:\n'default rate' or 'default payment'\nOutput 'N' if:\nThe methodology is specific to listed services/procedures\nNo default/fallback language is present" @@ -409,7 +408,7 @@ "prompt": "Identify all Procedure (CPT or HCPCS) Codes in the text: - CPT codes are exactly 5 numeric digits (00100-99999) - HCPCS codes are 1 letter followed by 4 numbers (A0000-V9999)." }, { - "field_name": "CPT4_PROC_DESC", + "field_name": "CPT4_PROC_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" @@ -433,7 +432,7 @@ "prompt": "Identify all Revenue codes (Rev codes) in the text: - 3-4 digit numeric codes - May have 'X' as a wildcard character - Start with digits 0-9." }, { - "field_name": "REVENUE_DESC", + "field_name": "REVENUE_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" @@ -445,7 +444,7 @@ "prompt": "Identify diagnosis codes (ICD-10) in the text: - 3-7 characters in length - First character must be a letter - Characters 2-3 must be numbers - Characters 4-7 (if present) can be numbers or letters." }, { - "field_name": "DIAG_DESC", + "field_name": "DIAG_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" @@ -457,25 +456,25 @@ "prompt": "What is the Diagnosis-Related Group (DRG) type mentioned in the context? It is generally either MS-DRG or APR-DRG." }, { - "field_name": "FACILITY_GROUPER_CD", + "field_name": "GROUPER_CD", "relationship": "one_to_n", "field_type": "code_primary_breakout", "prompt": "Identify grouper codes (DRGs) in the text: - Basic format: 3 digits (like 123) - May include severity/risk indicators (like 123-1) - May include decimal points (like 123.4) - Maximum length of 5 characters." }, { - "field_name": "FACILITY_GROUPER_DESC", + "field_name": "GROUPER_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" }, { - "field_name": "LINE_NDC_NUM", + "field_name": "NDC_CD", "relationship": "one_to_n", "field_type": "code_primary_breakout", "prompt": "Return a list of any National Drug Code numbers present. Look for an 11-digit number of the format XXXXX-XXXX-XX." }, { - "field_name": "LINE_NDC_DESC", + "field_name": "LINE_NDC_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" @@ -499,136 +498,207 @@ "prompt": "TBD" }, { - "field_name": "CLAIM_STATUS_DESC", + "field_name": "CLAIM_STATUS_CD_DESC", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" }, { - "field_name": "CONTRACT_FACILITY_OUTLIER_TERMS", + "field_name": "OUTLIER_TERMS", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" }, { - "field_name": "FACILITY_OUTLIER_FIXED_LOSS_THRESHOLD", + "field_name": "OUTLIER_FIXED_LOSS_THRESHOLD", "relationship": "one_to_n", "field_type": "outlier", "prompt": "What is the threshold amount to be compared to the cost of the claim, whereby if the cost exceeds the threshold, the outlier payment is calculated on the excess amount. This may be a percentage or a dollar value." }, { - "field_name": "FACILITY_OUTLIER_PERCENT_RATE_ON_EXCESS_CHARGES", + "field_name": "OUTLIER_PERCENT_RATE_ON_EXCESS_CHARGES", "relationship": "one_to_n", "field_type": "outlier", "prompt": "What is the percent rate that is applied to costs that exceed the outlier threshold?" }, { - "field_name": "FACILITY_OUTLIER_MAXIMUM", + "field_name": "OUTLIER_MAXIMUM", "relationship": "one_to_n", "field_type": "outlier", "prompt": "If there is a cap on the total amount to be paid, write that cap here. If there is not, write N/A." }, { - "field_name": "FACILITY_OUTLIER_EXCLUSION_CD", + "field_name": "OUTLIER_EXCLUSION_CD", "relationship": "one_to_n", "field_type": "outlier", "prompt": "If the text specifies that any codes are to be excluded from the outlier calculation, write those codes here. If not, write 'N/A'." }, { - "field_name": "FACILITY_OUTLIER_EXCLUSION_DESC", + "field_name": "OUTLIER_EXCLUSION_DESC", "relationship": "one_to_n", "field_type": "outlier", "prompt": "Describe anything that is excluded from the outlier calculation. Write only the exact text from the contract. If the text does not indicate that anything is excluded, write 'N/A'." }, { - "field_name": "CONTRACT_FACILITY_STOP_LOSS_TERMS", + "field_name": "STOP_LOSS_TERMS", "relationship": "one_to_n", "field_type": "TBD", "prompt": "TBD" }, { - "field_name": "FACILITY_STOP_LOSS_FIXED_LOSS_THRESHOLD", + "field_name": "STOP_LOSS_FIXED_LOSS_THRESHOLD", "relationship": "one_to_n", "field_type": "stop_loss", "prompt": "What is the threshold amount to be compared to the cost of the claim, whereby if the cost exceeds the threshold, the stop-loss payment is calculated on the excess amount. This may be a percentage or a dollar value." }, { - "field_name": "FACILITY_STOP_LOSS_PERCENT_RATE_ON_EXCESS_CHARGES", + "field_name": "STOP_LOSS_PERCENT_RATE_ON_EXCESS_CHARGES", "relationship": "one_to_n", "field_type": "stop_loss", "prompt": "What is the percent rate that is applied to costs that exceed the stop-loss threshold?" }, { - "field_name": "FACILITY_STOP_LOSS_DAILY_MAXIMUM", + "field_name": "STOP_LOSS_DAILY_MAXIMUM", "relationship": "one_to_n", "field_type": "stop_loss", "prompt": "If there is a cap on the total amount to be paid each day, write that cap here. If there is not, write N/A." }, { - "field_name": "FACILITY_STOP_LOSS_EXCLUSION_CD", + "field_name": "STOP_LOSS_EXCLUSION_CD", "relationship": "one_to_n", "field_type": "stop_loss", "prompt": "If the text specifies that any codes are to be excluded from the stop-loss calculation, write those codes here. If not, write 'N/A'." }, { - "field_name": "FACILITY_STOP_LOSS_EXCLUSION_DESC", + "field_name": "STOP_LOSS_EXCLUSION_DESC", "relationship": "one_to_n", "field_type": "stop_loss", "prompt": "Describe anything that is excluded from the stop-loss calculation. Write only the exact text from the contract. If the text does not indicate that anything is excluded, write 'N/A'." }, { - "field_name": "CONTRACT_SEQUESTRATION_PERCENT_RATE", + "field_name": "SEQUESTRATION_PERCENT_RATE", "relationship": "one_to_n", "field_type": "sequestration", "prompt": "What is quantity of the sequestration reduction? This is typically found as a percent value." }, { - "field_name": "CONTRACT_SEQUESTRATION_START_DT", + "field_name": "SEQUESTRATION_START_DT", "relationship": "one_to_n", "field_type": "sequestration", "prompt": "What is the Effective Date of the sequestration reduction? If none is specified, write 'N/A'." }, { - "field_name": "CONTRACT_SEQUESTRATION_END_DT", + "field_name": "SEQUESTRATION_END_DT", "relationship": "one_to_n", "field_type": "sequestration", "prompt": "What is the Termination Date of the sequestration reduction? If none is specified, write 'N/A'." }, { - "field_name": "CONTRACT_DISCOUNT_PERCENT_RATE", + "field_name": "DISCOUNT_PERCENT_RATE", "relationship": "one_to_n", - "field_type": "TBD", - "prompt": "TBD" + "field_type": "discount", + "prompt": "What is the discount to be applied to the normal rate? Write only the percentage value." }, { - "field_name": "CONTRACT_DISCOUNT_START_DT", + "field_name": "DISCOUNT_RATE_CHANGE_INTERVAL", "relationship": "one_to_n", - "field_type": "TBD", - "prompt": "TBD" + "field_type": "discount", + "prompt": "What is the rate change interval of the discount?" }, { - "field_name": "CONTRACT_DISCOUNT_END_DT", + "field_name": "DISCOUNT_START_DT", "relationship": "one_to_n", - "field_type": "TBD", - "prompt": "TBD" + "field_type": "discount", + "prompt": "If there is a date range for which the discount applies, write the start date here, in YYYY/MM/DD format." }, { - "field_name": "CONTRACT_PREMIUM_PERCENT_RATE", + "field_name": "DISCOUNT_END_DT", "relationship": "one_to_n", - "field_type": "TBD", - "prompt": "TBD" + "field_type": "discount", + "prompt": "If there is a date range for which the discount applies, write the end date here, in YYYY/MM/DD format." }, { - "field_name": "CONTRACT_PREMIUM_START_DT", + "field_name": "PREMIUM_PERCENT_RATE", "relationship": "one_to_n", - "field_type": "TBD", - "prompt": "TBD" + "field_type": "premium", + "prompt": "What is the discount to be applied to the normal rate? Write only the percentage value." }, { - "field_name": "CONTRACT_PREMIUM_END_DT", + "field_name": "PREMIUM_RATE_CHANGE_INTERVAL", + "relationship": "one_to_n", + "field_type": "premium", + "prompt": "What is the rate change interval of the premium?" + }, + { + "field_name": "PREMIUM_START_DT", + "relationship": "one_to_n", + "field_type": "premium", + "prompt": "If there is a date range for which the premium applies, write the end date here, in YYYY/MM/DD format." + }, + { + "field_name": "PREMIUM_END_DT", + "relationship": "one_to_n", + "field_type": "premium", + "prompt": "If there is a date range for which the premium applies, write the end date here, in YYYY/MM/DD format." + }, + { + "field_name": "ADDITION_DESC", + "relationship": "one_to_n", + "field_type": "addition", + "prompt": "Describe the conditions or scenarios under which additional rates may be applied. Use exact text from the document." + }, + { + "field_name": "ADDITION_MAX_FEE_RATE_INC", + "relationship": "one_to_n", + "field_type": "addition", + "prompt": "What is the maximum fee rate increase allowed for additional rates? Provide the exact value from the text." + }, + { + "field_name": "ADDITION_MAX_PCT_RATE_INC", + "relationship": "one_to_n", + "field_type": "addition", + "prompt": "What is the maximum percentage rate increase allowed for additional rates? Provide the exact value from the text." + }, + { + "field_name": "ADDITION_RATE_CHANGE_TIMELINE", + "relationship": "one_to_n", + "field_type": "addition", + "prompt": "What is the timeline for rate changes related to additional rates? Provide the exact text from the document." + }, + { + "field_name": "TRIGGER_CAP_THRESHOLD", + "relationship": "one_to_n", + "field_type": "trigger_cap", + "prompt": "What is the threshold for the trigger cap? Provide the exact value from the text." + }, + { + "field_name": "TRIGGER_BASE_THRESHOLD", + "relationship": "one_to_n", + "field_type": "trigger_cap", + "prompt": "What is the base threshold for the trigger? Provide the exact value from the text." + }, + { + "field_name": "RATE_ESCALATOR_IND", "relationship": "one_to_n", "field_type": "TBD", - "prompt": "TBD" + "prompt": "Does the text indicate the presence of a rate escalator? If yes, return 'Y'. Otherwise, return 'N'." + }, + { + "field_name": "RATE_ESCALATOR_DESC", + "relationship": "one_to_n", + "field_type": "TBD", + "prompt": "Describe the conditions or scenarios under which the rate escalator applies. Use exact text from the document." + }, + { + "field_name": "RATE_ESCALATOR_MAX_RATE_INC", + "relationship": "one_to_n", + "field_type": "TBD", + "prompt": "What is the maximum rate increase allowed under the rate escalator? Provide the exact value from the text." + }, + { + "field_name": "RATE_ESCALATOR_RATE_CHANGE_TIMELINE", + "relationship": "one_to_n", + "field_type": "TBD", + "prompt": "What is the timeline for rate changes under the rate escalator? Provide the exact text from the document." } - ] \ No newline at end of file diff --git a/fieldExtraction/src/prompts/investment_prompts.py b/fieldExtraction/src/prompts/investment_prompts.py index bd1d8b2..31046fe 100644 --- a/fieldExtraction/src/prompts/investment_prompts.py +++ b/fieldExtraction/src/prompts/investment_prompts.py @@ -1,4 +1,4 @@ -from src.constants.investment_values import VALID_LOBS, VALID_CONTRACT_NETWORKS, VALID_PROGRAMS, VALID_CONTRACT_CLAIM_TYPE, VALID_REIMBURSEMENT_METHOD, VALID_CARVEOUTS, VALID_PROV_TYPE, VALID_SPECIAL +from src.constants.investment_values import VALID_LOBS, VALID_NETWORKS, VALID_PROGRAMS, VALID_CLAIM_TYPE, VALID_REIMB_TERM, VALID_CARVEOUTS, VALID_PROV_TYPE, VALID_SPECIAL, VALID_AARETE_DERIVED_FEE_SCHEDULE import src.constants.valid as valid import pandas as pd from functools import cache @@ -294,8 +294,8 @@ Here are the attributes to be included in each dictionary, and instructions on h [GENERAL INSTRUCTIONS] The attributes are related to the reimbursement of different services and specialties. Ensure every compensation term (with a % or $ value) is captured. -If there is no clear CONTRACT_SERVICE_CD_OR_DESC, then fill in 'Covered Services' for the CONTRACT_SERVICE_CD_OR_DESC value. -If a reimbursement section explicitly refers to a specific plan or benefit program name (e.g., 'COMMERCIAL HMO', 'MEDICARE SELECT BENEFIT PROGRAM'), retain that full phrase as the CONTRACT_SERVICE_CD_OR_DESC and do not replace it with 'Covered Services'. +If there is no clear SERVICE_TERM, then fill in 'Covered Services' for the SERVICE_TERM value. +If a reimbursement section explicitly refers to a specific plan or benefit program name (e.g., 'COMMERCIAL HMO', 'MEDICARE SELECT BENEFIT PROGRAM'), retain that full phrase as the SERVICE_TERM and do not replace it with 'Covered Services'. Ensure any relevant detail is included, including any and all codes relating to the service and any rates in tables, if applicable. @@ -307,13 +307,13 @@ Some services have complex payment structures with multiple components. For anes 4. Any conversion factors that apply to the units 5. Any per-unit dollar amounts -When extracting anesthesia or similarly complex services, include ALL components of the payment methodology in the CONTRACT_REIMBURSEMENT_METHOD field. +When extracting anesthesia or similarly complex services, include ALL components of the payment methodology in the REIMB_TERM field. [THINGS TO IGNORE] Some values are found in sections explicitly identified as examples, samples, or identified as instructions for the reader - these are not real reimbursement terms and must be omitted from output. Other values might be related to liability - these must also be excluded. [LESSER OF LANGUAGE] -Include any 'Lesser of' statement that applies to the reimbursement as part of the CONTRACT_REIMBURSEMENT_METHOD. The 'Lesser of' statement might not be found in immediate proximity to the reimbursement term and may instead be found elsewhere in the exhibit text. This may be found in a paragraph before the compensation schedule, and may include language like "according to the lessor of Provider's Billed Charges or the following schedule", "all rates outlined below or submitted charges whichever is less" or similar. +Include any 'Lesser of' statement that applies to the reimbursement as part of the REIMB_TERM. The 'Lesser of' statement might not be found in immediate proximity to the reimbursement term and may instead be found elsewhere in the exhibit text. This may be found in a paragraph before the compensation schedule, and may include language like "according to the lessor of Provider's Billed Charges or the following schedule", "all rates outlined below or submitted charges whichever is less" or similar. Any 'lesser of' statement that applies to a table or schedule applies to ALL rows in that table, even if they appear to be different service types or have different payment structures (percentage-based vs. flat fee). Unless explicitly stated otherwise, assume that introductory 'lesser of' language applies to the entire table that follows it. In a case where there is verbiage such as "the lesser of the rates listed below or X", this is an indicator that the "lesser of" statement applies to these rates; in this case, construct a new statement by extracting the actual rate below and the other side of lesser of statement. For instance, if X is "100% of the provider's billed charges", the new statement would be "The lesser of [the below rate] and 100% of the provider's billed charges". [CRITICAL LESSER OF APPLICATION] @@ -326,9 +326,9 @@ IMPORTANT: When a contract contains a global "lesser of" statement (such as "the There should be NO exceptions - if a global "lesser of" statement exists, every rate must include it. [LESSER OF EXAMPLES] Text: 'Professional Covered Services is the lesser of: (i) Allowable Charges; or (ii) the "Contracted Rate" percentage found in Table 1. Table 1 - OB and Anesthesia Services : 100% of the Payor's Oregon Health Plan DMAP fee schedule. Radiology Services : 110% of Medicare Fee Schedule' -Answer: "[{{'CONTRACT_SERVICE_CD_OR_DESC' : 'OB and Anesthesia Services', 'CONTRACT_REIMBURSEMENT_METHOD' : 'lesser of (i) Allowable Charges; or (ii) 100% of the Payor's Oregon Health Plan DMAP fee schedule', ...}}, -{{'CONTRACT_SERVICE_CD_OR_DESC' : 'Radiology Services', 'CONTRACT_REIMBURSEMENT_METHOD' : 'lesser of (i) Allowable Charges; or (ii) 110% of Medicare Fee Schedule', ...}}]" -Here is an example of text with a Lesser of statement with flat dollar amounts that should also be included as a CONTRACT_REIMBURSEMENT_METHOD answer: +Answer: "[{{'SERVICE_TERM' : 'OB and Anesthesia Services', 'REIMB_TERM' : 'lesser of (i) Allowable Charges; or (ii) 100% of the Payor's Oregon Health Plan DMAP fee schedule', ...}}, +{{'SERVICE_TERM' : 'Radiology Services', 'REIMB_TERM' : 'lesser of (i) Allowable Charges; or (ii) 110% of Medicare Fee Schedule', ...}}]" +Here is an example of text with a Lesser of statement with flat dollar amounts that should also be included as a REIMB_TERM answer: Text: 'Professional Services are paid at the lesser of: (i) Provider's Billed Charges; or (ii) the rates in Schedule A. Schedule A - OB Services: @@ -336,9 +336,9 @@ OB Services: - CPT 59618: Attempted vaginal delivery, resulting in cesarean $1,700.00 Anesthesia Services: $39/unit' -Answer: "[{{'CONTRACT_SERVICE_CD_OR_DESC' : 'OB Services CPT 59400', 'CONTRACT_REIMBURSEMENT_METHOD' : 'lesser of (i) Provider's Billed Charges; or (ii) $1,700.00', ...}}, -{{'CONTRACT_SERVICE_CD_OR_DESC' : 'OB Services CPT 59618', 'CONTRACT_REIMBURSEMENT_METHOD' : 'lesser of (i) Provider's Billed Charges; or (ii) $1,700.00', ...}}, -{{'CONTRACT_SERVICE_CD_OR_DESC' : 'Anesthesia Services', 'CONTRACT_REIMBURSEMENT_METHOD' : 'lesser of (i) Provider's Billed Charges; or (ii) $39/unit', ...}}]" +Answer: "[{{'SERVICE_TERM' : 'OB Services CPT 59400', 'REIMB_TERM' : 'lesser of (i) Provider's Billed Charges; or (ii) $1,700.00', ...}}, +{{'SERVICE_TERM' : 'OB Services CPT 59618', 'REIMB_TERM' : 'lesser of (i) Provider's Billed Charges; or (ii) $1,700.00', ...}}, +{{'SERVICE_TERM' : 'Anesthesia Services', 'REIMB_TERM' : 'lesser of (i) Provider's Billed Charges; or (ii) $39/unit', ...}}]" [COMPLEX PAYMENT EXAMPLES] Text: 'Anesthesia Services: @@ -346,19 +346,19 @@ OB Epidural 00955 - Continuous epidural, labor and vaginal delivery: 5 base unit OB Epidural 00857 - Continuous epidural, labor and C-Section: 7 base units, plus up to three units for first hour of labor time, plus two units for each additional hour of labor, plus one unit for each fifteen minute interval of surgical time if labor goes into C-Section OB Epidural 00850 - Planned C-Section: 7 base units, plus one unit for each fifteen minute interval of surgical time' -Answer: "[{{'CONTRACT_SERVICE_CD_OR_DESC' : 'OB Epidural 00955 - Continuous epidural, labor and vaginal delivery', 'CONTRACT_REIMBURSEMENT_METHOD' : '5 base units, plus up to three units for first hour of labor time, plus two units for each additional hour of labor', ...}}, -{{'CONTRACT_SERVICE_CD_OR_DESC' : 'OB Epidural 00857 - Continuous epidural, labor and C-Section', 'CONTRACT_REIMBURSEMENT_METHOD' : '7 base units, plus up to three units for first hour of labor time, plus two units for each additional hour of labor, plus one unit for each fifteen minute interval of surgical time if labor goes into C-Section', ...}}, -{{'CONTRACT_SERVICE_CD_OR_DESC' : 'OB Epidural 00850 - Planned C-Section', 'CONTRACT_REIMBURSEMENT_METHOD' : '7 base units, plus one unit for each fifteen minute interval of surgical time', ...}}]" +Answer: "[{{'SERVICE_TERM' : 'OB Epidural 00955 - Continuous epidural, labor and vaginal delivery', 'REIMB_TERM' : '5 base units, plus up to three units for first hour of labor time, plus two units for each additional hour of labor', ...}}, +{{'SERVICE_TERM' : 'OB Epidural 00857 - Continuous epidural, labor and C-Section', 'REIMB_TERM' : '7 base units, plus up to three units for first hour of labor time, plus two units for each additional hour of labor, plus one unit for each fifteen minute interval of surgical time if labor goes into C-Section', ...}}, +{{'SERVICE_TERM' : 'OB Epidural 00850 - Planned C-Section', 'REIMB_TERM' : '7 base units, plus one unit for each fifteen minute interval of surgical time', ...}}]" [NOT TO EXCEED LANGUAGE] -Also include any 'not to exceed' type language in the CONTRACT_REIMBURSEMENT_METHOD. This can be phrased in various ways, including "not to exceed", "amount that exceeds", or similar. +Also include any 'not to exceed' type language in the REIMB_TERM. This can be phrased in various ways, including "not to exceed", "amount that exceeds", or similar. If the methodology is presented in a table, ensure each rate in the table has its own object. Also, concatenate any relevant "not to exceed" or "lesser of" statement that applies to the table with the portion of the methodology found in the table. [OTHER SPECIAL CONSIDERATIONS] Ensure that any and all rates related to Outliers, Stop Loss, and Sequestration are captured. [EXTENDED CONTRACT SERVICE CODES & DESCRIPTIONS] -Here are some examples of language with additional context to be included in the CONTRACT_SERVICE_CD_OR_DESC: +Here are some examples of language with additional context to be included in the SERVICE_TERM: Text: 'Covered Services that are Medicare Covered Services and are not Medicaid Covered Services', Text: 'Covered Services rendered to Covered Person who are eligible for Medicare and enrolled in a MMP Plan that may include coverage for both Medicare and Medicaid Covered Services' @@ -370,7 +370,7 @@ Here is the text to analyze: Return the list of answers below. Ensure you abide by proper JSON formatting, and that you do not forget to extract reimbursement items. """ -def REIMBURSEMENT_METHODOLOGY_BREAKOUT(methodology, questions): +def REIMB_TERM_BREAKOUT(methodology, questions): return f"""Analyze a given reimbursement methodology from a Payer-Provider contract: Populate a list of JSON dictionaries with the following fields: @@ -624,7 +624,7 @@ Write your JSON dictionary below: def PROV_GROUP_TIN_CHECK(contract_text): - # Switch to return JSON with keys PROV_GROUP_TIN, PROV_TIN_OTHER - as just the regexed TINs that are actual TINs + # Switch to return JSON with keys PROV_GROUP_TIN, PROV_OTHER_TIN - as just the regexed TINs that are actual TINs return f"""Examine the contract text below and determine which of the Tax Identification Numbers (TINs) seen belong to the provider group, as opposed to a specific provider. TINs are 9-digit numbers, often of the format '12-3456789'. They may also be found as a straight sequence of nine digits, like '123456789'. In some cases, they may be in the standard social security number format: '123-45-6789'. @@ -662,328 +662,3 @@ Here is the contract text to analyze: {PIPE_FORMAT_INSTRUCTIONS} """ - -##################################################################################### -####################################### LEGACY ###################################### -##################################################################################### - - -def BOTTOM_UP_METHODOLOGY_BREAKOUT(d): - return f"""Analyze the full methodology text listed below: -{d['FULL_METHODOLOGY']} - -Populate a dictionary with the following values: - -LESSER : If the methodology contains the words 'lesser of' or similar, write 'Y'. Otherwise, write 'N'. -RATE_STANDARD : If there is only one rate in the methodology, write that rate here. Use the format 'X% of Y'. Do not include Flat Fees here. If there is no rate in the methodology, write 'N/A'. This value MUST be different than the LESSER_RATE and NOT_TO_EXCEED values. -RATE_SHORT : Return only the percentage from RATE_STANDARD in decimal form, with no other text. For example, 100% -> 1. -FLAT_FEE_STANDARD : If any part of the methodology is a flat fee (e.g. $X), write that value here. Do not include percentages here. If there is a 'Per' statement like 'Per Diem', 'Per Unit', etc, inclue that here as well. If there is no dollar value in the methodology, leave this field N/A. This value MUST be different than the LESSER_RATE and NOT_TO_EXCEED values. -LESSER_RATE : If the methodology contains the words 'lesser of' or similar, what is the rate listed that is NOT the RATE_STANDARD or the FLAT_FEE_STANDARD? Answer in the format 'X% of Y', where X is a numeric value. If there is no 'lesser of' in the text, write 'N/A'. -NOT_TO_EXCEED : Only if the methodology contains the specific phrase "Not to exceed", write the amount that the payment is not to exceed using the template "X% of Y" where X is a numeric value, if the value is a %. If the value is a dollar value, use the format "$X", where X is the numeric value. If "Not to exceed" is not found, write 'N/A'. - -For the format 'X% of Y', if Y is in the below list, then apply the indicated abbreviation. If Y is not in the list, then write the full Y value: -Medicare --> MCR -Medicare Advantage --> MCR -Medicaid --> MCD -Medicare Advantage --> MA -Allowable Charges --> AC -Allowed Amount --> AA -Billed Charges --> BC -Average Sales Price --> ASP -Average Wholesale Price --> AWP -DMAP --> DMAP -Amount Payable by MCR --> MCR -Amount Payable by MCD --> MCD - -Here are some examples of methodology text, and the correct response: -Example 1 - -Methodology: "The maximum compensation for Covered Services rendered to a Covered Person shall be the "Allowed Amount." The Allowed Amount for Covered Services is the lesser of: (i) Allowable Charges; or (ii) as applicable, (a) 100% of the Payor's Medicaid fee schedule in effect on the date of service, or (b) for those Covered Services included in the Service Categories in Table 1 below, the applicable "Contracted Rate" set forth in Table 1 below. Example Service | 80% of the Medicare Rate in effect on the date of service." -Correct Response: -{{'LESSER' : 'Y', 'RATE_STANDARD' : '80% of MCR', 'RATE_SHORT' : '0.8', 'FLAT_FEE_STANDARD' : 'N/A', 'LESSER_RATE' : '100% of AC', 'NOT_TO_EXCEED' : 'N/A'.