From 3294902b95122d8fe4f6e9b235d7018317c848e4 Mon Sep 17 00:00:00 2001 From: Laurent Ouma <98098891+Omoshlawi@users.noreply.github.com> Date: Mon, 27 Jan 2025 17:27:24 +0400 Subject: [PATCH] Using json payload file as source for intervensions (#566) --- .../esm-billing-app/src/hooks/payload.json | 20824 ++++++++++++++++ .../src/hooks/useInterventions.ts | 57 +- .../esm-billing-app/src/hooks/usePackages.ts | 9 +- 3 files changed, 20866 insertions(+), 24 deletions(-) create mode 100644 packages/esm-billing-app/src/hooks/payload.json diff --git a/packages/esm-billing-app/src/hooks/payload.json b/packages/esm-billing-app/src/hooks/payload.json new file mode 100644 index 00000000..9a49b6f0 --- /dev/null +++ b/packages/esm-billing-app/src/hooks/payload.json @@ -0,0 +1,20824 @@ +{ + "status": "SUCCESS", + "customerMessage": "Benefit details successfully retrieved", + "debugMessage": null, + "data": [ + { + "interventionName": "Single Chamber pacemaker insertion (permanent)", + "interventionCode": "SHA-19-025", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "224000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Excision of Mediastinal Tumour", + "interventionCode": "SHA-19-045", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "280000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Hemodiafiltration", + "interventionCode": "SHA-16-002", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CASE BASED" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "104" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "10650" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB95}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Permanent dialysis catheter", + "interventionCode": "SHA-16-003", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "50000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB95}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Peritoneal dialysis ", + "interventionCode": "SHA-16-004", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CASE BASED" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "12" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "85200" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94.2}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB94.3}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Dialysis for acute kidney injury", + "interventionCode": "SHA-16-007", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "10650" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB95}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Rehabilitation for Drug & Substance Abuse", + "interventionCode": "SHA-10-005", + "interventionPackage": "SHA-10", + "interventionSubPackage": "SHA-10-SC-02", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\",\"LEVEL 3A\",\"LEVEL 3B\",\"LEVEL 3C\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CASE BASED" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "67200" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB95}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB95.0-QB95.Z}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Hemo dialysis ", + "interventionCode": "SHA-16-001", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CASE BASED" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "104" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "10650" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB95}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Post renal replacement therapy", + "interventionCode": "SHA-16-011", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "12" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "16666" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{GB63}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{GB64}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": 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"applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to phc", + "ruleCode": "cost_allocation_to_phc", + "value": "100" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "PHC Only" + } + ] + } + ] + }, + { + "interventionName": "Single pacemaker insertion (temporary)", + "interventionCode": "SHA-19-026", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "44800" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Aneurysm repair with cardiopulmonary bypass/Bentall’s procedure", + "interventionCode": "SHA-19-030", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "1008000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Arteriovenous fistula take-down", + "interventionCode": "SHA-19-033", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "33600" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Creation of Arteriovenous (AV) fistula", + "interventionCode": "SHA-19-041", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "78400" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim 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"insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CASE BASED" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "33600" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94.2}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB94.3}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": 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"levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 2\",\"LEVEL 4\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CAPITATION" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "FEMALE" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to phc", + "ruleCode": "cost_allocation_to_phc", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "3" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XT4Z}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XT4Z}" + }, 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Only" + } + ] + } + ] + }, + { + "interventionName": "Thoracic endovascular aortic repair (TEVAR)", + "interventionCode": "SHA-19-027", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", 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"value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "392000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Vascular access placement (catheters, AV fistula, AV graft)", + "interventionCode": "SHA-16-006", + "interventionPackage": "SHA-16", + "interventionSubPackage": "SHA-16-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\",\"LEVEL 3\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "78400" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB94}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB95}" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Ventricular