@divmain/jdm-asm 0.2.0 → 0.2.3

package/test-data/zen-reference/graphs/insurance-prior-authorization.json

@@ -1,467 +0,0 @@
-{
-  "tests": [
-    {
-      "input": {
-        "patientInfo": {
-          "insuranceType": "Commercial"
-        },
-        "diagnosisCodes": [
-          "M54.5",
-          "M51.26"
-        ],
-        "serviceType": "Imaging",
-        "serviceDetails": {
-          "code": "70551",
-          "cost": 1200,
-          "isEmergency": false
-        }
-      },
-      "output": {
-        "reason": "Advanced imaging requires prior authorization",
-        "requiresAuthorization": true,
-        "timestamp": 1755622502
-      }
-    }
-  ],
-  "nodes": [
-    {
-      "type": "inputNode",
-      "content": {
-        "schema": "{\n  \"type\": \"object\",\n  \"properties\": {\n    \"patientInfo\": {\n      \"type\": \"object\",\n      \"properties\": {\n        \"insuranceType\": {\n          \"type\": \"string\",\n          \"enum\": [\"Medicaid\", \"Medicare\", \"Commercial\"]\n        }\n      }\n    },\n    \"diagnosisCodes\": {\n      \"type\": \"array\",\n      \"items\": {\n        \"type\": \"string\"\n      }\n    },\n    \"serviceType\": {\n      \"type\": \"string\",\n      \"enum\": [\"Medication\", \"Procedure\", \"Equipment\", \"Imaging\"]\n    },\n    \"serviceDetails\": {\n      \"type\": \"object\",\n      \"properties\": {\n        \"code\": {\n          \"type\": \"string\"\n        },\n        \"cost\": {\n          \"type\": \"number\"\n        },\n        \"isEmergency\": {\n          \"type\": \"boolean\"\n        }\n      }\n    }\n  }\n}"
-      },
-      "id": "inputNode",
-      "name": "request",
-      "position": {
-        "x": 110,
-        "y": 161.5
-      }
-    },
-    {
-      "type": "switchNode",
-      "content": {
-        "hitPolicy": "first",
-        "statements": [
-          {
-            "id": "s1",
-            "condition": "patientInfo.insuranceType == 'Medicaid'",
-            "isDefault": false
-          },
-          {
-            "id": "s2",
-            "condition": "patientInfo.insuranceType == 'Medicare'",
-            "isDefault": false
-          },
-          {
-            "id": "s3",
-            "condition": "patientInfo.insuranceType == 'Commercial'",
-            "isDefault": false
-          },
-          {
-            "id": "s4",
-            "condition": "",
-            "isDefault": true
-          }
-        ]
-      },
-      "id": "insuranceTypeCheck",
-      "name": "Insurance Type Check",
-      "position": {
-        "x": 430,
-        "y": 161.5
-      }
-    },
-    {
-      "type": "decisionTableNode",
-      "content": {
-        "hitPolicy": "first",
-        "rules": [
-          {
-            "_id": "r1",
-            "i1": "'Medication'",
-            "i2": "> 200",
-            "o1": "true",
-            "o2": "'High-cost medication requires prior authorization'"
-          },
-          {
-            "_id": "r2",
-            "i1": "'Procedure'",
-            "i2": "> 500",
-            "o1": "true",
-            "o2": "'High-cost procedure requires prior authorization'"
-          },
-          {
-            "_id": "r3",
-            "i1": "'Imaging'",
-            "i2": "",
-            "o1": "true",
-            "o2": "'All imaging services require prior authorization'"
-          },
-          {
-            "_id": "r4",
-            "i1": "'Equipment'",
-            "i2": "> 300",
-            "o1": "true",
-            "o2": "'DME over threshold requires prior authorization'"
-          },
-          {
-            "_id": "r5",
-            "i1": "",
-            "i2": "",
-            "o1": "false",
-            "o2": "'Standard service does not require prior authorization'"
-          }
-        ],
-        "inputs": [
-          {
-            "id": "i1",
-            "name": "Service Type",
-            "field": "serviceType"
-          },
-          {
-            "id": "i2",
-            "name": "Cost",
-            "field": "serviceDetails.cost"
-          }
-        ],
-        "outputs": [
-          {
-            "id": "o1",
-            "name": "Requires Authorization",
-            "field": "requiresAuthorization"
-          },
-          {
-            "id": "o2",
-            "name": "Reason",
-            "field": "authorizationReason"
-          }
-        ],
-        "passThrough": true,