}} - -Example 2 - -Methodology: "The maximum compensation for Covered Services rendered to a Covered Person shall be the "Allowed Amount." The Allowed Amount for Covered Services is the lesser of: (i) Allowable Charges; (ii) 100% of the Payor's HEDIS target value in effect on the date of service, or (iii) for those Covered Services included in the Service Categories in Table 1 below, the applicable "Contracted Rate" set forth in Table 1 below. Example Service | $900.00 Per Unit" -Correct Response: {{'LESSER' : 'Y', 'RATE_STANDARD' : '100% of Payor's HEDIS target value', 'RATE_SHORT' : '1', 'FLAT_FEE_STANDARD' : '$900.00 Per Unit', 'LESSER_RATE' : '100% of AC', 'NOT_TO_EXCEED' : 'N/A'.}} - -Example 3 - -Methodology: "The maximum compensation for Covered Services rendered to a Covered Person shall be the "Allowed Amount." The Allowed Amount for Covered Services is the lesser of: (i) Allowable Charges or (ii) Medicaid Allowed Amount" -Correct Response: {{'LESSER' : 'Y', 'RATE_STANDARD' : '100% of MCD', 'RATE_SHORT' : '1', 'FLAT_FEE_STANDARD' : 'N/A', 'LESSER_RATE' : '100% of AC', 'NOT_TO_EXCEED' : 'N/A'.}} - -Example 4 - -Methodology: "The maximum compensation for Covered Services rendered to a Covered Person shall be the "Allowed Amount." The Allowed Amount for Covered Services is the lesser of: (i) Provider's Billed Charges or (ii) The amount payable by Medicare" -Correct Response: {{'LESSER' : 'Y', 'RATE_STANDARD' : '100% of MCR', 'RATE_SHORT' : '1', 'FLAT_FEE_STANDARD' : 'N/A', 'LESSER_RATE' : '100% of BC', 'NOT_TO_EXCEED' : 'N/A'.}} - -Example 5 - -Methodology: "Multiple procedures performed during the same day will be reimbursed at 100% for the primary procedure, 50% for the second procedure, and 50% for the third procedure, subsequent procedures shall not be eligible for reimbursement." -Correct Response: {{'LESSER' : 'N', 'RATE_STANDARD' : '100% of AC / 50% of AC / 50% of AC / 0% of AC', 'RATE_SHORT' : '1 / 0.5 / 0.5 / 0', 'FLAT_FEE_STANDARD' : 'N/A', 'LESSER_RATE' : 'N/A', 'NOT_TO_EXCEED' : 'N/A'.}} - -Example 6 - -Methodology: "Provider shall be entitled to the lesser of: (1) Anciliary Provider's billed charges; or (2) the amount payable by Medicare, not including Medicare coinsurance and deductibles, plus the amount payable by Medicaid as a secondary coverage based on the Medicaid fee schedule in effect on the date of service." - -Correct Response: {{'LESSER' : 'Y', 'RATE_STANDARD' : '100% of MCR', 'RATE_SHORT' : '1', 'FLAT_FEE_STANDARD' : 'N/A', 'LESSER_RATE' : '100% of BC', 'NOT_TO_EXCEED' : 'N/A'.}} - -Example 7 - -Methodology: "The Compensation Schedule for the Medicare Product at any given time is the lesser of (i) the Allowable Charges for the particular Covered Service, or (ii) the appropriate amount for such Covered Service under the Company's fee schedule in effect on the date of service for the Medicare Product." -Correct Response: {{'LESSER' : 'Y', 'RATE_STANDARD' : '100% of MCR', 'RATE_SHORT' : '1', 'FLAT_FEE_STANDARD' : 'N/A', 'LESSER_RATE' : '100% of AC', 'NOT_TO_EXCEED' : 'N/A'.}} - -Only return the dictionary, with no other commentary or explanation. Ensure you abide by proper JSON formatting. -""" - - -def BOTTOM_UP_ESCALATOR(d, page): - return f"""### PAGE START ### {page} ### PAGE END - -The above text contains a number of reimbursement terms. For the rest of this request, focus only on the specific term listed below: -Service: {d['FULL_SERVICE']} -Methodology: {d['FULL_METHODOLOGY']} - -Identify if the above reimbursement term is subject to any escalators, or increases in rate over time. Also identify if there are any exclusions. Fill out the following fields: -'RATE_ESCALATOR_IND' : If there is language on the page stating that the given rate will increase over time, return 'Y'. Otherwise return 'N'. -'RATE_ESCALATOR_DT' : If there is a rate escalator, on what date or time period does it kick in? Write the date or time period only. If 'N', return 'N/A' for this field. - -For the escalator fields, ensure that only updates and increases to the RATE itself (the percentage) are counted. Updates to Codes and other features do not apply here. - -Only return the dictionary, with no other commentary or explanation. Ensure you abide by proper JSON formatting. -""" - - - -def TOP_DOWN_PRIMARY(page): - return f"""### PAGE START ### {page} ### PAGE END - -The preceding text is one page of a contract between a Payer and a provider in their network. Extract the names of certain entities listed in the contract and return a single dictionary with the values below: - -Here are the attributes to be included in each dictionary, and instructions on how to correctly answer: -'EXHIBIT': CRITICAL - Capture the complete hierarchy of document identifiers found on the page: -- MUST include ALL of the following when present: - * Full Attachment names and numbers (e.g., "Attachment C: Commercial-Exchange - EPO") - * Complete Exhibit numbers/letters with full titles - * All relevant subtitles and section names - * Provider/Entity names when listed with exhibit information -- Format: List each component on a new line in the exact order found on page -- Example format for multi-level exhibits: - "Attachment C: Commercial-Exchange - EPO - EXHIBIT 1 - COMPENSATION SCHEDULE - PHYSICIAN SERVICES - LAILA HIRJEE MD PA" -- Rules for inclusion: - * Do NOT abbreviate or summarize any part of the exhibit names - * Do NOT include page numbers - * Do NOT cherry-pick only certain parts - capture the complete exhibit hierarchy - * Include ALL text that appears to be part of the exhibit/attachment header - * Keep exact capitalization and formatting as shown in document -- Write 'N/A' only if NO exhibit, attachment, or amendment identifiers are found - -Example 1: -Document text shows: -"Attachment C: Commercial-Exchange - EPO -EXHIBIT 1 -COMPENSATION SCHEDULE -PHYSICIAN SERVICES -LAILA HIRJEE MD PA" -Correct output: "Attachment C: Commercial-Exchange - EPO -EXHIBIT 1 -COMPENSATION SCHEDULE -PHYSICIAN SERVICES -LAILA HIRJEE MD PA" - -Example 2: -Document text shows: -"ATTACHMENT A - PPO -EXHIBIT 3 -MEDICARE ADVANTAGE" -Correct output: "ATTACHMENT A - PPO -EXHIBIT 3 -MEDICARE ADVANTAGE" - -Final check before returning result: -1. Did you capture the COMPLETE attachment/exhibit name including all descriptive text? -2. Did you include ALL levels of the exhibit hierarchy? -3. Did you maintain the exact formatting and line breaks as shown in the document? -4. Did you include any provider/entity names that were part of the exhibit header? - -'CONTRACT_LOB' : List the Line of Business mentioned on the page. Choose ONLY from the following: {valid.VALID_LOBS}. If there are multiple on the page, write them in a comma-separated list. If no LOB is found, write 'N/A'. -'CONTRACT_PROGRAM' : List any Programs or Plans mentioned on the page. {valid.VALID_PROGRAMS}. If no program is found, write 'N/A'. - -'DEFAULT_TERM' : If there is a section labelled 'Default' or similar, write that entire section here. It may also be a term that describes the reimbursement instructions if there is no established payment amount. This language often starts with a phrase like "if there is no published fee schedule..." If there is no such term, write 'N/A'. -'DEFAULT_RATE' : Write the rate from the Default Term in the form 'X% of Y'. It may be that the rate is not expressed in the form of a percentage; in this case, write '100% of Y,' Y being the payment reference. For example, if the default term specifies 'Any service not mentioned above shall be paid according to the plan's fee schedule,' write '100% of Plan's Fee Schedule.' If there is no Default Term, or no rate in the Default Term, write 'N/A'. -'CDM_IND' : Is there language on the page regarding CDM Neutralization? Write 'Y' if yes, 'N' if no. -'CHARGEMASTER' : Is there language on the page related to Chargemaster Protections? If so, return the sentence or sentences. If not, return 'N/A'. -'ADD_ON_REIMBURSEMENT_LANGUAGE' : Extract the Add On Reimbursement language present in the contract. If it is not present, answer N/A. - -If there are multiple answers for a given attribute, return the answers in a comma-separated list. - -For all attributes, only write an answer if it is written on the page. Do not make up new phrases or words or try to deduce answers that are not seen. Simply write 'N/A' if none of the listed options are seen. - -Only return the dictionary, with no other commentary or explanation. Ensure you abide by proper JSON formatting. -""" - - -TD_PRIMARY_FIELDS = [ - "EXHIBIT", - "CONTRACT_LOB", - "CONTRACT_PROGRAM", - "DEFAULT_TERM", - "DEFAULT_RATE", - "CDM_IND", - "CHARGEMASTER", - "ADD_ON_REIMBURSEMENT_LANGUAGE", -] - - - -##################################################################################### -###################################### AC Fields #################################### -##################################################################################### - - - - -def get_effective_date_prompt(context: str) -> str: - """ - Generate a prompt template to extract the effective date from a contract. - - Args: - context (str): The contract text to analyze. - - Returns: - str: The prompt template for extracting the effective date. - """ - prompt_template = f""" - Please analyze the following contract and extract ONLY the effective date of the contract or amendment. Follow these precise rules in order: - - 1. Look for dates that appear after phrases matching these exact patterns: - - "Effective Date:" followed by a date - - "FOR HEALTH PLAN USE ONLY" section containing "Effective Date:" - - "To be completed by Health Plan only:" section containing "Effective Date:" - - "is entered into as of" followed by a date - - 2. If multiple matches are found: - - Prioritize dates within "FOR HEALTH PLAN USE ONLY" or "To be completed by Health Plan only" sections - - Then prioritize dates that directly follow "Effective Date:" - - 3. Do not use the date found in the "Signature Date" section. - - If there is nothing next to "Effective Date:", return N/A. - - If there is only one date in the document, don't extract this date unless it is explicitly labeled "effective date". It is okay to return N/A. - - 4. If partial dates are found, return N/A. - - 5. Return the date in YYYY-MM-DD format or N/A if date not found. Enclose just your final answer in |pipes|. - - Here is the contract to analyze: - - ## START CONTRACT TEXT ## - - {context} - - ## END CONTRACT TEXT ## - - Ensure that you do not use the date found in the "Signature Date" section. - - Before returning the output, VERIFY the date format is YYYY-MM-DD. If the date is not found, return N/A. - - Finally state "Answer: |YYYY-MM-DD| or |N/A|" - """ - - return prompt_template - - -AC_DICT = { - "CONTRACT_TITLE": "What is the complete title of the contract or the document? It is generally written in CAPITAL LETTERS and is generally found at the beginning of the document before a paragraph containing provider and payer name. It typically contains the words AGREEMENT, AMENDMENT, CONTRACT, ADDENDUM, MEMORANDUM, LETTER, PROVIDER or REQUEST. In case of agreement, typical structure is the provider name, followed by the phrase with agreement, followed potentially by a number signifying a version of the contract. In case of amendment, typical structure is word amendment followed by number, followed by the phrase with agreement. Extract the complete title of the contract or document as accurately as possible. Ensure: All leading characters are included for each word (e.g. 'NETWORK' instead of 'ETWORK'). Spaces between words are preserved in phrases (e.g., 'PROVIDER COLLABORATION' instead of 'PROVIDERCOLLABORATION'). If text appears incomplete or lacks spacing, use logical patterns like capitalization or common formatting rules to infer and correct the output. Replace new lines and line breaks with space.", - "PAYER_NAME": "What is the name of the payer that is a party to the contract as stated in the Preamble?", - "PROV_GROUP_NAME": "What is the name of the Group provider that is a party to the contract? This is generally found near keyword provider. Only return the name of the Group provider along with dba name.", - # "PROV_GROUP_NPI": "What is the group provider's national provider identifier number mentioned in the contract? This may be found on the signature page or on the roster. It consists of 10 digits. Only return these 10 digits.", - # "PROV_GROUP_TIN_SIGNATORY": "What is the Group provider's taxpayer identification number stated near signature in the contract? This is a 9 digit long number typically with a hyphen after the first 2 digits. Return only this 9 digit number with a hyphen after the first 2 digits.", - # "PROV_GROUP_TIN": "What is the Group provider's taxpayer identification number stated in the contract? This is a 9 digit long number typically with a hyphen after the first 2 digits in it. Return only this 9 digit number with a hyphen after the first 2 digits. As an example, it has the format of XX-XXXXXXX Do not elaborate or add context. Do not pull any dates, do not pull any numbers that deviate from earlier described pattern. It must always be 9 digits. Strictly follow this instructions. Do not return any other information.", - # "PROV_NPI_OTHER": 'What are all the other provider national provider identifier numbers (NPI) associated with this agreement? They consist of 10 digits and do not contain "-". Provide the list of all the other provider identifier numbers including those that are present in the table or attachment.', - # "PROV_TIN_OTHER": "What are the provider taxpayer identification numbers (TIN) for each of the other providers associated with this agreement? They consist of 9 digits and may contain a hyphen after the first 2 digits. This is usually listed in the preample of the contract or on a roster. Provide only the 9 digit TINs.", - "TERMINATION_UPON_NOTICE": 'Extract the number of days can the contract be terminated by either party by giving notice. The answer may be found near the words "written notice of such termination" or "prior to the expiration". Only extract a value if one is present. Only return the number of days and nothing else.', - "TERMINATION_UPON_CAUSE": 'After how many days can the contract be terminated by either party upon breach of material term? The answer is usually found in section 7.2.2 or 10.2 but might be present in other sections as well. The answer is present after the Term language section. The answer may be found near the words "is in breach of any material term or condition". Here is an example of possible input text and the correct response. EXAMPLE INPUT TEXT: "By either party upon ninety (90) days prior written notice if the other party is in material breach of this Agreement, except that such termination shall not take place if the breach is cured within sixty (60) days following the written notice". EXAMPLE RESPONSE: 90.', - "TIME_TO_OBJECT": "How many days does the provider have to object to the amendment? The answer may be present in the Amendment section.", - "ASSIGNMENTS_CLAUSE_IND": 'Is assignment clause present in contract language? The answer is usually found in section 8.3 but might not always be present there. It can be found in the section with title containing "Assignment". Answer ONLY with Y or N. Do NOT write N/A.', - "NOTICE_PROVIDER_NAME": 'What is the notice provider name present usually near keywords like "Attn:". Return the full name, do not return any context. If it only says President/CEO and not the name itself then return N/A. Ensure that you do not pull the Payer\'s (EG. Superior Health Plan) info instead. Only pull the provider name.', - "NOTICE_PROVIDER_ADDRESS": "What is the notice provider address mentioned after the name of the provider. Only return the address of the provider, do not return any context. New Info --> Ensure Payer address (Eg. Superior Health Plan) isn't pulled. The payer address usually starts with 2100 South... Ensure you do not pull this. Always pull the provider address only. Ensure that you pull the full address with the city and state and zipcode. MAKE SURE YOU ALWAYS PULL THE CITY AND STATE AND ZIPCODE AT THE END. If it is not present in the text file, then do your best to at least return the state.", - "NPI_NAME": "What is the group provider's name whose national provider identifier number is mentioned in the contract? This may be found on the signature page or on the roster.", - "HEALTH_PLAN_STATE": "Which state is this health plan for?", - "SEQUESTRATION_LANGUAGE": "Is sequestration language present in the contract? It may be after reimbursement or compensation section. It is only present in case of medicare and medicare advantage. If Yes, extract the complete paragraph.", - # "SEQUESTRATION_REDUCTIONS_IND":"Are sequestration and reduction percentage present in the contract? Answer Yes if both are present otherwise answer No.", - "CONTRACT_AUTO_RENEWAL_IND": "If this contract automatically renews, answer Y. If this contract will remain in effect unless terminated, answer Y. If it will terminate after the mentioned termination date, answer N.", - "AMEND_CONTRACT_NOTICE_IND": 'Is amendment clause present in contract language? The answer is usually found in section 8.7 but might not always be present there. It may be found in the section with title containing "Amendment". Answer may be found near keywords "Agreement may be amended". Answer ONLY with Y or N. Do NOT write N/A.. Here is an example of possible input text and the correct response. EXAMPLE INPUT TEXT: "may amend this Agreement by giving Provider written notice". EXAMPLE RESPONSE: "Y". If the agreement does not explicitly indicate that it can be amended by giving written notice, the answer will be "N".', - "AFFILIATION_CLAUSE_IND": 'Is affiliation clause present in contract language? Answer may be found near keywords like "affiliate means a person or entity directly". Answer ONLY with Y or N. Do NOT write N/A.', - # "TERM_CLAUSE": """Extract the subsection or paragraph(s) labeled Term. It may also be labeled Termination. In instances there may be 2 bodies of text that you will need to pull. For example, first paragraph may be 'MCO must follow the procedures outlines in Section...' and the second one may be 'Not later than thirty (30) days following receipt of the termination notice...'. In this case, ensure that YOU ALWAYS PULL the whole text of the two paragraphs. If there are no such sections, extract the paragraph that most closely resembles this label. If there is still no correct answer, simply return 'N/A'.""", - "TERM_CLAUSE": """Extract the term or termination sections (or subsections or paragraphs), which are always present in the contract. They contain information related to term and termination of the contract. The biggest hint of a term or termination section will be the heading 'Term and Termination' or 'Term.'