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Feature/postprocessing

* tests

* passtest

* fixshorttests

* mosttests

* improvingbasedockerfile

* testspeeds

* testing

* host

* canparallel

* clean

* passfullsuite

* singlepagemax

* test

* findfeatures

* findstables

* tbls

* tablestoo

* tablestoo

* lateraltests

* tableloc

* cleanup

* inlinetable

* childids

* cleanup

* tests
This commit is contained in:
Michael McGuinness
2025-04-22 14:40:16 +00:00
parent edc50c7510
commit fee71e7740
404 changed files with 211048 additions and 2820 deletions
Download Patch File Download Diff File Expand all files Collapse all files
assets/sampleGeneration/generated/helloWorld.gen
+238 -182
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@@ -1,192 +1,248 @@
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assets/sampleOne/cnc_01-06.txt
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@@ -1,134 +1,130 @@
Document Index
AMENDMENT NUMBER ONE 1PARTICIPATING PROVIDER AGREEMENT 1
Attachment A: Medicaid 3
EXHIBIT 2 3COMPENSATION SCHEDULE 3PROFESSIONAL SERVICES 3
Additional Provisions: 3
Definitions: 4
Start of Page No. = 1
AMENDMENT NUMBER ONE
PARTICIPATING PROVIDER AGREEMENT
This Amendment Number One ("Amendment") is entered into as of December 1. 2019 by and between Dummy
HealthCare Inc. ("Health Plan") and Picture, LLC Novelty Pharmacy
("Provider"), collectively reterred to
HealthCare Inc. ("Health Plan") and Picture. LLC Novelty Pharmacy
("Provider"). collectively referred to
herein as the "Parties".
WHEREAS, Health Plan and Provider have previously entered into a Participating Provider Agreement (the
"Agreement") effective as of January 1. 2017 (defined in the Agreement as the "Effective Date"); and
WITEREAS, the Parties desire to amend the Agreement;
NOW THEREFORE, in consideration of the promises and mutual covenants herein contained. the Parties agree as
"Agreement") effective as of January 1. 2017 (defined in the Agreement as the "Effective Date"). and
WHEREAS. the Parties desire to amend the Agreement:
NOW THEREFORE in consideration of the promises and mutual covenants herein contained the Parties agree as
follows:
1.
Attachment A: Medicaid Exhibit 2 Compensation Schedule Professional Services shall be added
and
incorporated into the Agreement as shown by the attached.
2. All other terms and conditions of the Agreement and any amendments thereto, if any, shall remain in full
force and effect. If the terms of this Amendment conflict with any of the terms of the Agreement. the terms
I. Attachment A: Medicaid Exhibit 2 Compensation Schedule Professional Services shall be added and
incorporated into the Agreement as shown by the attached
2. All other terms and conditions of the Agreement and any amendments thereto. if any. shall remain in full
force and effect If the terms of this Amendment conflict with any of the terms of the Agreement. the terms
of this Amendment shall prevail.
PPA (NE) - All Products 03/30/16
Page I of 4
PPA (NF All Products 03/30
Page of 4
Start of Page No. = 2
IN WITNESS WHEREOF. the Parties hereto have executed and delivered this
IN WITNESS WHEREOF the Parties hereto have executed and delivered this
Amendment as of the date first set forth above.
HEALTH PLAN:
PROVIDER:
Dummy HealthCare Inc.
Authorization
Benth
PROVIDER
LLC Novelty Pharmacy
Authorized Signature
Authorized Signature
Bank
Mark Chappman
Jake Parelta
Printed Name:
Printed Name:
Title: PRocedent
"Printed Name:
Title: RPinCharge
Date: 11/19/9
Date: 11/15/19
ECM #: 112233
Tax ID Number: 12-3456789
Tax ID Number 12-3456789
State Medicaid Number: 0123456789
National Provider Identifier: 123456789
Mark Chappman
Printed Name:
Title: PRocedent
Date: 11/19/19
ECM #: 112233
PPA (NE) - All Products 03/30/16
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This page has 2 signature.
Start of Page No. = 3
Attachment A: Medicaid
EXHIBIT 2
COMPENSATION SCHEDULE
PROFESSIONAL SERVICES
Picture,
LLC Novelty Pharmacy
Picture, LLC Novelty Pharmacy
This compensation schedule ("Compensation Schedule") sets forth the maximum reimbursement amounts for
Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the
Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product Where the
Contracted Provider's tax identification number ("TIN") has been designated by the Payor as subject to this
Compensation Schedule. Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by
Compensation Schedule Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by