-        "inputField": null,
-        "outputPath": null,
-        "executionMode": "single"
-      },
-      "id": "medicaidRules",
-      "name": "Medicaid Rules",
-      "position": {
-        "x": 750,
-        "y": 63.5
-      }
-    },
-    {
-      "type": "decisionTableNode",
-      "content": {
-        "hitPolicy": "first",
-        "rules": [
-          {
-            "_id": "r1",
-            "i1": "'Medication'",
-            "i2": "contains($, 'J')",
-            "o1": "true",
-            "o2": "'Part B medication requires prior authorization'"
-          },
-          {
-            "_id": "r2",
-            "i1": "'Procedure'",
-            "i2": "number($) > 1000",
-            "o1": "true",
-            "o2": "'High-cost procedure requires prior authorization'"
-          },
-          {
-            "_id": "r3",
-            "i1": "'Imaging'",
-            "i2": "startsWith($, 'CT') or startsWith($, 'MRI')",
-            "o1": "true",
-            "o2": "'Advanced imaging requires prior authorization'"
-          },
-          {
-            "_id": "r4",
-            "i1": "'Equipment'",
-            "i2": "number($) > 500",
-            "o1": "true",
-            "o2": "'DME over threshold requires prior authorization'"
-          },
-          {
-            "_id": "r5",
-            "i1": "",
-            "i2": "",
-            "o1": "false",
-            "o2": "'Standard Medicare service does not require prior authorization'"
-          }
-        ],
-        "inputs": [
-          {
-            "id": "i1",
-            "name": "Service Type",
-            "field": "serviceType"
-          },
-          {
-            "id": "i2",
-            "name": "Code",
-            "field": "serviceDetails.code"
-          }
-        ],
-        "outputs": [
-          {
-            "id": "o1",
-            "name": "Requires Authorization",
-            "field": "requiresAuthorization"
-          },
-          {
-            "id": "o2",
-            "name": "Reason",
-            "field": "authorizationReason"
-          }
-        ],
-        "passThrough": true,
-        "inputField": null,
-        "outputPath": null,
-        "executionMode": "single",
-        "passThorough": false
-      },
-      "id": "medicareRules",
-      "name": "Medicare Rules",
-      "position": {
-        "x": 750,
-        "y": 161.5
-      }
-    },
-    {
-      "type": "decisionTableNode",
-      "content": {
-        "hitPolicy": "first",
-        "rules": [
-          {
-            "_id": "r1",
-            "i1": "'Medication'",
-            "i2": "contains(serviceDetails.code, 'SPE')",
-            "o1": "true",
-            "o2": "'Specialty medication requires prior authorization'"
-          },
-          {
-            "_id": "r2",
-            "i1": "'Procedure'",
-            "i2": "serviceDetails.code in ['33361', '33362', '33363', '33364']",
-            "o1": "true",
-            "o2": "'Specific procedures require prior authorization'"
-          },
-          {
-            "_id": "r3",
-            "i1": "'Imaging'",
-            "i2": "serviceDetails.code in ['70450', '70460', '70470', '70551', '70552', '70553']",
-            "o1": "true",
-            "o2": "'Advanced imaging requires prior authorization'"
-          },
-          {
-            "_id": "r4",
-            "i1": "'Equipment'",
-            "i2": "serviceDetails.cost > 1000",
-            "o1": "true",
-            "o2": "'High-cost equipment requires prior authorization'"
-          },
-          {
-            "_id": "r5",
-            "i1": "",
-            "i2": "serviceDetails.isEmergency == true",
-            "o1": "false",
-            "o2": "'Emergency services do not require prior authorization'"
-          },
-          {
-            "_id": "r6",
-            "i1": "",
-            "i2": "",
-            "o1": "false",
-            "o2": "'Standard commercial service does not require prior authorization'"
-          }
-        ],
-        "inputs": [
-          {
-            "id": "i1",
-            "name": "Service Type",
-            "field": "serviceType"
-          },
-          {
-            "id": "i2",
-            "name": "Additional Check"
-          }
-        ],
-        "outputs": [
-          {
-            "id": "o1",
-            "name": "Requires Authorization",
-            "field": "requiresAuthorization"
-          },
-          {