. Ensure that YOU ALWAYS PULL the whole text of all relevant paragraphs.""", - # "TIMELY_FILING": "Extract all of the clauses of text and section paragraphs along with their section number that are pertaining to the Timely Filing clause. This clause usually details the conditions and days for when a provider must submit a claim by. Look for section heading titled /'Payment of Clean Claims/'. Look for language such as /'all provider claims shall be processed within 30 days from the date of claim reciept by the MCO/'. We want to extract all following langauage such as MCO shall not pay any claim submitted by provider..., MCO must adjudicate all appealed claims, till the whole section that starts with 'MCO may deny a claim for failure to file'.", - "CREDENTIALING_APP_IND": "Is credentialing defined in section 2.4 or any other subsection of the contract? Answer ONLY with Y or N. Do NOT write N/A.", - "CONTRACT_EFFECTIVE_DT": "What is the contract effective date mentioned in any of the following locations: the signatory section, the preamble of the agreement, or the start of the amendment? Look for phrases such as /'This amendment is effective/'. If there is no clear effective date, return the date from the signature page. Return the date converted to YYYY-MM-DD format, with no other commentary or explanation. If there is no date, simply return 'N/A'.", - "CONTRACT_TERMINATION_DT": "What is the contract termination date? This might be listed within the Terms or Terms of Agreement section of the contract, or can be calculated by adding contract duration to the contract effective date. Return the date in YYYY-MM-DD format.", - "TIME_TO_OBJECT": "How many days does the provider have to object to the amendment? The answer may be present in the Amendment section. Only return the number of days, as an integer.", - "NON_RENEWAL_LANGUAGE": "Extract the section of the contract that describes non-renewal obligations, especially the number of days notice that must be given. Write the full relevant sentence or paragraph. Ensure that the exact term 'non-renewal' is present in the answer. Do NOT return an answer that does not have 'non-renewal'.", - "NON_RENEWAL_DAYS": "How many days of notice does the section indicate must be given to terminate the agreement? Examples are: 30, 60, 90, 180. Only return the number of days.", - "ACCESS_TO_MEDICAL_RECORDS": "Access clause contains information regarding access to medical records. It may be found in section 4.2 of the contract. Extract the Access clause present in the contract.", - # "ADD_ON_REIMBURSEMENT_IND":"Add On Reimbursement is usually present in Compensation section of the contract. Is Add On Reimbursement present in the Compensation section of the contract? Answer with a Yes or No, do not provide any other context.", - # "ADD_ON_REIMBURSEMENT_LANGUAGE":"Add On Reimbursement language is usually present in Compensation section of the contract. Extract the Add On Reimbursement language present in the contract. If it is not present, answer N/A.", - "CARVEOUT_VENDORS": "Carve-Out Vendors clause may be found in section 2.9 of the contract. Extract the Carve-Out Vendors clause present in the contract.", - "CLAIMS_EDITING_LANGUAGE": "Claims Editing Language is typically found in the claims section in the beginning parts of the contract. Extract Claims Editing Language present in the contract.", - # "CLAIMS_EDITING_LANGUAGE_IND":"Claims Editing Language is typically found in the claims section in the beginning parts of the contract. Is Claims Editing Language present in the contract? Answer with a Yes or No, do not provide any other context.", - "CLEAN_CLAIM": 'Extract the "Clean Claim" subsection present in definition section of the contract.', - # "CONFLICTS_BETWEEN_CERTAIN_DOCUMENTS_IND":"Is Conflicts Between Certain Documents clause present in the contract? Answer with a Yes or No, do not provide any other context.", - "CONFLICTS_BETWEEN_CERTAIN_DOCUMENTS_LANGUAGE": "Extract the Conflicts Between Certain Documents clause present in the contract.", - # "COST_SETTLEMENT_IND":"Is cost settlement language present in the contract? Answer with a Yes or No, do not provide any other context.", - "COST_SETTLEMENT_LANGUAGE": "Cost settlement language may be present in disputes and arbitration subsection of the contract. It usually contains keywords like settlementor cost settlement. Extract the cost settlement language present in the contract.", - "DEEMER_AMENDMENT": "Deemer Amendment clause may be found in section 8.7.2 of the contract. Extract the Deemer Amendment clause present in the contract.", - # "DELEGATED_FUNCTION_IND":"Is Delegated Function clause present in the contract? Answer with a Yes or No, do not provide any other context.", - "DELEGATED_TERMS": "Extract Delegated Terms present in the contract.", - "ECM": 'What is the "ECM" number mentioned in the contract? Only Answer the ECM number, do not provide any context. Do not provide ICM number.', - # "EXCLUSIVITY_REQUIREMENT_IND":"Is Exclusivity requirement clause present in the contract? Answer with a Yes or No, do not provide any other context.", - "EXCLUSIVITY_REQUIREMENT_LANGUAGE": "Extract Exclusivity requirement clause present in the contract.", - # "GUARANTEE_OF_PROVIDER_YIELD_IND":"Is Guarantee of Provider Yield Language present in the contract? Answer with a Yes or No, do not provide any other context.", - "GUARANTEE_OF_PROVIDER_YIELD_LANGUAGE": "Extract Guarantee of Provider Yield Language present in the contract.", - "HCBS_SERVICES": 'Extract HCBS services clause present either in the compensation or exhibit section of the contract. It may contain keywords like "for covered HCBS services, plan shall pay". Do not include definitions of HCBS.', - "INDEMNIFICATION": "Indemnification clause may be found in section 5.2 of the contract. Extract the Indemnification clause present in the contract. ", - # "INDEPENDENT_REVIEW_IND":"Is Independent Review language present in the contract? Answer with a Yes or No, do not provide any other context.", - "INDEPENDENT_REVIEW_LANGUAGE": "Extract Independent Review language present in the contract.", - # "INVOICE_PRICING_IND":"Is table with heading \"INVOICED SERVICES\" present in compensation schedule of the contract?", - "INVOICE_PRICING_LANGUAGE": 'Extract table with heading "INVOICED SERVICES" if it is present in compensation schedule of the contract.', - # "LATE_PAID_CLAIMS_IND":"Is Late Paid Claims language present in the contract? Answer with a Yes or No, do not provide any other context.", - "LATE_PAID_CLAIMS_LANGUAGE": "Extract Late Paid Claims language present in the contract. This will be a sentence or paragraph describing late paid claims, interest payments or similar. Here is an example of a correct response: 'Any Clean Claim, as defined in 42 C.F.R. § 422.500, shall be paid within thirty (30) days of receipt by Plan at such address as may be designated by Plan, and Plan shall pay interest on any Clean Claim not paid within thirty (30) days of such receipt by Plan at the rate of interest required by law, or as otherwise set forth in the Provider Manual.'. Here is an example of an incorrect response: 'Any Clean Claim, as defined in 42 C.F.R. 422.500, shall be paid within thirty (30) days of receipt by Health Plan, Payor or (if Provider contracts with Downstream Entities) Provider, as applicable, as designated by Provider or such Downstream Entity, as applicable.'.", - # "MEDICAL_NECESSITY_LANGUAGE":"Extract the \"Medically Necessary\" or \"Medical Necessity\" care (or services) verbiage mentioned in the compensation schedule or section of the contract. Do not mention what \"Medically Necessary\" means. If it is not present in compensation schedule or section, answer N/A.", - # "MEDICAL_NECESSITY_LANGUAGE_IND":"Is \"Medically Necessary\" or \"Medical Necessity\" care (or services) verbiage mentioned in the compensation schedule or section of the contract? Answer with a Yes or No, do not provide any other context.", - "MEMBER_CONFINEMENT_DAYS_LANGUAGE": "Extract Member Confinement Days Language present in the contract.", - # "MEMBER_CONFINEMENT_DAYS_LANGUAGE_IND":"Is Member Confinement Days Language present in the contract? Answer with a Yes or No, do not provide any other context.", - "NATIONAL_AGREEMENT_IND": "Are more than one states covered in the contract? Answer ONLY with Y or N. Do NOT write N/A.", - # "NETWORK_ACCESS_FEES_IND":"Is \"Network Access Fee\" present in the contract? If yes what is the fee mentioned?", - "NETWORK_ACCESS_FEES_LANGUAGE": 'Extract "Network Access Fee" verbiage present in the contract.', - # "NONSTANDARD_APPEALS_PROCESS_IND":"Is Nonstandard Appeals Process present in the contract? Answer with a Yes or No, do not provide any other context.", - "NONSTANDARD_APPEALS_PROCESS_LANGUAGE": "Extract Nonstandard Appeals Process language present in the contract.", - "PAYMENT_IN_ADVANCE_OF_CLAIMS_SUBMISSION_LANGUAGE": "Extract Payment in Advance of Claims Submission language present in the contract.", - # "PAYMENT_IN_ADVANCE_OF_CLAIMS_SUBMISSION_LANGUAGE_IND":"Is Payment in Advance of Claims Submission language present in the contract? Answer with a Yes or No, do not provide any other context.", - "PAYOR": '"Payor" is usually found in section 1.12 of the contract. Extract the "Payor" subsection present in definition section of the contract.', - "PMPM": "What is the PMPM rate mentioned in the contract? Only return the rate. Do not provide any context.", - "PREAUTHORIZATION": "Preauthorization clause may be found in section 2.7 of the contract. Extract the Preauthorization clause present in the contract.", - "PRODUCT_REMOVAL": "Product removal may be found in the products attachment, stating a product is being removed. Extract product removal language present in the contract.", - # "PROVIDER_BASED_BILLING_EXCLUSION_IND":"Provider-based Billing Exclusion is often listed under the ‘Additional Provisions’ section. Is Provider-based Billing Exclusion mentioned the contract? Answer with a Yes or No, do not provide any other context.", - "PROVIDER_BASED_BILLING_EXCLUSION_LANGUAGE": "Provider-based Billing Exclusion is often listed under the ‘Additional Provisions’ section. Extract the Provider-based Billing Exclusion language mentioned in the contract.", - "RECOVERY_RIGHTS": "Recovery Rights clause may be found in section 3.5 of the contract. Extract the entire Recovery Rights sentence or paragraph present in the contract.", - # "SINGLE_CODE_MULTIPLE_RATES_IND":"Is Single Code Multiple Rates present in the compensation or exhibit section of the contract? Answer with a Yes or No, do not provide any other context.", - # "SINGLE_CODE_MULTIPLE_RATES_LANGUAGE":"Extract Single Code Multiple Rates present in the compensation or exhibit section of the contract. If it is not present, answer N/A.", - "TEMPLATE": "Is this contract in standard Centene template containing definition, terms clauses and other standard sections. Answer with 'Y' or 'N'.", - "ARBITRATION_AND_DISPUTES": "Dispute Resolution clause is usually found in section 6.1 of the contract. Arbitration clause is usually found in section 6.2 of the contract. Extract both the Dispute Resolution and the arbitration clause present in the contract. In case one of them is present, extract that one.", - # "DISPARAGEMENT_PROHIBITION_IND":"Is Disparagement Prohibition clause present in the contract? It may be found in section 2.1 of the contract. Answer with a Yes or No, do not provide any other context.", - "DISPARAGEMENT_PROHIBITION_LANGUAGE": "Disparagement Prohibition clause may be found in section 2.1 of the contract. Extract the Disparagement Prohibition clause present in the contract.", - "ELIGIBILITY_VERIFICATION": "Eligibility Verification or Determination clause may be found in section 2.6 of the contract. Extract the Eligibility Verification or Determination clause present in the contract.", - "INSURANCE_REQUIREMENT": "Extract Insurance requirement mentioned in the contract.", - "PARTICIPATION_IN_PRODUCTS": "Participation in Products clause may be found in section 2.2.2 of the contract. Extract the Participation in Products clause present in the contract.", - "POLICIES_AND_PROCEDURES": "Extract the entire Policies and Procedures sentence or paragraph present in the contract. Do not extract language about conflicts and construction. Do not extract language about PP (Preferred Provider) nor PPG (Preferred Provider Group).", - "REGULATORY_REQUIREMENTS": 'Extract the entire Regulatory Requirements paragraph present in the contract. It usually contains the keyword "Regulatory Requirements".', - # "RELATIONSHIP_OF_PARTIES_IND":"Is Relationship of Parties clause present in the contract? Answer with a Yes or No, do not provide any other context.", - "RELATIONSHIP_OF_PARTIES_LANGUAGE": "Extract the entire Relationship of Parties passage present in the contract.", - "CONTRACT_CLAIM_TYPE_CD": "What is the Contract Type? (Possible Answers \"Professional\", \"Institutional\" or \"Ancillary\"). Answer to the best of your ability. It is possibly found near compensation language. ONLY RETURN WHETHER PROFESSIONAL OR FACILITY OR ANCILLARY. If not found return N/A - If it is a Provider, physician services then the answer would be \"Professional\" - If the document contains \"Hospital\" the answer is \"Institutional\". Otherwise, it's \"Ancillary\". It is Ancillary if it is services such as Audiology, Cardiac Monitoring, Diagnostic Imaging, Genetic Testing, Laboratory/Blood Testing, Radiology, Sleep Lab Services, Telemedicine, Allergy Services, Behavioral & Mental Health Services." -} - - -def AC_EFFECTIVE_DATE_CLEANUP(contract_text): - return f"""### Contract Start ### {contract_text} ### Contract End ### -Above is a contract. What is the contract effective date mentioned in any of the following locations: the signatory section, the preamble of the agreement, or the start of the amendment? Look for phrases such as /'This amendment is effective/'. -If there is no clear effective date, return the date from the signature page. -Return the date converted to YYYY-MM-DD format, with no other commentary or explanation. If there is no date, simply return 'N/A'.""" diff --git a/fieldExtraction/src/testbed/one_to_n_comparison.py b/fieldExtraction/src/testbed/one_to_n_comparison.py index c311c29..a3e1316 100644 --- a/fieldExtraction/src/testbed/one_to_n_comparison.py +++ b/fieldExtraction/src/testbed/one_to_n_comparison.py @@ -46,7 +46,7 @@ def evaluate_one_to_n_fields_fuzzy_matching_field_by_field( Args: labels_df (pd.DataFrame): DataFrame with ground truth labels predictions_df (pd.DataFrame): DataFrame with predictions - key_field (str): Field that identifies the contract (probably "CONTRACT_FILE_NAME") + key_field (str): Field that identifies the contract (probably "FILE_NAME") comparison_fields (list): A list of fields to compare against the labels thresholds: Thresholds for each comparison field (same length as comparison_fields); defaults to 95 for all """ diff --git a/fieldExtraction/src/testbed/one_to_one_comparison.py b/fieldExtraction/src/testbed/one_to_one_comparison.py index 437795e..f3f1f49 100644 --- a/fieldExtraction/src/testbed/one_to_one_comparison.py +++ b/fieldExtraction/src/testbed/one_to_one_comparison.py @@ -20,7 +20,7 @@ def load_predictions(filename: str) -> pd.DataFrame: return df def consolidate_one_to_one_fields_in_predictions(predictions_df: pd.DataFrame) -> pd.DataFrame: - """One-to-one fields need to be consolidated (by taking the first value) across CONTRACT_FILE_NAMEs. + """One-to-one fields need to be consolidated (by taking the first value) across FILE_NAMEs. Args: predictions_df (pd.DataFrame): Predictions DataFrame @@ -30,10 +30,10 @@ def consolidate_one_to_one_fields_in_predictions(predictions_df: pd.DataFrame) - """ one_to_one_fields = FieldSet(file_path=config.FIELD_JSON_PATH).filter(relationship="one_to_one").list_fields() print(one_to_one_fields) - # Group by CONTRACT_FILE_NAME and take just the one-to-one fields. Since they'll be repeated + # Group by FILE_NAME and take just the one-to-one fields. Since they'll be repeated # across rows, we'll just take the first one - consolidated_df = predictions_df.groupby('CONTRACT_FILE_NAME').first().reset_index() + consolidated_df = predictions_df.groupby('FILE_NAME').first().reset_index() return consolidated_df @@ -44,7 +44,7 @@ def sort_label_and_prediction_columns(merged_df: pd.DataFrame) -> pd.DataFrame: merged_df (pd.DataFrame): Merged DataFrame of labels and predictions Returns: - pd.DataFrame: Sorted DataFrame with labels and predictions next to each other. The first column is always CONTRACT_FILE_NAME. + pd.DataFrame: Sorted DataFrame with labels and predictions next to each other. The first column is always FILE_NAME. """ # List of columns in the original merged DataFrame columns = merged_df.columns.tolist() @@ -63,7 +63,7 @@ def sort_label_and_prediction_columns(merged_df: pd.DataFrame) -> pd.DataFrame: ordered_columns.append(pred_col) # Reindex the DataFrame with the new column order - merged_df = merged_df[["CONTRACT_FILE_NAME"] + ordered_columns] + merged_df = merged_df[["FILE_NAME"] + ordered_columns] return merged_df @@ -82,13 +82,13 @@ if __name__ == "__main__": sheetname_labels = script_config["sheetname_labels_dates"] df_labels_dates = load_labels_file(filename_labels, sheetname_labels) - # Extract date fields from labels and predictions (also CONTRACT_FILE_NAME) + # Extract date fields from labels and predictions (also FILE_NAME) date_fields = df_labels_dates.columns.tolist() print(date_fields) predicted_date_fields = consolidated_one_to_one_predictions[date_fields] - # Join labels and predictions on CONTRACT_FILE_NAME - merged_df = pd.merge(df_labels_dates, predicted_date_fields, on="CONTRACT_FILE_NAME", suffixes=['_labels', '_predictions']) + # Join labels and predictions on FILE_NAME + merged_df = pd.merge(df_labels_dates, predicted_date_fields, on="FILE_NAME", suffixes=['_labels', '_predictions']) sorted_df = sort_label_and_prediction_columns(merged_df) @@ -100,11 +100,11 @@ if __name__ == "__main__": sheetname_labels = script_config["sheetname_labels_tin_npi"] df_labels_tin_npi = load_labels_file(filename_labels, sheetname_labels) - # Extract TIN/NPI fields from labels and predictions (also CONTRACT_FILE_NAME) + # Extract TIN/NPI fields from labels and predictions (also FILE_NAME) tin_npi_fields = df_labels_tin_npi.columns.tolist() predicted_tin_npi_fields = consolidated_one_to_one_predictions[tin_npi_fields] - # Join labels and predictions on CONTRACT_FILE_NAME - merged_df = pd.merge(df_labels_tin_npi, predicted_tin_npi_fields, on="CONTRACT_FILE_NAME", suffixes=['_labels', '_predictions']) + # Join labels and predictions on FILE_NAME + merged_df = pd.merge(df_labels_tin_npi, predicted_tin_npi_fields, on="FILE_NAME", suffixes=['_labels', '_predictions']) sorted_df = sort_label_and_prediction_columns(merged_df) sorted_df.to_csv("merged_predictions_labels_TIN_NPI.csv", index=False) \ No newline at end of file diff --git a/fieldExtraction/src/testbed/test_methodology_breakout.ipynb b/fieldExtraction/src/testbed/test_methodology_breakout.ipynb index 05d8c5f..b709bc8 100644 --- a/fieldExtraction/src/testbed/test_methodology_breakout.ipynb +++ b/fieldExtraction/src/testbed/test_methodology_breakout.ipynb @@ -2,7 +2,7 @@ "cells": [ { "cell_type": "code", - "execution_count": 1, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ @@ -11,7 +11,7 @@ }, { "cell_type": "code", - "execution_count": 2, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ @@ -22,17 +22,9 @@ }, { "cell_type": "code", - "execution_count": 3, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "/home/maamseek/doczy.ai/fieldExtraction\n" - ] - } - ], + "outputs": [], "source": [ "# import sys\n", "# sys.path.append('../../') # Update this path to the correct path where the 'src' module is located\n", @@ -43,17 +35,9 @@ }, { "cell_type": "code", - "execution_count": 4, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "doczy-output exists\n" - ] - } - ], + "outputs": [], "source": [ "from src import config\n", "\n", @@ -62,7 +46,7 @@ }, { "cell_type": "code", - "execution_count": 5, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ @@ -74,11 +58,11 @@ "file_path = \"Reimbursement Field Files/\"\n", "labels_files = os.listdir(file_path)\n", "\n", - "# fields = [\"CONTRACT_SERVICE_CD_OR_DESC\", \"CONTRACT_REIMBURSEMENT_METHOD\"] # comparison fields\n", - "fields = [\"AARETE_DERIVED_REIMBURSEMENT_METHOD\", \n", - " \"CONTRACT_REIMBURSEMENT_FEE_RATE\", \n", - " # \"CONTRACT_REIMBURSEMENT_PERCENT_RATE\",\n", - " \"CONTRACT_FEE_SCHEDULE_DESC\",\n", + "# fields = [\"SERVICE_TERM\", \"REIMB_TERM\"] # comparison fields\n", + "fields = [\"AARETE_DERIVED_REIMB_METHOD\", \n", + " \"REIMB_FEE_RATE\", \n", + " # \"REIMB_PCT_RATE\",\n", + " \"FEE_SCHEDULE\",\n", " \"AARETE_DERIVED_FEE_SCHEDULE\",\n", " \"AARETE_DERIVED_FEE_SCHEDULE_VERSION\"\n", " ]" @@ -86,48 +70,9 @@ }, { "cell_type": "code", - "execution_count": 6, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "Reading 46-0979580-Harris and Theodore Anesthesia Services, LLC-ICMProviderAgreement_313205.csv\n", - "Reading 95-2648499-Mission Pathology Medical Associates-ICMProviderAgreement_254534.xlsx\n", - "Reading 429670586-Melissa Ann Clark-ICMProviderAgreement_128379_1.csv\n", - "Reading 2014-01-01 United Health Centers San Joaquin AMD MU.txt-RESULTS.xlsx\n", - "Reading 050540697 Deepak Nanda 2017 PHSP MU.txt-RESULTS.xlsx\n", - "Reading 95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.xlsx\n", - "Reading 02-0677066-Eyemasters-ICMProviderAgreement_64220_2.txt-RESULTS.xlsx\n", - "Reading 65-0825133-Florida Cancer Specialists, P.L.-ICMProviderAgreement_192252_53.xlsx\n", - "Reading BSW _ Original Contract _ 1.1.2000 MU.xlsx\n", - "Reading 92-2764433-MAGNOLIA MOBILE HOME CARE LLC-ICMProviderAgreement_322270.xlsx\n", - "Reading DocziAI_2-12.xlsx\n", - "Reading 2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof MU.txt-RESULTS.xlsx\n", - "Reading Adena Health System National Template Agreement C19460229AA.txt-RESULTS.xlsx\n", - "Reading 86-0898663-Founder Health, LLC dba Preferred Homecare-ICMProviderAgreement_120661.csv\n", - "Reading 33-0057155-Apria Healthcare, Inc.-ICMProviderAgreementAmendment_26762.txt-RESULTS.xlsx\n", - "Reading Custom_2009-08-10 Adventist - University Community Hopstial LTAC MU.txt-RESULTS.xlsx\n", - "Reading 2001-11-01 California Emergency Physicians PSA_MU.txt-RESULTS.xlsx\n", - "Reading 5.2000_Rehab Designs of America_VendorAgreement MU.txt-RESULTS.xlsx\n", - "Reading 00-125434-Central MS Diagnostic, LLC-ICMProviderAgreement_78285.txt-RESULTS.xlsx\n", - "Reading Custom_PSA - Advanced Gastroenterology of Texas PLLC -Executed 47-4543923 MU.txt-RESULTS.xlsx\n", - "Reading ICMProviderAgreement_ICMProviderAgreement_295973_15.txt-RESULTS.xlsx\n", - "Reading Fac1_Bullhead City_Western Arizona Med Center - 860982071 MU.xlsx\n", - "Reading 06-1798267-Anthony W. Le, A Professional Corp-ICMProviderAgreement_316844.txt-RESULTS.xlsx\n", - "Reading 2022 01 20 West Park Primary Care_Master (Master) PHY Executed.pdf.filepart MU.txt-RESULTS.xlsx\n", - "Reading 2018 09 01 UTMB (Amendment 10 change in reimbursement) MU.txt-RESULTS.xlsx\n", - "Reading 36-2902782-Circle Family HealthCare Network-ICMProviderAgreement_59631.csv\n", - "Reading 84-5179194-Heart and Soul Hospice LLC-ICMProviderAgreement_273737.csv\n", - "Reading 39-0806250-Divine Saviour Hospital-ICMProviderAgreement_97009.csv\n", - "Reading 61-1400871-West Kentucky Dermatology PSC-ICMProviderAgreement_104221.csv\n", - "Reading 91-1885077-COASTAL ANESTHESIOLOGY MEDICAL-ICMProviderAgreement_242069.csv\n", - "Reading 20-1668371-Midwest Medical Equipment Solutions, Inc.-ICMProviderAgreementAmendment_166876.txt-RESULTS.xlsx\n", - "Extracted 31 dataframes.\n" - ] - } - ], + "outputs": [], "source": [ "\n", "# make list of dataframes from labels_files\n", @@ -153,7 +98,7 @@ }, { "cell_type": "code", - "execution_count": 7, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ @@ -168,19 +113,9 @@ }, { "cell_type": "code", - "execution_count": 8, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "nan 0\n", - "Custom_2009-08-10 Adventist - University Community Hopstial LTAC MU.txt 2\n", - "2018 09 01 UTMB (Amendment 10 change in reimbursement) MU.txt 2\n" - ] - } - ], + "outputs": [], "source": [ "labels_df[labels_df['data_source'] == 'DocziAI_2-12.xlsx']\n", "\n", @@ -194,17 +129,9 @@ }, { "cell_type": "code", - "execution_count": 9, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "There are 70 unique contract file names in the labels dataframe.\n" - ] - } - ], + "outputs": [], "source": [ "unique_contracts_labels = labels_df['CONTRACT_FILE_NAME'].nunique()\n", "print(f\"There are {unique_contracts_labels} unique contract file names in the labels dataframe.