Septal Defect (VSD) percutaneous device closure", + "interventionCode": "SHA-19-028", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "414400" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Aorto-femoral and other Arterial bypass", + "interventionCode": "SHA-19-032", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "392000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Cox Maze IV Procedure", + "interventionCode": "SHA-19-040", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "448000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Achalasia cardia/Diverticulum", + "interventionCode": "SHA-19-029", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "280000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs 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5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "78400" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Creation of Arteriovenous (AV) fistula with graft", + "interventionCode": "SHA-19-042", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "168000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Carotid arteriotomy", + "interventionCode": "SHA-19-035", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "145600" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Decortication", + "interventionCode": "SHA-19-043", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, 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"ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Closed valvotomy", + "interventionCode": "SHA-19-036", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "168000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": 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mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "246400" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Congenital arteriovenous (AV) fistula malformation resection", + "interventionCode": "SHA-19-039", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "201600" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Laboratory investigations", + "interventionCode": "SHA-12-002", + "interventionPackage": "SHA-12", + "interventionSubPackage": "SHA-12-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 2\",\"LEVEL 4\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CAPITATION" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to phc", + "ruleCode": "cost_allocation_to_phc", + "value": "100" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "PHC Only" + } + ] + } + ] + }, + { + "interventionName": "Emergency laparotomy", + "interventionCode": "SHA-19-503", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "67200" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Major trauma", + "interventionCode": "SHA-01-004", + "interventionPackage": "SHA-01", + "interventionSubPackage": "SHA-01-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to eccif", + "ruleCode": "cost_allocation_to_eccif", + "value": "100" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{\"ND90.0 - ND90.Z\",\" ND91.0 - ND91.Z\",\" ND94.0 - ND94.Z\",\" ND92.0 - ND92.Z\",\" ND93.0 - ND93.Z\",\" ND95.0 - ND95.Z\",\" ND96.0 - ND96.Z\",\" ND97.0 - ND97.Z\",\" NA0A.0 -NAOA.0Z\",\" \"}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{ND90,\" ND91\",\" ND92\",\" ND93\",\" ND94\",\" ND95\",\" ND96\",\" ND97\",\" ND9Y\",\" ND9Z\",\" NE00\",\" NE01\",\" NE02\",\" NE0Z\",\" NE10\",\" NE11\",\" NE2Z\",\" NA0A\",\" NAOA.10\",\" NAOA.11\",\" NAOA.12\",\" NA09.Y\",\" NAOA.Y\",\" NAO9.Z\",\" NA01.7\",\" NAOA.O\",\" NAO1.Y\",\" NAOI.2\",\" NA21\",\" NA21.4\",\" NA21.5\",\" NA21.Z\",\" NA01.3\",\" NA21.Y\",\" NA81\",\" NA81.2\",\" NB31.3\",\" NB51\",\" NB62.6\",\" NC11\",\" NC31\",\" NC52\",\" NC71 NC91\",\" ND12\",\" NA02\",\" NA22\",\" NA82\",\" NB52\",\" KA45\",\" NC12.03\",\" NC12.10\",\" NC12.5\",\" NC32.7\",\" NC53.4\",\" NC53.7\",\" NC72.7\",\" NC92\",\" ND13.6\"}" + }, + { + "ruleName": "Investigation tariff", + "ruleCode": "investigation_tariff", + "value": "79400" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff", + "ruleCode": "management_tariff", + "value": "79400" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "no" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "ECCIF Only" + } + ] + } + ] + }, + { + "interventionName": "Shock states", + "interventionCode": "SHA-01-005", + "interventionPackage": "SHA-01", + "interventionSubPackage": 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"ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{\"1C45.0 - IC45.Z\",\" MG40.0 - MG40.Z\"}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{NF0A.4,\" XS26\",\" IC45\",IG41,\" BA60.9\",\" JA05.3\",\" JBOD.1\",\" MG40\"}" + }, + { + "ruleName": "Investigation tariff", + "ruleCode": "investigation_tariff", + "value": "67300" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff", + "ruleCode": "management_tariff", + "value": "67300" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "no" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": 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"value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG31}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG31}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": 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"ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "MRI Extremity or Shoulder or Leg", + "interventionCode": "SHA-09-064", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "11000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM0529}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM0529}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "U/S carotid doppler/duplex", + "interventionCode": "SHA-09-066", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "5000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM5TN4,XD6EX8,XD89G9,XD7FU9,XD4T58}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM5TN4,XD6EX8,XD89G9,XD7FU9,XD4T58}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "U/S venous duplex/extremity", + "interventionCode": "SHA-09-068", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "5000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM5TN4,XD6EX8,XD89G9,XD7FU9,XD4T60}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM5TN4,XD6EX8,XD89G9,XD7FU9,XD4T60}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Unconscious/Altered level of