-            "id": "o2",
-            "name": "Reason",
-            "field": "authorizationReason"
-          }
-        ],
-        "passThrough": true,
-        "inputField": null,
-        "outputPath": null,
-        "executionMode": "single"
-      },
-      "id": "commercialRules",
-      "name": "Commercial Rules",
-      "position": {
-        "x": 750,
-        "y": 259.5
-      }
-    },
-    {
-      "type": "decisionTableNode",
-      "content": {
-        "hitPolicy": "first",
-        "rules": [
-          {
-            "_id": "r1",
-            "i1": "some($, startsWith(#, 'Z51'))",
-            "i2": "requiresAuthorization == true",
-            "o1": "false",
-            "o2": "'Encounter for chemotherapy exempt from prior authorization'"
-          },
-          {
-            "_id": "r2",
-            "i1": "some($, # in ['O09.511', 'O09.512', 'O09.513', 'O09.519'])",
-            "i2": "requiresAuthorization == true",
-            "o1": "false",
-            "o2": "'Pregnancy-related services exempt from prior authorization'"
-          },
-          {
-            "_id": "r3",
-            "i1": "some($, # in ['U07.1'])",
-            "i2": "requiresAuthorization == true and serviceType == 'Imaging'",
-            "o1": "false",
-            "o2": "'COVID-19 related imaging exempt from prior authorization'"
-          },
-          {
-            "_id": "r4",
-            "i1": "",
-            "i2": "",
-            "o1": "requiresAuthorization",
-            "o2": "authorizationReason"
-          }
-        ],
-        "inputs": [
-          {
-            "id": "i1",
-            "name": "Diagnosis Codes",
-            "field": "diagnosisCodes"
-          },
-          {
-            "id": "i2",
-            "name": "Current Authorization Status"
-          }
-        ],
-        "outputs": [
-          {
-            "id": "o1",
-            "name": "Final Authorization Required",
-            "field": "requiresAuthorization"
-          },
-          {
-            "id": "o2",
-            "name": "Final Reason",
-            "field": "authorizationReason"
-          }
-        ],
-        "passThrough": true,
-        "inputField": null,
-        "outputPath": null,
-        "executionMode": "single",
-        "passThorough": false
-      },
-      "id": "diagnosisCheck",
-      "name": "Diagnosis Code Exclusions",
-      "position": {
-        "x": 1070,
-        "y": 161.5
-      }
-    },
-    {
-      "type": "expressionNode",
-      "content": {
-        "expressions": [
-          {
-            "id": "e1",
-            "key": "requiresAuthorization",
-            "value": "requiresAuthorization"
-          },
-          {
-            "id": "e2",
-            "key": "reason",
-            "value": "authorizationReason"
-          },
-          {
-            "id": "e3",
-            "key": "timestamp",
-            "value": "date('now')"
-          }
-        ],
-        "passThrough": false,
-        "inputField": null,
-        "outputPath": null,
-        "executionMode": "single"
-      },
-      "id": "finalDetermination",
-      "name": "Final Determination",
-      "position": {
-        "x": 1390,
-        "y": 161.5
-      }
-    }
-  ],
-  "edges": [
-    {
-      "id": "edge1",
-      "sourceId": "inputNode",
-      "targetId": "insuranceTypeCheck",
-      "type": "edge"
-    },
-    {
-      "id": "edge2",
-      "sourceId": "insuranceTypeCheck",
-      "targetId": "medicaidRules",
-      "sourceHandle": "s1",
-      "type": "edge"
-    },
-    {
-      "id": "edge3",
-      "sourceId": "insuranceTypeCheck",
-      "targetId": "medicareRules",
-      "sourceHandle": "s2",
-      "type": "edge"
-    },
-    {
-      "id": "edge4",
-      "sourceId": "insuranceTypeCheck",
-      "targetId": "commercialRules",
-      "sourceHandle": "s3",
-      "type": "edge"
-    },
-    {
-      "id": "edge5",
-      "sourceId": "medicaidRules",
-      "targetId": "diagnosisCheck",
-      "type": "edge"
-    },
-    {
-      "id": "edge6",
-      "sourceId": "medicareRules",
-      "targetId": "diagnosisCheck",
-      "type": "edge"
-    },
-    {
-      "id": "edge7",
-      "sourceId": "commercialRules",
-      "targetId": "diagnosisCheck",
-      "type": "edge"
-    },
-    {
-      "id": "edge8",
-      "sourceId": "diagnosisCheck",
-      "targetId": "finalDetermination",
-      "type": "edge"
-    }
-  ]
-}