\")\n", @@ -217,49 +144,31 @@ }, { "cell_type": "code", - "execution_count": 10, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "(532, 14)\n" - ] - }, - { - "data": { - "text/plain": [ - "(284, 4)" - ] - }, - "execution_count": 10, - "metadata": {}, - "output_type": "execute_result" - } - ], + "outputs": [], "source": [ "labels_df = pd.read_csv('labels_df.csv')\n", "\n", "labels_df = labels_df[['CONTRACT_FILE_NAME',\n", - " 'CONTRACT_SERVICE_CD_OR_DESC',\n", - " 'CONTRACT_REIMBURSEMENT_METHOD',\n", - " 'CONTRACT_CARVEOUT_IND',\n", - " 'CONTRACT_LESSER_OF_IND',\n", - " 'CONTRACT_GREATER_OF_IND',\n", - " 'AARETE_DERIVED_REIMBURSEMENT_METHOD',\n", - " 'CONTRACT_REIMBURSEMENT_FEE_RATE',\n", - " 'CONTRACT_REIMBURSEMENT_PERCENT_RATE',\n", + " 'SERVICE_TERM',\n", + " 'REIMB_TERM',\n", + " 'CARVEOUT_IND',\n", + " 'LESSER_OF_IND',\n", + " 'GREATER_OF_IND',\n", + " 'AARETE_DERIVED_REIMB_METHOD',\n", + " 'REIMB_FEE_RATE',\n", + " 'REIMB_PCT_RATE',\n", " 'NOT_TO_EXCEED_IND',\n", - " 'CONTRACT_DEFAULT_IND',\n", - " 'CONTRACT_FEE_SCHEDULE_DESC',\n", + " 'DEFAULT_IND',\n", + " 'FEE_SCHEDULE',\n", " 'AARETE_DERIVED_FEE_SCHEDULE',\n", " 'AARETE_DERIVED_FEE_SCHEDULE_VERSION',\n", - "# 'CONTRACT_FEE_SCHEDULE_VERSION'\n", + "# 'FEE_SCHEDULE_VERSION'\n", " ]]\n", "labels_df = labels_df.drop_duplicates()\n", "labels_df = labels_df.replace('N/A', '').fillna('')\n", - "labels_df['CONTRACT_REIMBURSEMENT_PERCENT_RATE'] = labels_df['CONTRACT_REIMBURSEMENT_PERCENT_RATE'].replace('', 100)\n", + "labels_df['REIMB_PCT_RATE'] = labels_df['REIMB_PCT_RATE'].replace('', 100)\n", "# labels_df[\"CONTRACT_FILE_NAME\"].unique()\n", "labels_df = labels_df[labels_df[\n", " 'CONTRACT_FILE_NAME'].isin([\"95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt\",\n", @@ -273,595 +182,20 @@ "labels_df.to_csv('labels_to_compare.csv', index=False)\n", "labels_df = pd.read_csv('labels_to_compare.csv')\n", "\n", - "labels_df_for_prediction = labels_df[[\"CONTRACT_FILE_NAME\", \"CONTRACT_SERVICE_CD_OR_DESC\", \"CONTRACT_CARVEOUT_IND\", \"CONTRACT_REIMBURSEMENT_METHOD\"]]\n", + "labels_df_for_prediction = labels_df[[\"CONTRACT_FILE_NAME\", \"SERVICE_TERM\", \"CARVEOUT_IND\", \"REIMB_TERM\"]]\n", "labels_df_unique_rows = labels_df_for_prediction.drop_duplicates()\n", "labels_df_unique_rows.shape" ] }, { "cell_type": "code", - "execution_count": 11, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hemodialysis, in-center (condition code 71) | CPT : 90999 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\"}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hemodialysis, in-center (condition code 71) | CPT : 90999 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hemodialysis, in-center (condition code 71) | CPT : 90999 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '265', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hemodialysis-in-center, nocturnal (condition code 71) | CPT : 90999.UJ | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\"}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hemodialysis-in-center, nocturnal (condition code 71) | CPT : 90999.UJ | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hemodialysis-in-center, nocturnal (condition code 71) | CPT : 90999.UJ | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '265', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Hemodialysis (condition code 74) | CPT : 90999 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\"}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Hemodialysis (condition code 74) | CPT : 90999 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Hemodialysis (condition code 74) | CPT : 90999 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '265', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Hemodialysis Training | CPT : 90993 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\"}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Hemodialysis Training | CPT : 90993 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Hemodialysis Training | CPT : 90993 | Rev. Code : 821', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '265', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ultrafiltration | CPT : 90999 | Rev. Code : 881', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of: (i) the Provider's Allowable Charges; or (ii) $265 per treatment\"}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ultrafiltration | CPT : 90999 | Rev. 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Code : 851', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"HMO shall pay Provider the lesser of: (i) Provider's Allowable Charges; or (ii) $295 per treatment\"}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CCPD Training treatment | CPT : 90993 | Rev. 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"[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Other Pharmaceuticals (and their administration) not included in Schedule A of Exhibit 1, including but not limited to vaccines and IV antibiotics', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Provider shall be reimbursed one hundred percent (100%) of the then-current Medicare allowable rate', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare allowable rate', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Services', 'CONTRACT_CARVEOUT_IND': nan, 'CONTRACT_REIMBURSEMENT_METHOD': 'For all other Covered Services or items (i) prescribed by a physician (or other licensed provider), (ii) not addressed in Sections 3-6 of this Exhibit 2, (iii) for which a rate is not specified in this Exhibit, and (iv) which Provider provides to Covered Persons, Provider shall be compensated by Payor at one hundred percent (100%) of the then-current Medicare allowable rate'}\n", - "[{'CONTRACT_FILE_NAME': '95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Services', 'CONTRACT_CARVEOUT_IND': nan, 'CONTRACT_REIMBURSEMENT_METHOD': 'For all other Covered Services or items (i) prescribed by a physician (or other licensed provider), (ii) not addressed in Sections 3-6 of this Exhibit 2, (iii) for which a rate is not specified in this Exhibit, and (iv) which Provider provides to Covered Persons, Provider shall be compensated by Payor at one hundred percent (100%) of the then-current Medicare allowable rate', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'Y', 'CONTRACT_FEE_SCHEDULE_DESC': 'then-current Medicare allowable rate', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicine', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $62.00\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicine', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $62.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicine', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $62.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '62.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $62.00\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $62.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $62.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '62.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Lab/Pathology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $59.00\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Lab/Pathology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $59.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Lab/Pathology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $59.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory services without an RBRVS weight', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'will be allowed at 100% of the 2018 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory services without an RBRVS weight', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'will be allowed at 100% of the 2018 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': '2018 Medicare Clinical Diagnostic Lab Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': '2018', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2018'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $59.00\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $59.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $59.00\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $47.00. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $47.00. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $47.00. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '47.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"maximum plan allowable shall be the lesser of Provider's Billed Charges or the fee schedule set forth below Reimbursement will be based upon the 2018 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI applied) with a conversion factor of $47.00. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RVU', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered services performed by Mid-Level Professionals', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/ Conversion Factor methodology. maximum plan allowable shall be the lesser of Provider's Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered services performed by Mid-Level Professionals', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/ Conversion Factor methodology. maximum plan allowable shall be the lesser of Provider's Billed Charges\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hearing Aids', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Reimbursement of Hearing Aids will be paid at one hundred (100%) percent of billed charges, not to exceed acquisition cost, plus five (5%) percent.'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hearing Aids', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Reimbursement of Hearing Aids will be paid at one hundred (100%) percent of billed charges, not to exceed acquisition cost, plus five (5%) percent.'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hearing Aid Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Fitting, Orientation and Checking of Hearing Aids is considered a miscellaneous charge. These services are reimbursed using the Medicine Conversion Factor and are subject to any Hearing Aid benefit limitation.'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hearing Aid Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Fitting, Orientation and Checking of Hearing Aids is considered a miscellaneous charge. These services are reimbursed using the Medicine Conversion Factor and are subject to any Hearing Aid benefit limitation.'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Unlisted Procedures and/or Supplies (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Unlisted procedures will be allowed at sixty percent (60%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit).'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Unlisted Procedures and/or Supplies (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Unlisted procedures will be allowed at sixty percent (60%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit).'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Pharmaceuticals (including Injectables and Cancer Drugs)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Pharmaceuticals (including Injectables and Cancer Drugs)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'DME will be reimbursed at ninety five percent (95%) of the current Medicare DMEPOS schedule, available as of January 1. Moda Health will not implement Medicare quarterly updates. For rental DME, Moda Health will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period for DME as defined by CMS.'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'DME will be reimbursed at ninety five percent (95%) of the current Medicare DMEPOS schedule, available as of January 1. Moda Health will not implement Medicare quarterly updates. For rental DME, Moda Health will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period for DME as defined by CMS.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '95', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'current Medicare DMEPOS schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE_DMEPOS', 'CONTRACT_FEE_SCHEDULE_VERSION': 'current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'DME will be reimbursed at ninety five percent (95%) of the current Medicare DMEPOS schedule, available as of January 1. Moda Health will not implement Medicare quarterly updates. For rental DME, Moda Health will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period for DME as defined by CMS.', 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'current Medicare DMEPOS schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE_DMEPOS', 'CONTRACT_FEE_SCHEDULE_VERSION': 'current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Rental Durable Medical Equipment (DME) (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'For rental DME, Moda Health will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period for DME as defined by CMS.'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Rental Durable Medical Equipment (DME) (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'For rental DME, Moda Health will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period for DME as defined by CMS.', 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Rental Durable Medical Equipment (DME) (not including Hearing Aids)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'For rental DME, Moda Health will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period for DME as defined by CMS.', 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': '', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'For inpatient and outpatient services, all subsequent procedures performed on the same day as primary procedures will be reimbursed at 50% of the allowed amount for the procedure.'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'For inpatient and outpatient services, all subsequent procedures performed on the same day as primary procedures will be reimbursed at 50% of the allowed amount for the procedure.'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychiatric Diagnostic Evaluation', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $139.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychiatric Diagnostic Evaluation', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $139.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $52.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $52.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy 45 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $89.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy 45 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $89.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $93.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $93.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy for crisis: first 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $104.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy for crisis: first 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $104.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy for crisis: each additional 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $52.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Psychotherapy for crisis: each additional 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $52.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Family Psychotherapy--Client not present', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $98.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Family Psychotherapy--Client not present', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $98.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Family Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $100.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Family Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $100.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Multiple-family group psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $46.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Multiple-family group psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $46.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Group Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $46.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Group Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $46.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior assessment, initial assessment, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior assessment, initial assessment, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior assessment, re-assessment, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior assessment, re-assessment, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, individual, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, individual, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, group, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $5.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, group, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $5.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, family, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, family, per 15 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, family, per 15 minutes--client not present', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Professional Counselor; Licensed Marriage & Family Therapist; Licensed Clinical Social Worker; Licensed Psychologist Associate - Health and behavior intervention, family, per 15 minutes--client not present', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $21.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychiatric Diagnostic Evaluation', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $162.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychiatric Diagnostic Evaluation', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $162.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $60.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $60.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy 45 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $113.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy 45 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $113.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $119.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $119.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy for crisis: first 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $120.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy for crisis: first 60 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $120.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy for crisis: each additional 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $60.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Psychotherapy for crisis: each additional 30 minutes', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $60.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Family Psychotherapy--Client not present', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $122.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Family Psychotherapy--Client not present', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $122.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Family Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $122.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Family Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $122.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Multiple-family group psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $53.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Multiple-family group psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $53.00 or (ii) 100% of Provider's Covered Billed Charges.\"}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychologist - Group Psychotherapy', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of: (i) $53.00 or (ii) 100% of Provider's Covered Billed Charges.\"}\n", - 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"{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '58'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '58'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '100'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '100'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '145'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '145'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '220'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '220'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '275'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, new patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '275'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '28'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '28'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '58'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '58'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '97'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '97'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '142'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '142'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '195'}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Licensed Psychiatric Mental Health Nurse Practitioner (in Group Practice) Fee Schedule Evaluation and Management, established patient', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '195'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicine', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $62.00 (ii) 100% of Provider's Covered Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicine', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $62.00 (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '62.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicine', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $62.00 (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $62.00 (ii) 100% of Provider's Covered Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $62.00 (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '62.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $62.00 (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Lab/Pathology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $45.00 (ii) 100% of Provider's Covered Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Lab/Pathology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $45.00 (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '45.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Lab/Pathology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Reimbursement will be based upon the current year RBRVS version effective January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: $45.00 (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory services without an RBRVS weight', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Laboratory services without an RBRVS weight will be allowed at 100% of the current year Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1. (ii) 100% of Provider's Covered Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory services without an RBRVS weight', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Laboratory services without an RBRVS weight will be allowed at 100% of the current year Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1. (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Clinical Diagnostic Lab Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'current year', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': 'Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory services without an RBRVS weight', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Laboratory services without an RBRVS weight will be allowed at 100% of the current year Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1. (ii) 100% of Provider's Covered Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 107% of the relevant Ohio Department of Medicaid (ODM) rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 107% of the relevant Ohio Department of Medicaid (ODM) rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '107', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Ohio Department of Medicaid (ODM) rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 105% of the relevant ODM rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 105% of the relevant ODM rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '105', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'STATE_MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Reference Lab', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Reference Lab', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Care Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Care Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Infusion Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service. For the period from October 1, 2017 through November 30, 2017, Plan shall continue to reimburse services listed and priced separately on the Attachment A that was effective December 1, 2010. The parties agree to review the impact of and adopt the Ohio Medicaid fee schedule for these separately listed services effective 12/1/17.