consciouness", + "interventionCode": "SHA-01-006", + "interventionPackage": "SHA-01", + "interventionSubPackage": "SHA-01-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to eccif", + "ruleCode": "cost_allocation_to_eccif", + "value": "100" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{\"MB20.0 - MB20.Y\",\" NAO7.00 - NA07.0Z\",\" 8E22.0 - 8E22.Z\"}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB20,\" NA07.0\",\" 8E22\",\" 8E2Z\"}" + }, + { + "ruleName": "Investigation tariff", + "ruleCode": "investigation_tariff", + "value": "12700" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff", + "ruleCode": "management_tariff", + "value": "12700" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "no" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "ECCIF Only" + } + ] + } + ] + }, + { + "interventionName": "Chemo port insertion", + "interventionCode": "SHA-06-028", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "15000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB97,XM7RS5}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB97,XM7RS5}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Head with contrast", + "interventionCode": "SHA-09-001", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG01}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG01}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Coronary Angiography", + "interventionCode": "SHA-09-005", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "8000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG05}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG05}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Myelogram", + "interventionCode": "SHA-09-009", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "8000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG09}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG09}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Abdominal Pelvic", + "interventionCode": "SHA-09-011", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG11}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG11}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Head non contrast", + "interventionCode": "SHA-09-012", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG12}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG12}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT HRCT Chest", + "interventionCode": "SHA-09-014", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG14}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG14}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Cervical Spine", + "interventionCode": "SHA-09-017", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG17}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG17}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT. Scan Pelvimetry", + "interventionCode": "SHA-09-025", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG25}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG25}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Severe respiratory distress", + "interventionCode": "SHA-01-007", + "interventionPackage": "SHA-01", + "interventionSubPackage": "SHA-01-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to eccif", + "ruleCode": "cost_allocation_to_eccif", + "value": "100" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{\"CB41.0 - CB41.2Z\",\" KB23.0 - KB23.0Z\"}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{CB41,\" KB23\",\" KB23.Z\",\" XN1V8\"}" + }, + { + "ruleName": "Investigation tariff", + "ruleCode": "investigation_tariff", + "value": "8000" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff", + "ruleCode": "management_tariff", + "value": "8000" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "no" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "ECCIF Only" + } + ] + } + ] + }, + { + "interventionName": "Liver Function Tests", + "interventionCode": "SHA-06-031", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels 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"ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Carotid Arteriography", + "interventionCode": "SHA-09-003", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "8000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG03}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG03}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": 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"ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Neck", + "interventionCode": "SHA-09-022", + "interventionPackage": 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"cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG22}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG22}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Pelvis Without Contrast", + "interventionCode": "SHA-09-026", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": 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"ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": 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"false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "MRI CVJ Craniovertebral Junction", + "interventionCode": "SHA-09-042", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": 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"ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM0529}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM0529}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "MRI Chest", + "interventionCode": "SHA-09-046", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment 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"ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "MRI Abdominal Aortic Angiography", + "interventionCode": "SHA-09-050", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": 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+ { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "11000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM0529}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM0529}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Seizures/Status epilepticus", + "interventionCode": "SHA-01-008", + "interventionPackage": "SHA-01", + "interventionSubPackage": "SHA-01-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to eccif", + "ruleCode": "cost_allocation_to_eccif", + "value": "100" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{\"8A63.0 - 8A63.Z\",\" 8A68.0- 8A68.Z\"}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{KBO6,\" SE35\",\" SE33\",\" 6B60.4\",\" 6C40.42\",\" 6C40.43\",\" 6C44.42\",\" 