the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and
this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set
forth herein less all applicable Cost-Sharing Amounts. All capitalized terms used in this Compensation Schedule
shall have the meanings set forth in the Agreement, the applicable Product Attachment. or the Definitions section set
this Compensation Schedule Payment under this Compensation Schedule shall consist of the Allowed Amount as set
forth herein less all applicable Cost-Sharing Amounts All capitalized terms used in this Compensation Schedule
shall have the meanings set forth in the Agreement. the applicable Product Attachment or the Definitions section set
forth at the end of this Compensation Schedule.
The maximum compensation for professional Covered Services rendered to a Covered Person shall be the "Allowed
Amount." Except as otherwise provided in this Compensation Schedule. the Allowed Amount for professional
Covered Services is the lesser of: (i) Allowable Charges; or (ii) one hundred percent (100%) of the Payor's Medicaid
fee schedule.
fee schedule
Additional Provisions:
1.
Code Change Updates. Payor utilizes nationally recognized coding structures (including. without limitation,
revenue codes, CPT codes, HCPCS codes, ICD codes, national drug codes, ASA relative values, etc., or their
successors) for basic coding and descriptions of the services rendered. Updates to billing-related codes shall
Code Change Updates Payor utilizes nationally recognized coding structures (including without limitation,
revenue codes CPT codes. HCPCS codes, ICD codes. national drug codes. ASA relative values etc., or their
successors) for basic coding and descriptions of the services rendered Updates to billing-related codes shall
become effective on the date ("Code Change Effective Date") that is the later of: (i) the first day of the month
following sixty (60) days after publication by the governmental agency having authority over the applicable
Product of such governmental agency's acceptance of such code updates, (ii) the effective date of such code
Product of such governmental agency's acceptance of such code updates. (ii) the effective date of such code
updates as determined by such governmental agency or (iii) if a date is not established by such governmental
agency or the applicable Product is not regulated by such governmental agency. the date that changes are made
to nationally recognized codes. Such updates may include changes to service groupings. Claims processed prior
to the Code Change Effective Date shall not be reprocessed to reflect any such code updates.
2.
Fee Change Updates. Updates to the fee schedule shall become effective on the effective date of such fee
Fee Change Updates Updates to the fee schedule shall become effective on the effective date of such fee
schedule updates. as determined by the Payor ("Fee Change Effective Date"). The date of implementation of any
fee schedule updates. i.e. the date on which such fee change is first used for reimbursement ("Fee Change
Implementation Date"). shall be the later of: (i) the first date on which Payor is reasonably able to implement the
update in the claims payment system; or (ii) the Fee Change Effective Date. Claims processed prior to the Fee
Change implementation Date shall not be reprocessed to reflect any updates to such fee schedule. even if service
update in the claims payment system; or (ii) the Fee Change Effective Date Claims processed prior to the Fee
Change Implementation Date shall not be reprocessed to reflect any updates to such fee schedule. even if service
was provided after the Fee Change Effective Date.
3.
Modifier, Unless specifically indicated otherwise, fee amounts listed in the fee schedule represent global fees
and may be subject to reductions based on appropriate Modifier (for example, professional and technical
modifiers). As used in the previous sentence, "global fees" refers to services billed without a Modifier, for which
3. Modifier Unless specifically indicated otherwise fee amounts listed in the fee schedule represent global fees
and may be subject to reductions based on appropriate Modifier (for example. professional and technical
modifiers) As used in the previous contence. "global fees" refers to services billed without a Modifier. for which
the fee amount includes both the professional component and the technical component. Any Cost-Sharing
Amounts that the Covered Person is responsible to pay under the Coverage Agreement will be subtracted from