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Infusion Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service. For the period from October 1, 2017 through November 30, 2017, Plan shall continue to reimburse services listed and priced separately on the Attachment A that was effective December 1, 2010. The parties agree to review the impact of and adopt the Ohio Medicaid fee schedule for these separately listed services effective 12/1/17.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospice Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospice Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'DME', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'DME', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'ODM rate schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of $26.00 per ASA unit.'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital at a rate of $26.00 per ASA unit.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per ASA Unit', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '26.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Facility', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital 60% of billed charges for inpatient facility'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Facility', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital 60% of billed charges for inpatient facility', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '60', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Outpatient Facility', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital 50% of billed charges for outpatient facility'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Outpatient Facility', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital 50% of billed charges for outpatient facility', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '50', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital 45% of billed charges for professional services'}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Plan shall reimburse Hospital 45% of billed charges for professional services', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '45', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and outpatient facility services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 151% of the then current hospital specific Medicare Allowed Amount (excluding sequestration) for those Covered Persons enrolled in any Plan Marketplace product\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and outpatient facility services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 151% of the then current hospital specific Medicare Allowed Amount (excluding sequestration) for those Covered Persons enrolled in any Plan Marketplace product\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and outpatient facility services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 151% of the then current hospital specific Medicare Allowed Amount (excluding sequestration) for those Covered Persons enrolled in any Plan Marketplace product\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '151', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'hospital specific Medicare Allowed Amount', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Injectable medications rendered in the inpatient or outpatient facility setting', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 151% of the then current hospital specific Medicare Allowed Amount (excluding sequestration)\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Injectable medications rendered in the inpatient or outpatient facility setting', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 151% of the then current hospital specific Medicare Allowed Amount (excluding sequestration)\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Injectable medications rendered in the inpatient or outpatient facility setting', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 151% of the then current hospital specific Medicare Allowed Amount (excluding sequestration)\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '151', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'then current hospital specific Medicare Allowed Amount', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All other injectable medications', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 100% of the Medicare Allowed Amount\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All other injectable medications', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 100% of the Medicare Allowed Amount\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All other injectable medications', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 100% of the Medicare Allowed Amount\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Allowed Amount', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home health, hospice, SNF, and dialysis services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 100% of the Medicare Allowed Amount\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home health, hospice, SNF, and dialysis services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 100% of the Medicare Allowed Amount\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home health, hospice, SNF, and dialysis services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 100% of the Medicare Allowed Amount\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Allowed Amount', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Reference lab and DME', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 75% of the Medicare Allowed Amount\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Reference lab and DME', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 75% of the Medicare Allowed Amount\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Reference lab and DME', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 75% of the Medicare Allowed Amount\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '75', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Allowed Amount', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 130% of the then current Medicare Allowed Amount for all Covered Persons enrolled in any Plan Marketplace product\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 130% of the then current Medicare Allowed Amount for all Covered Persons enrolled in any Plan Marketplace product\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 130% of the then current Medicare Allowed Amount for all Covered Persons enrolled in any Plan Marketplace product\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '130', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Allowed Amount', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Codes with no RBRVS value', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 70% of billed charges\"}\n", - "[{'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Codes with no RBRVS value', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 70% of billed charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': 'Akron General Health System_Eleventh Amendment_20171001.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Codes with no RBRVS value', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Hospital's total billed charges included on the claim or 70% of billed charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '70', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred and five percent (105%) of the then current Texas Medicaid Fee Schedule\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred and five percent (105%) of the then current Texas Medicaid Fee Schedule\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred and five percent (105%) of the then current Texas Medicaid Fee Schedule\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '105', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Vaginal delivery only, after previous cesarean delivery (Current Procedural Coding (CPT) 59612)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or four hundred and dollars ($400.00) above the then current reimbursement for CPT R code 59514 (Cesarean delivery only)\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Vaginal delivery only, after previous cesarean delivery (Current Procedural Coding (CPT) 59612)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or four hundred and dollars ($400.00) above the then current reimbursement for CPT R code 59514 (Cesarean delivery only)\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology services (CPT codes 70000 through 79999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or eighty (80%) of the Texas Medicaid Fee Schedule\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology services (CPT codes 70000 through 79999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or eighty (80%) of the Texas Medicaid Fee Schedule\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Clinical Laboratory services (CPT codes 80000 through 87999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or sixty percent (60%) of the Texas Medicaid Clinical Laboratory Fee Schedule\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Clinical Laboratory services (CPT codes 80000 through 87999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or sixty percent (60%) of the Texas Medicaid Clinical Laboratory Fee Schedule\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs dispensed and administered by Physician/Provider', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of the Texas Medicaid reimbursement\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs dispensed and administered by Physician/Provider', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of the Texas Medicaid reimbursement\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs dispensed and administered by Physician/Provider', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of the Texas Medicaid reimbursement\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid reimbursement', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Rho (D) immune globulin billed with Healthcare Common Procedure Code System (HCPCS) codes J2788, J2790, J2791, J2792', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred and twenty percent (120%) of the Texas Medicaid Fee Schedule\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Rho (D) immune globulin billed with Healthcare Common Procedure Code System (HCPCS) codes J2788, J2790, J2791, J2792', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"the lesser of Physician/Provider's Billed Charges or one hundred and twenty percent (120%) of the Texas Medicaid Fee Schedule\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Service for which no reimbursement is defined by any of the methods listed above', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"thirty percent (30%) of Physician/Provider's Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Service for which no reimbursement is defined by any of the methods listed above', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"thirty percent (30%) of Physician/Provider's Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '30', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of the then current Medicare Fee Schedule, less any applicable Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of the then current Medicare Fee Schedule, less any applicable Member Expense\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of the then current Medicare Fee Schedule, less any applicable Member Expense\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology services (CPT R codes 70000 through 79999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or eighty (80%) of the then current Medicare Fee Schedule, less any applicable Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology services (CPT R codes 70000 through 79999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or eighty (80%) of the then current Medicare Fee Schedule, less any applicable Member Expense\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Clinical Laboratory services (CPT codes 80000 through 87999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or sixty percent (60%) of then current Medicare Clinical Lab Fee Schedule, less any applicable Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Clinical Laboratory services (CPT codes 80000 through 87999)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or sixty percent (60%) of then current Medicare Clinical Lab Fee Schedule, less any applicable Member Expense\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment, Prosthetics/Orthotics, and Supplies', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or eighty (80%) of the then current Medicare DMEPOS Fee Schedule, less any applicable Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment, Prosthetics/Orthotics, and Supplies', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or eighty (80%) of the then current Medicare DMEPOS Fee Schedule, less any applicable Member Expense\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs dispensed and administered by Physician/Provider', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of then current APS reimbursement, in accordance with Medicare reimbursement methodology, less any applicable Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs dispensed and administered by Physician/Provider', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent (100%) of then current APS reimbursement, in accordance with Medicare reimbursement methodology, less any applicable Member Expense\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered vaccines for which there is no allowable in the Medicare Fee Schedule', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent and five (105%) of then current Medicaid Fee Schedule allowable, less any applicable Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered vaccines for which there is no allowable in the Medicare Fee Schedule', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of Physician/Provider's Billed Charges or one hundred percent and five (105%) of then current Medicaid Fee Schedule allowable, less any applicable Member Expense\"}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Service for which no reimbursement is defined by any of the methods listed above', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Community shall compensate Physician/Provider according to thirty percent (30%) of Physician/Provider's Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Service for which no reimbursement is defined by any of the methods listed above', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Community shall compensate Physician/Provider according to thirty percent (30%) of Physician/Provider's Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '30', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Dual Special Needs Plan (DSNP)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Where Payor is the only Payor for Medicare Covered Services, Physician/Provider's maximum compensation shall be the lesser of 1) Physician/Provider's Billed Charges or 2) one hundred percent (100%) of the Medicare payment in effect on the date of service as primary coverage, not including Member Expense\"}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Dual Special Needs Plan (DSNP)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Where Payor is the only Payor for Medicare Covered Services, Physician/Provider's maximum compensation shall be the lesser of 1) Physician/Provider's Billed Charges or 2) one hundred percent (100%) of the Medicare payment in effect on the date of service as primary coverage, not including Member Expense\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Dual Special Needs Plan (DSNP)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Where Payor is the only Payor for Medicare Covered Services, Physician/Provider's maximum compensation shall be the lesser of 1) Physician/Provider's Billed Charges or 2) one hundred percent (100%) of the Medicare payment in effect on the date of service as primary coverage, not including Member Expense\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Medicare Member Cost Share', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Acute/Medical Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Community shall process Clean Claims based on the then current Medicare or Medicaid Fee Schedule as applicable to services rendered and according to Medicare reimbursement methodology, including the geographic practice cost index (GPCI), or Medicaid reimbursement methodology as applicable'}\n", - "[{'CONTRACT_FILE_NAME': \"Progressive Women's Health, PLLC_Physician Agreement MU.txt\", 'CONTRACT_SERVICE_CD_OR_DESC': 'Acute/Medical Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Community shall process Clean Claims based on the then current Medicare or Medicaid Fee Schedule as applicable to services rendered and according to Medicare reimbursement methodology, including the geographic practice cost index (GPCI), or Medicaid reimbursement methodology as applicable'}]\n", - 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"[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Radiology', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '100% of Texas Medicaid Fee Schedule', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Emergency Room (entire case) Level 1 - 99281 Level 2 - 99282 Level 3 - 99283 Level 4 - 99284 Level 5 - 99285', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '300'}\n", - 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"{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '175% of Texas Medicaid Fee Schedule Ungrouped Procedures at 175% of Grouper 4'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '175% of Texas Medicaid Fee Schedule Ungrouped Procedures at 175% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '175', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': ''}, {'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '175% of Texas Medicaid Fee Schedule Ungrouped Procedures at 175% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '175', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - 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110% of the current SDA '}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INPATIENT', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '2 - Clear Lake Regional Medical Center - 110% of the current SDA '}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INPATIENT', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '3 - All Other Hospitals - 105% of the current SDA'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INPATIENT', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '3 - All Other Hospitals - 105% of the current SDA', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '105', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'SDA', 'AARETE_DERIVED_FEE_SCHEDULE': 'SDA', 'CONTRACT_FEE_SCHEDULE_VERSION': 'current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospital Outpatient Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '140% of Texas Medicaid Fee Schedule Ungrouped Procedures at 140% of Grouper 4'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospital Outpatient Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '140% of Texas Medicaid Fee Schedule Ungrouped Procedures at 140% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '140', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospital Outpatient Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '140% of Texas Medicaid Fee Schedule Ungrouped Procedures at 140% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '140', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '140% of Texas Medicaid Fee Schedule Ungrouped Procedures at 140% of Grouper 4'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '140% of Texas Medicaid Fee Schedule Ungrouped Procedures at 140% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '140', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '140% of Texas Medicaid Fee Schedule Ungrouped Procedures at 140% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '140', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Reimbursement, including outlier payment', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"1. - The Woman's Hospital of Texas a. 160% of the current SDA for cases that include Rev Codes 173-174 b. 105% with a Texas Medicaid SDA for all other APR-DRGs. \"}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Reimbursement, including outlier payment', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"1. - The Woman's Hospital of Texas a. 160% of the current SDA for cases that include Rev Codes 173-174 b. 105% with a Texas Medicaid SDA for all other APR-DRGs. \", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '160', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Reimbursement, including outlier payment', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"1. - The Woman's Hospital of Texas a. 160% of the current SDA for cases that include Rev Codes 173-174 b. 105% with a Texas Medicaid SDA for all other APR-DRGs. \", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '105', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Reimbursement, including outlier payment', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '2 - Clear Lake Regional Medical Center - 110% of the current SDA '}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Reimbursement, including outlier payment', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '2 - Clear Lake Regional Medical Center - 110% of the current SDA ', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '110', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'SDA', 'AARETE_DERIVED_FEE_SCHEDULE': 'SDA', 'CONTRACT_FEE_SCHEDULE_VERSION': 'current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Emergency Room (entire case) Level 1 - 99281 Level 2 - 99282 Level 3 1 99283 Level 4 - 99284 Level 5 - 99285', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '300'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Emergency Room (entire case) Level 1 - 99281 Level 2 - 99282 Level 3 1 99283 Level 4 - 99284 Level 5 - 99285', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '300', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '300', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospital Outpatient Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '112% of Texas Medicaid Fee Schedule Ungrouped Procedures at 112% of Grouper 4'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospital Outpatient Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '112% of Texas Medicaid Fee Schedule Ungrouped Procedures at 112% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '112', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Hospital Outpatient Surgery', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '112% of Texas Medicaid Fee Schedule Ungrouped Procedures at 112% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '112', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '112% of Texas Medicaid Fee Schedule Ungrouped Procedures at 112% of Grouper 4'}\n", - "[{'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '112% of Texas Medicaid Fee Schedule Ungrouped Procedures at 112% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '112', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Texas Medicaid Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICAID', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Ambulatory Surgery Center', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '112% of Texas Medicaid Fee Schedule Ungrouped Procedures at 112% of Grouper 4', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '112', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights. $24,200 Conversion Factor\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights. $24,200 Conversion Factor\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '24200', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights. $24,200 Conversion Factor\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services CMS MS-DRGs: 619-621', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges $18,000 Case Rate\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services CMS MS-DRGs: 619-621', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges $18,000 Case Rate\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services CMS MS-DRGs: 470', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges $30,000 Case Rate\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services CMS MS-DRGs: 470', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges $30,000 Case Rate\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. 422% of Medicare\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. 422% of Medicare\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '422', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. 422% of Medicare\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Infusion Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider\\'s billed charges. OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES. Presence of HCPC Code listed in \"Site of Care Medication List\" below on claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. 140% of Medicare Applies to the Entire Claim'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Infusion Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider\\'s billed charges. OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES. Presence of HCPC Code listed in \"Site of Care Medication List\" below on claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. 140% of Medicare Applies to the Entire Claim'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights.\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': '10-1-2020 MS-DRG table', 'AARETE_DERIVED_FEE_SCHEDULE': 'MS_DRG', 'CONTRACT_FEE_SCHEDULE_VERSION': 'version 38', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '10-1-2020'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-2020 MS-DRG table weight (version 38). Any new MS-DRGs not listed on the MS-DRG table specified above will price with then current MS-DRG weights.\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Bariatric Surgery Case Rates CMS MS-DRGs: 619-621', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $18,000 Case Rate\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Bariatric Surgery Case Rates CMS MS-DRGs: 619-621', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $18,000 Case Rate\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Case Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '18000', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Bariatric Surgery Case Rates CMS MS-DRGs: 619-621', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $18,000 Case Rate\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Major Joint Replacement without Major Complications or Comorbidities Case Rates CMS MS-DRGs: 470', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services \\nshall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $30,000 Case Rate\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Major Joint Replacement without Major Complications or Comorbidities Case Rates CMS MS-DRGs: 470', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services \\nshall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $30,000 Case Rate\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'PROVIDER_SPECIFIC', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Major Joint Replacement without Major Complications or Comorbidities Case Rates CMS MS-DRGs: 470', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services \\nshall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $30,000 Case Rate\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Major Joint Replacement without Major Complications or Comorbidities Case Rates CMS MS-DRGs: 470', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services \\nshall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. $30,000 Case Rate\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Case Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '30000', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 343% of Medicare or (ii) 100% of Provider's billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 343% of Medicare or (ii) 100% of Provider's billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '343', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Outpatient Prospective Payment System (OPPS)', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE_OPPS', 'CONTRACT_FEE_SCHEDULE_VERSION': 'in effect on the date of service', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 343% of Medicare or (ii) 100% of Provider's billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"140% of Medicare Applies to the Entire Claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. Applies to outpatient claims that include any of the drugs listed in the 'Site of Care Medication Prior Authorization List'.Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. \"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"140% of Medicare Applies to the Entire Claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. Applies to outpatient claims that include any of the drugs listed in the 'Site of Care Medication Prior Authorization List'.Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. \", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '140', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"140% of Medicare Applies to the Entire Claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. Applies to outpatient claims that include any of the drugs listed in the 'Site of Care Medication Prior Authorization List'.Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. \", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'Y', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"140% of Medicare Applies to the Entire Claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. Applies to outpatient claims that include any of the drugs listed in the 'Site of Care Medication Prior Authorization List'.\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"140% of Medicare Applies to the Entire Claim. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments. Applies to outpatient claims that include any of the drugs listed in the 'Site of Care Medication Prior Authorization List'.\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Grouper', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '140', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Hospital Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 200% of CMS\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Hospital Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 200% of CMS\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '200', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Hospital Inpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 200% of CMS\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Hospital Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 200% of CMS\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Hospital Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 200% of CMS\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '200', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered Hospital Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 200% of CMS\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 97% of Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 97% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '97', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 97% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'PERCENT_OF_BILLED', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': ''}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 95% of Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 95% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'PERCENT_OF_BILLED', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': ''}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient and Outpatient Services', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. 95% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '95', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"50% of Covered Billed Charges Applies to the Entire Claim The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges.\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"50% of Covered Billed Charges Applies to the Entire Claim The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '50', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"50% of Covered Billed Charges Applies to the Entire Claim The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'PERCENT_OF_CHARGES', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'All Covered Outpatient Services - OUTPATIENT SERVICES CARVE OUT - INFUSION SERVICES', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"50% of Covered Billed Charges Applies to the Entire Claim The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for inpatient Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges.\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services, excluding services listed below', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $92.00 Conversion Factor 2020 RBRVS version effective January 1 using the Site of Service Based RVU or (ii) 100% of Provider's billed charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services, excluding services listed below', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $92.00 Conversion Factor 2020 RBRVS version effective January 1 using the Site of Service Based RVU or (ii) 100% of Provider's billed charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'RBRVS', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '92.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services, excluding services listed below', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $92.00 Conversion Factor 2020 RBRVS version effective January 1 using the Site of Service Based RVU or (ii) 100% of Provider's billed charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services delivered by ND, LMT, LAC, RD', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $92.00 Conversion Factor 2020 RBRVS version effective January 1 using the Site of Service Based RVU or (ii) 100% of Provider's billed charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Professional services delivered by ND, LMT, LAC, RD', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $92.00 Conversion Factor 2020 RBRVS version effective January 1 using the Site of Service Based RVU or (ii) 100% of Provider's billed charges\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $69.00 Conversion Factor; using ASA Base Units or (ii) 100% of Provider's billed charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Anesthesia Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) $69.00 Conversion Factor; using ASA Base Units or (ii) 100% of Provider's billed charges\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 120% of 2020 Clinical Laboratory Fee Schedule available as of January 1 or (ii) 100% of Provider's billed charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Laboratory Services', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 120% of 2020 Clinical Laboratory Fee Schedule available as of January 1 or (ii) 100% of Provider's billed charges\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Pharmaceuticals', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 120% of current CMS Medicare Part B Fee Schedule or (ii) 100% of Provider's billed charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Pharmaceuticals', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) 120% of current CMS Medicare Part B Fee Schedule or (ii) 100% of Provider's billed charges\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Durable Medical Equipment: 100% of 2020 DME fee schedule\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Durable Medical Equipment', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Durable Medical Equipment: 100% of 2020 DME fee schedule\"}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established', 'CONTRACT_CARVEOUT_IND': nan, 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established: 80% of Billed Charges\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established', 'CONTRACT_CARVEOUT_IND': nan, 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established: 80% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'PERCENT_OF_BILLED', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established', 'CONTRACT_CARVEOUT_IND': nan, 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established: 80% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established', 'CONTRACT_CARVEOUT_IND': nan, 'CONTRACT_REIMBURSEMENT_METHOD': \"The maximum compensation for Covered Services rendered to a Member shall be the Allowed Amount as set forth below. Except as otherwise provided in this Exhibit, the Allowed Amount for Covered Services shall be the lessor of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Covered By Report Procedures, Procedures not Listed and Procedures with Relativities not Established: 80% of Billed Charges\", 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '80', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'Y', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Admit Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $189.52 Per Visit\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Admit Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $189.52 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '189.52', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Admit Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $189.52 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Subsequent Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $157.49 Per Visit\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Subsequent Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $157.49 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '157.49', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Subsequent Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $157.49 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Visit - Per Hour', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $59.00 Per Hour\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Visit - Per Hour', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $59.00 Per Hour\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'RN & LPN Visit - Per Hour', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $59.00 Per Hour\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Admit Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $189.52 Per Visit\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Admit Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $189.52 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '189.52', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Admit Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $189.52 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Subsequent Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $157.49 Per Visit\"}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Subsequent Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $157.49 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '157.49', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Subsequent Visit', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': \"The lesser of (i) the rates set forth in this Exhibit or (ii) 100% of Provider's billed charges. Rate: $157.49 Per Visit\", 'CONTRACT_LESSER_OF_IND': 'Y', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Visit - Per Hour | Revenue Code : 422', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Physical Therapy Visit - Per Hour | Revenue Code : 422', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Occupational Therapy Admit Visit | Revenue Code : 434', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $189.52 | Type : Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Occupational Therapy Admit Visit | Revenue Code : 434', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $189.52 | Type : Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '189.52', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Occupational Therapy Subsequent Visit | Revenue Code : 430, 431, 439', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $157.49 | Type : Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Occupational Therapy Subsequent Visit | Revenue Code : 430, 431, 439', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $157.49 | Type : Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '157.49', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Occupational Therapy Visit - Per Hour | Revenue Code : 432', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Occupational Therapy Visit - Per Hour | Revenue Code : 432', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Speech Therapy Admit Visit | Revenue Code : 444', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $189.52 | Type : Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Speech Therapy Admit Visit | Revenue Code : 444', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $189.52 | Type : Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '189.52', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Speech Therapy Subsequent Visit | Revenue Code : 440, 441, 449', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $157.49 | Type : Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Speech Therapy Subsequent Visit | Revenue Code : 440, 441, 449', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $157.49 | Type : Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '157.49', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Speech Therapy Visit - Per Hour | Revenue Code : 442', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Speech Therapy Visit - Per Hour | Revenue Code : 442', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medical Social Worker Visit | Revenue Code : 561', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $189.52 | Type : Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medical Social Worker Visit | Revenue Code : 561', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $189.52 | Type : Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '189.52', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medical Social Work Subsequent Visit | Revenue Code : 569', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $157.49 | Type : Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medical Social Work Subsequent Visit | Revenue Code : 569', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $157.49 | Type : Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '157.49', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medical Social Worker Visit - Per Hour | Revenue Code : 562', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medical Social Worker Visit - Per Hour | Revenue Code : 562', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $59.00 | Type : Per Hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '59.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Health Aide Revenue Code 570, 571, 579', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$96.31 Per Visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Health Aide Revenue Code 570, 571, 579', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$96.31 Per Visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '96.31', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Health Aide Visit - Per Hour Revenue Code 572', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$29.00 Per Hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home Health Aide Visit - Per Hour Revenue Code 572', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$29.00 Per Hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '29.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Routine Home Hospice Care | HCPCS Code(s) : T2042 | Revenue Code : 651', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $200.85 | Type : Per Diem'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Routine Home Hospice Care | HCPCS Code(s) : T2042 | Revenue Code : 651', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $200.85 | Type : Per Diem', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '200.85', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Continuous Home Hospice Care | HCPCS Code(s) : T2043 | Revenue Code : 652', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $37.08 (min 8 hrs, max 24 hrs) | Type : Per Hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Continuous Home Hospice Care | HCPCS Code(s) : T2043 | Revenue Code : 652', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $37.08 (min 8 hrs, max 24 hrs) | Type : Per Hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '37.08', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Respite Care | HCPCS Code(s) : T2044 | Revenue Code : 655', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $200.85 | Type : Per Diem'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Respite Care | HCPCS Code(s) : T2044 | Revenue Code : 655', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $200.85 | Type : Per Diem', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '200.85', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Hospice Care | HCPCS Code(s) : T2045, T2046 | Revenue Code : 656', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $770.00 | Type : Per Diem'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Inpatient Hospice Care | HCPCS Code(s) : T2045, T2046 | Revenue Code : 656', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Rate : $770.00 | Type : Per Diem', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '770.