the Allowed Amount in determining the amount to be paid.
4.
Anesthesia Modifier Pricing Rules. The dollar amount that will be used in the calculation of time-based and non-
4. Anesthesia Modifier Pricing Rules, The dollar amount that will be used in the calculation of time-based and non-
time based anesthesia management fees in accordance with the anesthesia payment policy. Unless specifically
PPA (NE) - All Products 03/30/16
Page 3 of 4
PPA (NE) All Products 03/30/16
Page of 4
Start of Page No. = 4
stated otherwise, the anesthesia conversion factor indicated is fixed and will not change. The anesthesia
conversion factor is based on an anesthesia time unit value of 15 minutes.
5. Payment for Multiple Procedures. Where multiple outpatient surgical or scope procedures performed on a
Covered Person during a single occasion of surgery, reimbursement will be as follows: i) the procedure for which
stated otherwise. the anesthesia conversion factor indicated is fixed and will not change. The anesthesia
conversion factor is based on an anesthesia time unit value of 15 minutes
5. Payment for Multiple Procedures Where multiple outpatient surgical or scope procedures performed on a
Covered Person during a single occasion of surgery. reimbursement will be as follows: i) the procedure for which
the Allowed Amount under this Compensation Schedule is greatest will be reimbursed at one hundred percent
(100%) of such Allowed Amount; and ii) the other procedures under this Compensation Schedule will each be
reimbursed at fifty percent (50%) of such Allowed Amounts..
6. Place of Service Pricing Rules. This fee schedule follows CMS guidelines for determining when services are
(100%) of such Allowed Amount: and ii) the other procedures under this Compensation Schedule will each be
reimbursed at fifty percent (50%) of such Allowed Amounts.
6
Place of Service Pricing Rules This fee schedule follows CMS guidelines for determining when services are
priced at the facility or non-facility fee schedule (with the exception of services performed at Ambulatory Surgery
Centers. POS 24, which will be priced at the facility fee schedule).
7. Payment under this Compensation Schedule. All payments under this Compensation Schedule are subject to the
terms and conditions set forth in the Agreement. the Provider Manual and any applicable billing manual.
Centers. POS 24. which will be priced at the facility fee schedule).
7. Payment under this Compensation Schedule All payments under this Compensation Schedule are subject to the
terms and conditions set forth in the Agreement. the Provider Manual and any applicable billing manual
Definitions:
1. Allowed Amount means the amount designated in this Compensation Schedule as the maximum amount payable
to a Contracted Provider for any particular Covered Service provided to any particular Covered Person, pursuant
to this Agreement or its Attachments.
2. Allowable Charges means a Contracted Provider's billed charges for services that qualify as Covered Services.
3. Cost-Sharing Amounts means any amounts payable by a Covered Person. such as copayments. cost-sharing,
coinsurance, deductibles or other amounts that are the Covered Person's financial responsibility under the
applicable Coverage Agreement. if applicable.
PPA (NE) - All Products 03/30/16
Page 4 of 4
to this Agreement or its Attachments
2. Allowable Charges means a Contracted Provider's billed charges for services that qualify as Covered Services
3. Cost-Sharing Amounts means any amounts payable by a Covered Person. such as copayments. cost-sharing
coinsurance deductibles or other amounts that are the Covered Person's financial responsibility under the
applicable Coverage Agreement. if applicable
PPA (NE All Products 03/30/16
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assets/sampleOne/generated/hn_0109.gen
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assets/sampleOne/hn_0109.txt
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@@ -1,46 +1,35 @@
Document Index
EXHIBIT A-1 2
COMMERCIAL BENEFIT PROGRAMS 2
DIRECT NETWORK FEE-FOR-SERVICE 2RATE EXHIBIT 2
MEDICARE ADVANTAGE PROGRAM 3DIRECT NETWORK FEE-FOR-SERVICE 3RATE EXHIBIT 3
I. Payment Rates 3
MEDI-CAL BENEFIT PROGRAM 4DIRECT NETWORK FEE-FOR-SERVICE 4RATE EXHIBIT 4
Start of Page No. = 1
7.14
Status as Independent Entities. None of the provisions of this Agreement is intended to create,
nor
shall be deemed or construed to create any relationship between Provider and All Health or a Payor other than