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Medicare Part B Drug Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'MEDICARE', 'CONTRACT_FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}, {'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'WAC', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'Y', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicare Part B Drugs (including Injectables and Cancer Drugs) not appear on the Medicare Part B Drug Schedule', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Medicare Part B Drugs (including Injectables and Cancer Drugs) not appear on the Medicare Part B Drug Schedule', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Moda Health shall compensate Provider at one hundred percent (100%) of the then-current Medicare Part B Drug Schedule for medications that require administration by a licensed professional in the medical setting, as labeled by the Food and Drug Administration (FDA). In the event the medication does not appear on the Medicare Part B Drug Schedule, reimbursement will be based on 100% of the Wholesale Acquisition Cost (WAC).'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Unlisted Procedures and/or Supplies', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Unlisted procedures will be allowed at sixty percent (60%) of billed charges for medically necessary or unlisted procedures (a procedure without a Relative Value Unit).'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Unlisted Procedures and/or Supplies', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'Unlisted procedures will be allowed at sixty percent (60%) of billed charges for medically necessary or unlisted procedures (a procedure without a Relative Value Unit).'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Unlisted Therapies, Services and Products', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'For all medically necessary therapies, services and products not itemized on the following schedule, such therapies, services and products shall be reimbursed at a rate of eighty-five percent (85%) of billed charges.'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Unlisted Therapies, Services and Products', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': 'For all medically necessary therapies, services and products not itemized on the following schedule, such therapies, services and products shall be reimbursed at a rate of eighty-five percent (85%) of billed charges.'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9500)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '78'}\n", - "[]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9501)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '88'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9501)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '88', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '88', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9502)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '98'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9502)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '98', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9503)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '108'}\n", - "[]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9504)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '118'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9504)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '118', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '118', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9497)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '118'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (S9497)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '118', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '118', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), Per Diem (S9343)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '17.22'}\n", - "[]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), Per Diem (S9341)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '21.08'}\n", - "[]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), Per Diem (S9342)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '26.62'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), Per Diem (S9342)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '26.62', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '26.62', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ENTERAL FORMULA (NDC)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '106% of PEN'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ENTERAL FORMULA (NDC)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '106% of PEN', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '106', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'PEN', 'AARETE_DERIVED_FEE_SCHEDULE': 'PEN', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': ''}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9365', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '259.29'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9365', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '259.29', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '259.29', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9366', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '259.29'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9366', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '259.29', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '259.29', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9367', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '364.26'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9367', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '364.26', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '364.26', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9368', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '405.33'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'TOTAL PARENTERAL NUTRITION (TPN) THERAPY S9368', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '405.33', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '405.33', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'SPECIALTY AMINO ACIDS (SEE ABOVE), PER DAY (in addition to Per Diem charge) ', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'TPN therapy in quantities of less than one liter per day shall be coded with S9364 and the rate shall be equal to the rate for S9365.'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'SPECIALTY AMINO ACIDS (SEE ABOVE), PER DAY (in addition to Per Diem charge) ', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'TPN therapy in quantities of less than one liter per day shall be coded with S9364 and the rate shall be equal to the rate for S9365.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'OTHER', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'CURRENT'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PARENTERAL NUTRITION SOLUTION, LIPIDS', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '106% of PEN'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PARENTERAL NUTRITION SOLUTION, LIPIDS', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '106% of PEN', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '106', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'PEN', 'AARETE_DERIVED_FEE_SCHEDULE': 'PEN', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': ''}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ALL OTHER DRUGS NOT PART OF A STANDARD TPN FORMULA: ADDITIONAL TRACE ELEMENTS, ADDITIONAL VITAMINS, DRUGS FOR NON_x0002_NUTRITIONAL PURPOSES ', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '106% of PEN'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ALL OTHER DRUGS NOT PART OF A STANDARD TPN FORMULA: ADDITIONAL TRACE ELEMENTS, ADDITIONAL VITAMINS, DRUGS FOR NON_x0002_NUTRITIONAL PURPOSES ', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '106% of PEN', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '106', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'PEN', 'AARETE_DERIVED_FEE_SCHEDULE': 'PEN', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': ''}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9374', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9374', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9375', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9375', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9376', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9376', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9377', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HYDRATION THERAPY S9377', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, hydration therapy; more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PAIN MANAGEMENT S9325', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $112.59'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PAIN MANAGEMENT S9325', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $112.59', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '112.59', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PAIN MANAGEMENT S9328', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $131.13'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PAIN MANAGEMENT S9328', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $131.13', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '131.13', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CARDIAC THERAPY (e.g. dobutamine, MILRINONE) S9348', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g. dobutamine, milrinone); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $80.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CARDIAC THERAPY (e.g. dobutamine, MILRINONE) S9348', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g. dobutamine, milrinone); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $80.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '80.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOSUPPRESSIVE THERAPY S9490', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, corticosteroid infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $95.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOSUPPRESSIVE THERAPY S9490', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, corticosteroid infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $95.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '95.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOSUPPRESSIVE THERAPY S9490-TF', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, level ii immunosuppressive infusion therapy (e.g. Cyclosporine, Prograf, CellCept, Thymoglobulin, Atgam); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $100.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOSUPPRESSIVE THERAPY S9490-TF', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, level ii immunosuppressive infusion therapy (e.g. Cyclosporine, Prograf, CellCept, Thymoglobulin, Atgam); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $100.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '100.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOSUPPRESSIVE THERAPY S9490-TG', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, level iii immunosuppressive infusion therapy (e.g. Zenapax); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $175.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOSUPPRESSIVE THERAPY S9490-TG', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, level iii immunosuppressive infusion therapy (e.g. Zenapax); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $175.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '175.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTI-EMETIC THERAPY S9351', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, continuous or INTERMITTENT anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $98.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTI-EMETIC THERAPY S9351', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, continuous or INTERMITTENT anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $98.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTI-EMETIC THERAPY S9370', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home therapy, INTERMITTENT anti-emetic injection therapy; administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $98.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTI-EMETIC THERAPY S9370', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home therapy, INTERMITTENT anti-emetic injection therapy; administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $98.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTICOAGULATION THERAPY (e.g. heparin, LMWH, Lovenox) S9336', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, continuous anticoagulant infusion therapy (e.g. heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTICOAGULATION THERAPY (e.g. heparin, LMWH, Lovenox) S9336', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, continuous anticoagulant infusion therapy (e.g. heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTICOAGULATION THERAPY (e.g. heparin, LMWH, Lovenox) S9372', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home therapy; intermittent anticoagulant injection therapy (e.g. heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (do not use this code for flushing of infusion devices with heparin to maintain patency). The rate shall be $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTICOAGULATION THERAPY (e.g. heparin, LMWH, Lovenox) S9372', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home therapy; intermittent anticoagulant injection therapy (e.g. heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (do not use this code for flushing of infusion devices with heparin to maintain patency). The rate shall be $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INTERFERON THERAPY', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy, Interferon; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $35.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INTERFERON THERAPY', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy, Interferon; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $35.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '35.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'GROWTH HORMONE THERAPY S9558', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy; growth hormone, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $35.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'GROWTH HORMONE THERAPY S9558', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy; growth hormone, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $35.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '35.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HEMATOPOIETIC HORMONE THERAPY (e.g. EPOGEN, NEUPOGEN)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home therapy; hematopoietic hormone injection therapy (e.g. erythropoietin, G-CSF, GM- CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $35.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HEMATOPOIETIC HORMONE THERAPY (e.g. EPOGEN, NEUPOGEN)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home therapy; hematopoietic hormone injection therapy (e.g. erythropoietin, G-CSF, GM- CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. The rate shall be $35.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '35.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HORMONAL THERAPY (e.g. LEUPROLIDE, GOSERELIN) CODE: S9560', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy; hormonal therapy (e.g. leuprolide, goserelin), administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $35.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'HORMONAL THERAPY (e.g. LEUPROLIDE, GOSERELIN) CODE: S9560', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy; hormonal therapy (e.g. leuprolide, goserelin), administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $35.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '35.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CHELATION (IRON BINDING) THERAPY CODE: S9355', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $75.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CHELATION (IRON BINDING) THERAPY CODE: S9355', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $75.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '75.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CHEMOTHERAPY CODE: S9329', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $125.83'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'CHEMOTHERAPY CODE: S9329', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $125.83', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '125.83', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'DIURETIC THERAPY CODE: S9361', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $100.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'DIURETIC THERAPY CODE: S9361', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $100.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '100.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'AEROSOLIZED DRUG THERAPY* (e.g. pentamidine) CODE: S9061', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home administration of aerosolized drug therapy (e.g. Pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $60.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'AEROSOLIZED DRUG THERAPY* (e.g. pentamidine) CODE: S9061', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home administration of aerosolized drug therapy (e.g. Pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $60.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '60.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'AEROSOLIZED DRUG THERAPY* (e.g. pentamidine) CODE: NDC', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'ALL AEROSOLIZED THERAPY DRUGS RATE: CMS + 15%'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'AEROSOLIZED DRUG THERAPY* (e.g. pentamidine) CODE: NDC', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'ALL AEROSOLIZED THERAPY DRUGS RATE: CMS + 15%', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'CONTRACT_FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOGLOBULIN THERAPY CODE: S9338', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination; and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $98.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IMMUNOGLOBULIN THERAPY CODE: S9338', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination; and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $98.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'SUBCUTANEOUS IMMUNOGLOBULIN THERAPY (e.g. VIVAGLOBIN®) CODE: S9338', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination; and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $98.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'SUBCUTANEOUS IMMUNOGLOBULIN THERAPY (e.g. VIVAGLOBIN®) CODE: S9338', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination; and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem RATE: $98.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ALPHA-1-PROTEINASE INHIBITOR (e.g. ARALASTT, ZEMAIRA) S9346', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, alpha-1-proteinase inhibitor (e.g. AralastTM); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $98.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ALPHA-1-PROTEINASE INHIBITOR (e.g. ARALASTT, ZEMAIRA) S9346', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, alpha-1-proteinase inhibitor (e.g. AralastTM); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $98.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTI-TUMOR NECROSIS FACTOR (e.g. infliximab, REMICADE) S9359', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g. infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $90.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ANTI-TUMOR NECROSIS FACTOR (e.g. infliximab, REMICADE) S9359', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g. infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $90.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '90.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ABATACEPT THERAPY (e.g. ORENCIA) S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, ABATACEPT; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $119.22'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ABATACEPT THERAPY (e.g. ORENCIA) S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, ABATACEPT; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $119.22', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '119.22', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ENZYME REPLACEMENT THERAPIES S9357', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, enzyme replacement intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $98.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ENZYME REPLACEMENT THERAPIES S9357', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, enzyme replacement intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $98.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '98.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'NATALIZUMAB THERAPY (e.g. TYSABRIR) S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, NATALIZUMAB; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $90.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'NATALIZUMAB THERAPY (e.g. TYSABRIR) S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, NATALIZUMAB; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $90.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '90.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ECULIZUMAB THERAPY (e.g. SOLIRIS®) S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, Eculiezumab; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $90.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'ECULIZUMAB THERAPY (e.g. SOLIRIS®) S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, Eculiezumab; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $90.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '90.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IBANDRONATE THERAPY (e.g. BONIVA®) S9542', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy, IBANDRONATE; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $7.50'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'IBANDRONATE THERAPY (e.g. BONIVA®) S9542', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy, IBANDRONATE; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $7.50', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '7.50', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'NALTREXONE THERAPY (e.g. VIVITROL®) S9542', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy, NALTREXONE; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $7.50'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'NALTREXONE THERAPY (e.g. VIVITROL®) S9542', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home injectable therapy, NALTREXONE; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem. RATE: $7.50', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '7.50', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'HOME INFUSION THERAPY, NOT OTHERWISE CLASSIFIED; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem: $115.30'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED S9379', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'HOME INFUSION THERAPY, NOT OTHERWISE CLASSIFIED; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem: $115.30', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '115.30', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED S9542', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'HOME INJECTABLE THERAPY; NOT OTHERWISE CLASSIFIED; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem: $7.50'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED S9542', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'HOME INJECTABLE THERAPY; NOT OTHERWISE CLASSIFIED; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem: $7.50', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '7.50', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5498', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, catheter care/maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), Per Diem: $9.