7.14 Status as Independent Entities. None of the provisions of this Agreement is intended to create,
nor shall be deemed or construed to create any relationship between Provider and All Health or a Payor other than
that of independent entities contracting with each other solely for the purpose of effecting the provisions of this
Agreement. Neither Provider nor All Health /Payor, nor any of their respective agents, employees or representatives
shall be construed to be the agent, employee or representative of the other.
Agreement Neither Provider nor All Health /Payor. nor any of their respective agents, employees or representatives
shall be construed to be the agent employee or representative of the other
7.15
Addenda. Each Addendum to this Agreement is made a part of this Agreement as though set
forth fully herein. Any provision of an Addendum that is in conflict with any provision of this Agreement shall take
Addenda Each Addendum to this Agreement is made a part of this Agreement as though set
forth fully herein Any provision of an Addendum that is in conflict with any provision of this Agreement shall take
precedence and supersede the conflicting provision of this Agreement with respect to the subject matter of the
Addendum.
7.16
Calculation of Time. The parties agree that for purposes of calculating time under this
Agreement, any time period of less than ten (10) days shall be deemed to refer to business days and any time period
Addendum
7.16 Calculation of Time. The parties agree that for purposes of calculating time under this
Agreement any time period of less than ten (10) days shall be deemed to refer to business days and any time period
of ten (10) days or more shall be deemed to refer to calendar days unless the term "business" precedes the term
"days".
"days"
7.17
Waiver of Breach. The waiver of any breach of this Agreement by either party shall not
Waiver of Breach The waiver of any breach of this Agreement by either party shall not
constitute a continuing waiver of any subsequent breach of either the same or any other provision(s) of this
Agreement. Further, any such waiver shall not be construed to be a waiver on the part of such party to enforce strict
compliance in the future and to exercise any right or remedy related thereto.
Agreement Further, any such waiver shall not be construed to be a waiver on the part of such party to enforce strict
compliance in the future and to exercise any right or remedy related thereto
THIS CONTRACT CONTAINS A BINDING ARBITRATION CLAUSE, WHICH MAY BE ENFORCED
BY THE PARTIES.
IN WITNESS WHEREOF, the parties have executed this Agreement.
BY THE PARTIES
IN WITNESS WHEREOF the parties have executed this Agreement
PROVIDER
ALL HEALTH
Smoke
Smith
Signature
Health Net Signature
Peanth
Harvey
DUONG M.S.
DUONG MS
Steve Carrol
Print Name
Print Name
@@ -48,7 +37,7 @@ MEDICAL DIRECTOR
VP Provider Network Management & Strategy
Title
Title
Dummy Group Name, Inc.
Dummy Group Name Inc.
Group Name (If Applicable)
Date
3/28/2011
@@ -59,34 +48,34 @@ Effective Date
2/2/2011
Date
California Provider Participation Agreement
18
Fee-For-Service Direct Network Template
For-Service Direct Network Template
HN-DN-PPA-11-03-2010
18
This page has 2 signature.
Start of Page No. = 2
EXHIBIT A-1
COMMERCIAL BENEFIT PROGRAMS
DIRECT NETWORK FEE-FOR-SERVICE
RATE EXHIBIT
Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E.
All Health or Payor shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary
Covered Services delivered under commercial Benefit Programs pursuant to this Addendum, the lesser of: (i) the rates
listed below, or (ii) 100% of Provider's billed charges.
Covered Services delivered under commercial Benefit Programs pursuant to this Addendum, the lesser of (i) the rates
listed below. or (ii) 100% of Provider's billed charges.
-------Table Start--------
[["Category of Service","Compensation"],["Covered Services delivered or arranged by Provider. excluding Laboratory services","95% of CMS Allowable"],["Anesthesia Services when provided by an Anesthesiologist or Certified Registered Nurse Anesthetist (American Society of Anesthesiology (ASA) unit scale)","$39 ASA unit"],["Medical/Surgical Services by an Anesthesiologist or Certified Registered Nurse Anesthetist","95% of CMS Allowable"],["Laboratory Services performed in Provider or Professional Provider office","95% of CMS Allowable"],["Pharmaceuticals","95% of the Average Wholesale Price (AWP)"],["OB Services - CPT 59400: Global Obstetric care with vaginal delivery - CPT 59510: Global Obstetric care with cesarean delivery - CPT 59610: Vaginal Delivery after previous cesarean delivery - CPT 59618: Attempted vaginal delivery, resulting in cesarean","$1,700.00 $1,700.00 $1,700.00 $1,700.00"],["Immunizations","95% of the Average Wholesale Price (AWP) as determined by Health Net."],["General Health Panel - CPT 80050: General Health Panel CPT 80055: Obstetric Panel","$20.00 $15.00"],["By Report (BR) Procedures, Procedures not Listed and Procedures with Relativities not Established","75% of billed charges for Covered Services"]]
-------Table End--------
California Provider Participation Agreement
22
Fee-For-Service Direct Network Template
HN-DN-PPA-11-03-2010
22
-------Table Start--------
7436be95-25d1-41ad-9abb-1d9e85b85440
[['Category of Service', 'Compensation'], ['Covered Services delivered or arranged by Provider, excluding Laboratory services', '95% of CMS Allowable'], ['Anesthesia Services when provided by an Anesthesiologist or Certified Registered Nurse Anesthetist (American Society of Anesthesiology (ASA) unit scale)', '$39 / ASA unit'], ['Medical/Surgical Services by an Anesthesiologist or Certified Registered Nurse Anesthetist', '95% of CMS Allowable'], ['Laboratory Services performed in Provider or Professional Provider office', '95% of CMS Allowable'], ['Pharmaceuticals', '95% of the Average Wholesale Price (AWP)'], ['OB Services - CPT 59400: Global Obstetric care with vaginal delivery - CPT 59510: Global Obstetric care with cesarean delivery - CPT 59610: Vaginal Delivery after previous cesarean delivery - CPT 59618: Attempted vaginal delivery, resulting in cesarean', '$1,700.00 $1,700.00 $1,700.00 $1,700.00'], ['Immunizations', '95% of the Average Wholesale Price (AWP) as determined by Health Net.'], ['General Health Panel - CPT 80050: General Health Panel - CPT 80055: Obstetric Panel', '$20.00 $15.00'], ['By Report (BR) Procedures, Procedures not Listed and Procedures with Relativities not Established', '75% of billed charges for Covered Services']]
DIRECT NETWORK FEE-FOR-SERVICE RATE EXHIBIT
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Start of Page No. = 3
EXHIBIT B-1
MEDICARE ADVANTAGE PROGRAM
DIRECT NETWORK FEE-FOR-SERVICE
@@ -95,20 +84,18 @@ I. Payment Rates
Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
All Health shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary Covered
Services delivered under Medicare Advantage Benefit Programs pursuant to this Addendum, the lesser of: (i) the rates
listed below, or (ii) 100% of Provider's billed charges.
California Provider Participation Agreement
27
Fee-For-Service Direct Network Template
HN-DN-PPA-11-03-2010
listed below, or (ii) 100% of Provider's billed charges
-------Table Start--------
[['Category of Service', 'Compensation'], ['Covered Services delivered or arranged by Provider', '100% of CMS Allowable'], ['General Health Panel - CPT 80050: General Health Panel - CPT 80055: Obstetric Panel', '$20.00 $15.00'], ['By Report (BR) Procedures, Procedures not Listed and Procedures with Relativities not Established', '75% of billed charges for Covered Services']]
None
[["Category of Service","Compensation"],["Covered Services delivered or arranged by Provider","100% of CMS Allowable"],["General Health Panel",""],["- CPT 80050 General Health Panel","$20.00"],["- CPT 80055: Obstetric Panel","$15.00"],["By Report (BR) Procedures. Procedures not Listed and Procedures with Relativities not Established","75% of billed charges for Covered Services"]]
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California Provider Participation Agreement
Fee-Fer-Service Direct Network Template
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27
Start of Page No. = 4
EXHIBIT C-1
MEDI-CAL BENEFIT PROGRAM
DIRECT NETWORK FEE-FOR-SERVICE
@@ -118,8 +105,10 @@ All Health shall pay and Provider shall accept as payment in full for non-capita
Services delivered pursuant to this Addendum, the lesser of: 100% of the State of California Medi-Cal Fee Schedule
rates in effect at the time of service, subject to any adjustments made by the State of California under the applicable
Medi-Cal Fee-For-Service Program; (ii) Fee-for-service rates for the commercial Benefit Program set forth in
Addendum A, Exhibit A-1; or (iii) Provider's billed charges.
Addendum A. Exhibit A-1: or (iii) Provider's billed charges.
California Provider Participation Agreement
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Fee-For-Service Direct Network Template
HN-DN-PPA-11-03-2010
HN-DN-PPA-11-03-2010
34