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5498', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, catheter care/maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), Per Diem: $9.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '9.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5501', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, catheter care/maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem: $11.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5501', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, catheter care/maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem: $11.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '11.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5502', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, catheter care/maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), Per Diem (use this code for interim maintenance of vascular access not currently in use): $70.00'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5502', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, catheter care/maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), Per Diem (use this code for interim maintenance of vascular access not currently in use): $70.00', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Diem', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '70.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5517', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting: $ 100.00 per kit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5517', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting: $ 100.00 per kit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Kit', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '100.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5518', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies necessary for catheter repair: $ 50.00 per kit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5518', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies necessary for catheter repair: $ 50.00 per kit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Kit', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '50.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5520', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion: $ 105.00 per kit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5520', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion: $ 105.00 per kit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Kit', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '105.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5521', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion: $ 105.00 per kit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'INFUSION OR INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED CATHETER CARE & INSERTION SUPPLIES S5521', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': 'Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion: $ 105.00 per kit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Kit', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '105.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion/specialty drug administration, per visit (up to 2 hours) (99601)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 95.00 per visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion/specialty drug administration, per visit (up to 2 hours) (99601)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 95.00 per visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '95.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Each additional hour (List separately in addition to primary procedure) (Use 99602 in conjunction with code 99601) (99602)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 50.00 per hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Each additional hour (List separately in addition to primary procedure) (Use 99602 in conjunction with code 99601) (99602)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 50.00 per hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '50.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion/specialty drug administration, per visit (up to 2 hours) (99601-SS)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$47.50 per visit'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion/specialty drug administration, per visit (up to 2 hours) (99601-SS)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$47.50 per visit', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Per Visit', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '47.50', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Each additional hour (List separately in addition to primary procedure) (Use 99602-SS in conjunction with code 99601-SS) (99602-SS)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$25.00 per hour'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Each additional hour (List separately in addition to primary procedure) (Use 99602-SS in conjunction with code 99601-SS) (99602-SS)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$25.00 per hour', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Hour', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '25.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) (S5522)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 175.00 per procedure'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) (S5522)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 175.00 per procedure', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '175.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, insertion of midline central venous catheter, nursing services only (no supplies or catheter included) (S5523)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 115.00 per procedure'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Home infusion therapy, insertion of midline central venous catheter, nursing services only (no supplies or catheter included) (S5523)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 115.00 per procedure', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '115.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PRE-TRANSPLANT ENVIRONMENTAL ASSESSMENT (96150)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 175.00 per assessment'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'PRE-TRANSPLANT ENVIRONMENTAL ASSESSMENT (96150)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '$ 175.00 per assessment', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'Per Each', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '175.00', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered ASC Services (not including carve-outs listed separately)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '189% of the 2020 CMS ASC Fee Schedule For codes newly added to a more recent CMS ASC fee schedule published after the effective date of this Agreement, the above percentage will be applied to the CMS fee in effect on the date the services were rendered.'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Covered ASC Services (not including carve-outs listed separately)', 'CONTRACT_CARVEOUT_IND': 'N', 'CONTRACT_REIMBURSEMENT_METHOD': '189% of the 2020 CMS ASC Fee Schedule For codes newly added to a more recent CMS ASC fee schedule published after the effective date of this Agreement, the above percentage will be applied to the CMS fee in effect on the date the services were rendered.', 'CONTRACT_LESSER_OF_IND': 'N', 'CONTRACT_GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMBURSEMENT_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE_FOR_FLAT_RATE': 'N/A', 'CONTRACT_REIMBURSEMENT_FEE_RATE': '', 'CONTRACT_REIMBURSEMENT_PERCENT_RATE': '189', 'NOT_TO_EXCEED_IND': 'N', 'CONTRACT_DEFAULT_IND': 'N', 'CONTRACT_FEE_SCHEDULE_DESC': '2020 CMS ASC Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS_ASC', 'CONTRACT_FEE_SCHEDULE_VERSION': '2020', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2020'}]\n", - "{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list (CMS Payment Indicator K2)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '100% of the current CMS ASC Fee Schedule'}\n", - "[{'CONTRACT_FILE_NAME': '2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt', 'CONTRACT_SERVICE_CD_OR_DESC': 'Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list (CMS Payment Indicator K2)', 'CONTRACT_CARVEOUT_IND': 'Y', 'CONTRACT_REIMBURSEMENT_METHOD': '100% of the current CMS ASC Fee Schedule'}]\n" - ] - } - ], + "outputs": [], "source": [ "from src.investment.one_to_n_funcs import get_methodology_breakout\n", "\n", - "reimbursement_primary_answers = labels_df_unique_rows[[\"CONTRACT_FILE_NAME\", \"CONTRACT_SERVICE_CD_OR_DESC\", \"CONTRACT_CARVEOUT_IND\", \"CONTRACT_REIMBURSEMENT_METHOD\"]].to_dict(orient='records')\n", + "reimbursement_primary_answers = labels_df_unique_rows[[\"CONTRACT_FILE_NAME\", \"SERVICE_TERM\", \"CARVEOUT_IND\", \"REIMB_TERM\"]].to_dict(orient='records')\n", "predictions_list = []\n", "\n", "for reimbursement_primary in reimbursement_primary_answers:\n", @@ -876,77 +210,41 @@ }, { "cell_type": "code", - "execution_count": 12, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ - "# Remove rows where 'AARETE_DERIVED_REIMBURSEMENT_METHOD' value is \"Medicare Member Cost Share\"\n", - "predictions_df = predictions_df[predictions_df['AARETE_DERIVED_REIMBURSEMENT_METHOD'] != \"Medicare Member Cost Share\"]\n", + "# Remove rows where 'AARETE_DERIVED_REIMB_METHOD' value is \"Medicare Member Cost Share\"\n", + "predictions_df = predictions_df[predictions_df['AARETE_DERIVED_REIMB_METHOD'] != \"Medicare Member Cost Share\"]\n", "\n", - "# Standardize 'AARETE_DERIVED_REIMBURSEMENT_METHOD' values\n", + "# Standardize 'AARETE_DERIVED_REIMB_METHOD' values\n", "# Copy AWP, ASP, WAC to AARETE_DERIVED_FEE_SCHEDULE column for the corresponding row\n", "medrx_fee_schedule_values = ['AWP', 'ASP', 'WAC']\n", - "predictions_df.loc[predictions_df['AARETE_DERIVED_REIMBURSEMENT_METHOD'].isin(medrx_fee_schedule_values), 'AARETE_DERIVED_FEE_SCHEDULE'] = predictions_df['AARETE_DERIVED_REIMBURSEMENT_METHOD']\n", + "predictions_df.loc[predictions_df['AARETE_DERIVED_REIMB_METHOD'].isin(medrx_fee_schedule_values), 'AARETE_DERIVED_FEE_SCHEDULE'] = predictions_df['AARETE_DERIVED_REIMB_METHOD']\n", "\n", - "# Convert AARETE_DERIVED_REIMBURSEMENT_METHOD values [AWP, ASP, WAC] to 'MedRx'\n", - "predictions_df['AARETE_DERIVED_REIMBURSEMENT_METHOD'] = predictions_df['AARETE_DERIVED_REIMBURSEMENT_METHOD'].replace({'AWP': 'MedRx', 'ASP': 'MedRx', 'WAC': 'MedRx'})" + "# Convert AARETE_DERIVED_REIMB_METHOD values [AWP, ASP, WAC] to 'MedRx'\n", + "predictions_df['AARETE_DERIVED_REIMB_METHOD'] = predictions_df['AARETE_DERIVED_REIMB_METHOD'].replace({'AWP': 'MedRx', 'ASP': 'MedRx', 'WAC': 'MedRx'})" ] }, { "cell_type": "code", - "execution_count": 13, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "data": { - "text/plain": [ - "(353, 15)" - ] - }, - "execution_count": 13, - "metadata": {}, - "output_type": "execute_result" - } - ], + "outputs": [], "source": [ "predictions_df = predictions_df.replace('N/A', '').fillna('')\n", "predictions_df.to_csv('predictions.csv', index=False)\n", "predictions_df = pd.read_csv('predictions.csv')\n", - "predictions_df.drop(\"CONTRACT_FEE_SCHEDULE_VERSION\", axis=1, inplace=True)\n", + "predictions_df.drop(\"FEE_SCHEDULE_VERSION\", axis=1, inplace=True)\n", "\n", "predictions_df.shape" ] }, { "cell_type": "code", - "execution_count": 14, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "Processing 95-3372911; Multiple-Davita Healthcare Partners, Inc.-ICMProviderAgreement_138658.txt\n", - "false_negatives: 14 | false_positives: 14 | true_positives: 31 | accuracy: 0.5254237288135594 | precision: 0.6888888888888889 | recall: 0.6888888888888889 | f1_score: 0.6888888888888889\n", - "\n", - "Processing Custom_2018-09-15 COMM Agmt FE - Bandon Community Health Center dba Coast Community Health Center.txt\n", - "false_negatives: 162 | false_positives: 88 | true_positives: 11 | accuracy: 0.0421455938697318 | precision: 0.1111111111111111 | recall: 0.06358381502890173 | f1_score: 0.08088235294117646\n", - "\n", - "Processing Akron General Health System_Eleventh Amendment_20171001.txt\n", - "false_negatives: 7 | false_positives: 7 | true_positives: 19 | accuracy: 0.5757575757575758 | precision: 0.7307692307692307 | recall: 0.7307692307692307 | f1_score: 0.7307692307692306\n", - "\n", - "Processing Progressive Women's Health, PLLC_Physician Agreement MU.txt\n", - "false_negatives: 20 | false_positives: 10 | true_positives: 10 | accuracy: 0.25 | precision: 0.5 | recall: 0.3333333333333333 | f1_score: 0.4\n", - "\n", - "Processing 2019 01 01 Gulf Coast Division (Agreement_STAR, CHIP, CHIP P, STAR_PLUS) MU.txt\n", - "false_negatives: 17 | false_positives: 19 | true_positives: 8 | accuracy: 0.18181818181818182 | precision: 0.2962962962962963 | recall: 0.32 | f1_score: 0.30769230769230765\n", - "\n", - "Processing 2021-07-15 COMM Agmt FE - Samaritan Health Services MU.txt\n", - "false_negatives: 183 | false_positives: 86 | true_positives: 50 | accuracy: 0.15673981191222572 | precision: 0.36764705882352944 | recall: 0.2145922746781116 | f1_score: 0.2710027100271003\n", - "\n" - ] - } - ], + "outputs": [], "source": [ "precisions = []\n", "recalls = []\n", @@ -984,7 +282,7 @@ " )\n", " comparisons[contract_file_name] = comparison\n", "\n", - " # comparison = evaluate_one_to_n_fields_fuzzy_matching_field_by_field(labels_df_contract, predictions_df_contract, \"CONTRACT_FILE_NAME\", ['CONTRACT_REIMBURSEMENT_METHOD', 'CONTRACT_FEE_SCHEDULE_DESC'])\n", + " # comparison = evaluate_one_to_n_fields_fuzzy_matching_field_by_field(labels_df_contract, predictions_df_contract, \"CONTRACT_FILE_NAME\", ['REIMB_TERM', 'FEE_SCHEDULE'])\n", "\n", " precisions.append(comparison[\"precision\"])\n", " recalls.append(comparison[\"recall\"])\n", @@ -1003,25 +301,9 @@ }, { "cell_type": "code", - "execution_count": 15, + "execution_count": null, "metadata": {}, - "outputs": [ - { - "name": "stdout", - "output_type": "stream", - "text": [ - "Median accuracy across 6 contracts at match threshold 90: 0.2159\n", - "Median precision across 6 contracts at match threshold 90: 0.4338\n", - "Median recall across 6 contracts at match threshold 90: 0.3267\n", - "Mean accuracy across 6 contracts at match threshold 90: 0.2886\n", - "Mean precision across 6 contracts at match threshold 90: 0.4491\n", - "Mean recall across 6 contracts at match threshold 90: 0.3919\n", - "Grand accuracy across 6 contracts at match threshold 90: 0.1706 (total true positives: 129, total false positives: 224, total false negatives: 403)\n", - "Grand precision across 6 contracts at match threshold 90: 0.3654 (total true positives: 129, total false positives: 224)\n", - "Grand recall across 6 contracts at match threshold 90: 0.2425 (total true positives: 129, total false negatives: 403)\n" - ] - } - ], + "outputs": [], "source": [ "from statistics import median, mean\n", "\n", @@ -1038,7 +320,7 @@ }, { "cell_type": "code", - "execution_count": 15, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ @@ -1047,7 +329,7 @@ }, { "cell_type": "code", - "execution_count": 16, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ diff --git a/fieldExtraction/src/testbed/test_one_to_n.ipynb b/fieldExtraction/src/testbed/test_one_to_n.ipynb index 46c6542..ecaccde 100644 --- a/fieldExtraction/src/testbed/test_one_to_n.ipynb +++ b/fieldExtraction/src/testbed/test_one_to_n.ipynb @@ -13,7 +13,7 @@ }, { "cell_type": "code", - "execution_count": 2, + "execution_count": null, "metadata": {}, "outputs": [], "source": [ @@ -23,7 +23,7 @@ "# You'll need access to the `investment_samples` sharepoint folder\n", "labels_files = os.listdir(\"Reimbursement Field Files\")\n", "\n", - "fields = [\"CONTRACT_SERVICE_CD_OR_DESC\", \"CONTRACT_REIMBURSEMENT_METHOD\"] # comparison fields" + "fields = [\"SERVICE_TERM\", \"REIMB_TERM\"] # comparison fields" ] }, { @@ -293,7 +293,7 @@ "type": "float" }, { - "name": "FACILITY_GROUPER_CD", + "name": "GROUPER_CD", "rawType": "object", "type": "unknown" }, @@ -328,7 +328,7 @@ "type": "unknown" }, { - "name": "FACILITY_GROUPER_DESC", + "name": "GROUPER_CD_DESC", "rawType": "object", "type": "unknown" }, @@ -428,62 +428,62 @@ "type": "unknown" }, { - "name": "CONTRACT_FACILITY_STOP_LOSS_TERMS", + "name": "CONTRACT_STOP_LOSS_TERMS", "rawType": "object", "type": "unknown" }, { - "name": "FACILITY_STOP_LOSS_FIXED_LOSS_THRESHOLD", + "name": "STOP_LOSS_FIXED_LOSS_THRESHOLD", "rawType": "object", "type": "unknown" }, { - "name": "FACILITY_STOP_LOSS_PERCENT_RATE_ON_EXCESS_CHARGES", + "name": "STOP_LOSS_PERCENT_RATE_ON_EXCESS_CHARGES", "rawType": "float64", "type": "float" }, { - "name": "FACILITY_STOP_LOSS_DAILY_MAXIMUM", + "name": "STOP_LOSS_DAILY_MAXIMUM", "rawType": "float64", "type": "float" }, { - "name": "FACILITY_STOP_LOSS_EXCLUSION_CD", + "name": "STOP_LOSS_EXCLUSION_CD", "rawType": "object", "type": "unknown" }, { - "name": "FACILITY_STOP_LOSS_EXCLUSION_DESC", + "name": "STOP_LOSS_EXCLUSION_DESC", "rawType": "object", "type": "unknown" }, { - "name": "CONTRACT_FACILITY_OUTLIER_TERMS", + "name": "CONTRACT_OUTLIER_TERMS", "rawType": "object", "type": "unknown" }, { - "name": "FACILITY_OUTLIER_FIXED_LOSS_THRESHOLD", + "name": "OUTLIER_FIXED_LOSS_THRESHOLD", "rawType": "object", "type": "unknown" }, { - "name": "FACILITY_OUTLIER_PERCENT_RATE_ON_EXCESS_CHARGES", + "name": "OUTLIER_PERCENT_RATE_ON_EXCESS_CHARGES", "rawType": "float64", "type": "float" }, { - "name": "FACILITY_OUTLIER_MAXIMUM", + "name": "OUTLIER_MAXIMUM", "rawType": "object", "type": "unknown" }, { - "name": "FACILITY_OUTLIER_EXCLUSION_CD", + "name": "OUTLIER_EXCLUSION_CD", "rawType": "float64", "type": "float" }, { - "name": "FACILITY_OUTLIER_EXCLUSION_DESC", + "name": "OUTLIER_EXCLUSION_DESC", "rawType": "float64", "type": "float" }, @@ -5278,7 +5278,7 @@ }, { "cell_type": "code", - "execution_count": 6, + "execution_count": null, "metadata": {}, "outputs": [ { @@ -5292,17 +5292,17 @@ } ], "source": [ - "for fn in labels_df['CONTRACT_FILE_NAME'].unique():\n", - " n_sources = len(labels_df[labels_df['CONTRACT_FILE_NAME'] == fn]['data_source'].unique())\n", + "for fn in labels_df['FILE_NAME'].unique():\n", + " n_sources = len(labels_df[labels_df['FILE_NAME'] == fn]['data_source'].unique())\n", " if n_sources != 1:\n", " # Remove rows from docziAI that have a separate data source\n", - " labels_df = labels_df[~((labels_df['CONTRACT_FILE_NAME'] == fn) & (labels_df['data_source'] == 'DocziAI_2-12.xlsx'))]\n", + " labels_df = labels_df[~((labels_df['FILE_NAME'] == fn) & (labels_df['data_source'] == 'DocziAI_2-12.xlsx'))]\n", " print(fn, n_sources)" ] }, { "cell_type": "code", - "execution_count": 7, + "execution_count": null, "metadata": {}, "outputs": [ { @@ -5315,16 +5315,16 @@ } ], "source": [ - "unique_contracts_labels = labels_df['CONTRACT_FILE_NAME'].nunique()\n", + "unique_contracts_labels = labels_df['FILE_NAME'].nunique()\n", "print(f\"There are {unique_contracts_labels} unique contract file names in the labels dataframe.\")\n", "\n", - "unique_contracts_predictions = predictions_df['CONTRACT_FILE_NAME'].nunique()\n", + "unique_contracts_predictions = predictions_df['FILE_NAME'].nunique()\n", "print(f\"There are {unique_contracts_predictions} unique contract file names in the predictions dataframe.\")" ] }, { "cell_type": "code", - "execution_count": 8, + "execution_count": null, "metadata": {}, "outputs": [ { @@ -5559,13 +5559,13 @@ "total_false_negatives = 0\n", "\n", "\n", - "for contract_file_name in labels_df[\"CONTRACT_FILE_NAME\"].unique():\n", + "for contract_file_name in labels_df[\"FILE_NAME\"].unique():\n", " print(f\"Processing {contract_file_name}\")\n", " labels_df_contract = labels_df[\n", - " labels_df[\"CONTRACT_FILE_NAME\"] == contract_file_name\n", + " labels_df[\"FILE_NAME\"] == contract_file_name\n", " ]\n", " predictions_df_contract = predictions_df[\n", - " predictions_df[\"CONTRACT_FILE_NAME\"] == contract_file_name\n", + " predictions_df[\"FILE_NAME\"] == contract_file_name\n", " ]\n", " if len(labels_df_contract) == 0:\n", " print(f\"Contract {contract_file_name} not found in labels.\\n\")\n", @@ -5578,13 +5578,13 @@ " comparison = evaluate_one_to_n_fields_fuzzy_matching_field_by_field(\n", " labels_df_contract,\n", " predictions_df_contract,\n", - " \"CONTRACT_FILE_NAME\",\n", + " \"FILE_NAME\",\n", " fields,\n", " thresholds=MATCH_THRESHOLD\n", " )\n", " comparisons[contract_file_name] = comparison\n", "\n", - " # comparison = evaluate_one_to_n_fields_fuzzy_matching_field_by_field(labels_df_contract, predictions_df_contract, \"CONTRACT_FILE_NAME\", ['CONTRACT_REIMBURSEMENT_METHOD', 'CONTRACT_FEE_SCHEDULE_DESC'])\n", + " # comparison = evaluate_one_to_n_fields_fuzzy_matching_field_by_field(labels_df_contract, predictions_df_contract, \"FILE_NAME\", ['REIMB_TERM', 'FEE_SCHEDULE'])\n", "\n", " precisions.append(comparison[\"precision\"])\n", " recalls.append(comparison[\"recall\"])\n", @@ -5796,7 +5796,7 @@ ], "metadata": { "kernelspec": { - "display_name": "doczy-smart-chunking-M88SnQcW-py3.12", + "display_name": "doczy-smart-chunking-BxQLr-8H-py3.12", "language": "python", "name": "python3" }, @@ -5810,7 +5810,7 @@ "name": "python", "nbconvert_exporter": "python", "pygments_lexer": "ipython3", - "version": "3.12.7" + "version": "3.12.3" } }, "nbformat": 4, diff --git a/fieldExtraction/tests/one_to_n_test.py b/fieldExtraction/tests/one_to_n_test.py index a1ee1c9..5acf737 100644 --- a/fieldExtraction/tests/one_to_n_test.py +++ b/fieldExtraction/tests/one_to_n_test.py @@ -35,18 +35,18 @@ class TestOneToN(unittest.TestCase): mock_get_exhibit_header.assert_called_once_with(exhibit_text, filename) mock_prompt_dynamic.assert_called() mock_process_dynamic.assert_called() - self.assertEqual(result, {"field1": "value1", "field2": "value2", "EXHIBIT_NAME": "Exhibit Header"}) + self.assertEqual(result, {"field1": "value1", "field2": "value2", "EXHIBIT_TITLE": "Exhibit Header"}) def test_combine_exhibit_and_reimbursement(self): - exhibit_level_answers = {"EXHIBIT_NAME": "Exhibit Header", "field1": "value1"} + exhibit_level_answers = {"EXHIBIT_TITLE": "Exhibit Header", "field1": "value1"} reimbursement_level_answers = [{"field2": "value2"}, {"field3": "value3"}] tin_npi_answers = {} result = combine_one_to_n_answers(exhibit_level_answers, reimbursement_level_answers, tin_npi_answers) self.assertEqual(result, [ - {"field2": "value2", "EXHIBIT_NAME": "Exhibit Header", "field1": "value1"}, - {"field3": "value3", "EXHIBIT_NAME": "Exhibit Header", "field1": "value1"} + {"field2": "value2", "EXHIBIT_TITLE": "Exhibit Header", "field1": "value1"}, + {"field3": "value3", "EXHIBIT_TITLE": "Exhibit Header", "field1": "value1"} ])