6C44.43\",\" 6C4E.42\",\" 6C4F.42\",\" 6C4F.43\",\" 6C4G.42\",\" 6C45.43\",\" 8A42\",\" 8A60\",\" 8A61.12\",\" 8A61.22\",\" 8A63\",\" 8A64\",\" 8A65\",\" 8A66\",\" 8A68\",\" 8A6Z\"}" + }, + { + "ruleName": "Investigation tariff", + "ruleCode": "investigation_tariff", + "value": "12200" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff", + "ruleCode": "management_tariff", + "value": "12200" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "no" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "ECCIF Only" + } + ] + } + ] + }, + { + "interventionName": "Apharetic platelet transfusion", + "interventionCode": "SHA-06-027", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "3" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "20000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QB99}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QB99}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Aortography", + "interventionCode": "SHA-09-002", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "8000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG02}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG02}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Forensic for Whole Body", + "interventionCode": "SHA-09-013", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG13}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG13}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT scan KUB", + "interventionCode": "SHA-09-016", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG16}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG16}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Paranasal Sinuses", + "interventionCode": "SHA-09-024", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG24}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG24}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT. Scan Radiculography", + "interventionCode": "SHA-09-027", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG27}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG27}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "MRI Orbits", + "interventionCode": "SHA-09-038", + "interventionPackage": "SHA-09", + "interventionSubPackage": 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"needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "MRI Brachial Plexus", + "interventionCode": "SHA-09-044", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "11000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM0529}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM0529}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member 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"Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "70000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{2A00-2F9Z}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{2A00-2F9Z}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "no" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Radiotherapy", + "interventionCode": "SHA-06-025", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": 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"value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "CASE BASED" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "FEMALE" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Upper age limit", + "ruleCode": "upper_age_limit", + "value": "55" + }, + { + "ruleName": "Lower age limit", + "ruleCode": "lower_age_limit", + "value": "10" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity 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{ + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "PHC and SHIF" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Cerebral Angiography", + "interventionCode": "SHA-09-004", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": 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"value": "55" + }, + { + "ruleName": "Lower age limit", + "ruleCode": "lower_age_limit", + "value": "10" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "1" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "10000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{QA46,QA48,JB20,JB21,JB22,JB23,JB24,JB22,JB40,KAO5,JA82,JB00,JN07,JB08,JB09,JBOZ,JBOA,JBOC,JBOD}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{QA46,QA48,JB20,JB21,JB22,JB23,JB24,JB22,JB40,KAO5,JA82,JB00,JN07,JB08,JB09,JBOZ,JBOA,JBOC,JBOD}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "PHC and SHIF" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Pyelography", + "interventionCode": "SHA-09-007", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "8000" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG07}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG07}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan 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"ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, + { + "ruleName": "Overall tariff", + "ruleCode": "overall_tariff", + "value": "6900" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG10}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{MB71,MC90,MD41,ME21,ME22,ME90,ME91,ME92,MG00,MG10}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "CT Scan Joints and Extremities", + "interventionCode": "SHA-09-020", + "interventionPackage": "SHA-09", + "interventionSubPackage": "SHA-09-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", 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"name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP and IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 3\",\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "2" + }, 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"Diagnosis block", + "ruleCode": "diagnosis_block", + "value": "{XM0529}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM0529}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": 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KB60, 5A0Z, 5A61.5\"}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{\"JA63.0 - JA63.Z, KB60.0 - KB60.Z, QA0A.10, 5A10 - 5A4Z\"}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": 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"ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", 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"ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "false" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Loop recorder-reveal XT", + "interventionCode": "SHA-19-015", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme 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"ruleCode": "overall_tariff", + "value": "358400" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "ANNUALLY" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "no" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": 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"{XM5TN4,XD6EX8,XD89G9,XD7FU9,XD4T64}" + }, + { + "ruleName": "Diagnosis list", + "ruleCode": "diagnosis_list", + "value": "{XM5TN4,XD6EX8,XD89G9,XD7FU9,XD4T64}" + }, + { + "ruleName": "Annual quantity limit type", + "ruleCode": "annual_quantity_limit_type", + "value": "INTERVENTION" + }, + { + "ruleName": "Investigation tariff has limit", + "ruleCode": "investigation_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Management tariff has limit", + "ruleCode": "management_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Need approval before claim submission", + "ruleCode": "need_approval_before_claim_submission", + "value": "false" + }, + { + "ruleName": "Overall tariff has limit", + "ruleCode": "overall_tariff_has_limit", + "value": "false" + }, + { + "ruleName": "Needs doctor authorization", + "ruleCode": "needs_doctor_authorization", + "value": "false" + }, + { + "ruleName": "Needs manual preauth approval", + "ruleCode": "needs_manual_preauth_approval", + "value": "no" + }, + { + "ruleName": "Needs member authorization", + "ruleCode": "needs_member_authorization", + "value": "false" + }, + { + "ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Behavioural Disorders", + "interventionCode": "SHA-10-001", + "interventionPackage": "SHA-10", + "interventionSubPackage": "SHA-10-SC-02", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "false" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "PER DIEM" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": "Applicable facility ownership", + "ruleCode": "applicable_facility_ownership", + "value": "ALL" + }, + { + "ruleName": "Cost allocation to shif", + "ruleCode": "cost_allocation_to_shif", + "value": "100" + }, + { + "ruleName": "Annual quantity limit", + "ruleCode": "annual_quantity_limit", + "value": "180" + }, + { + "ruleName": "Level 4 tariff", + "ruleCode": "level_4_tariff", + "value": "3360" + }, + { + "ruleName": "Level 5 tariff", + "ruleCode": "level_5_tariff", + "value": "3920" + }, + { + "ruleName": "Level 6 tariff", + "ruleCode": "level_6_tariff", + "value": "4480" + }, + { + "ruleName": "Usage frequency type", + "ruleCode": "usage_frequency_type", + "value": "QUARTERLY" + }, + { + "ruleName": "Diagnosis block", + "ruleCode": "diagnosis_block", 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"ruleName": "Needs protocols", + "ruleCode": "needs_protocols", + "value": "no" + }, + { + "ruleName": "Fund", + "ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Creatinine", + "interventionCode": "SHA-18-003", + "interventionPackage": "SHA-18", + "interventionSubPackage": "SHA-18-SC-01", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "OP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "INDIVIDUAL" + }, + { + "ruleName": "Applicable 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"ruleCode": "fund", + "value": "SHIF Only" + } + ] + } + ] + }, + { + "interventionName": "Pulmonary artery catheterization", + "interventionCode": "SHA-19-020", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [ + { + "code": "UHC", + "name": "UHC SHA Scheme Fund", + "rules": [ + { + "ruleName": "Access point", + "ruleCode": "access_point", + "value": "IP" + }, + { + "ruleName": "Requires preauth", + "ruleCode": "requires_preauth", + "value": "no" + }, + { + "ruleName": "Levels applicable", + "ruleCode": "levels_applicable", + "value": "{\"LEVEL 4\",\"LEVEL 5\",\"LEVEL 6\"}" + }, + { + "ruleName": "Payment mechanism", + "ruleCode": "payment_mechanism", + "value": "FEE FOR SERVICE" + }, + { + "ruleName": "Coverage level", + "ruleCode": "coverage_level", + "value": "HOUSEHOLD" + }, + { + "ruleName": "Applicable gender", + "ruleCode": "applicable_gender", + "value": "ALL" + }, + { + "ruleName": 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"interventionName": "Removal of hardware (plates & nails)", + "interventionCode": "SHA-19-450", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Toes and fingers Disarticulation", + "interventionCode": "SHA-19-462", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Rectosigmoidectomy", + "interventionCode": "SHA-19-480", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Open removal of calculus from kidney", + "interventionCode": "SHA-19-514", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Repair of kidney 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"interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Skin graft <10 % total body surface area (TBSA)", + "interventionCode": "SHA-19-493", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ileal or colonic replacement of ureter", + "interventionCode": "SHA-19-509", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Pan endoscopy laser urethrotomy", + "interventionCode": "SHA-19-519", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Radical nephrectomy for Tumours", + "interventionCode": "SHA-19-525", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Urethroplasty complex with buccal mucosa", + "interventionCode": "SHA-19-547", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Reduction Mammoplasty (bilateral)", + "interventionCode": "SHA-19-490", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cystoscopy rigid uretero, nephroscopy, laser lithotripsy", + "interventionCode": "SHA-19-500", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Endoscopic extraction of higher ureteric or /Kidney calculus", + "interventionCode": "SHA-19-505", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Pyelolithotomy", + "interventionCode": "SHA-19-524", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Radical prostatectomy (laparoscopic)", + "interventionCode": "SHA-19-528", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Repair of bladder", + "interventionCode": "SHA-19-532", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Simple Nephrectomy", + "interventionCode": "SHA-19-538", + "interventionPackage": "SHA-19", + 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"interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Primary Open Pacemaker Implantation", + "interventionCode": "SHA-19-059", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Enucleation Mandibular/ Maxillary cyst", + "interventionCode": "SHA-19-227", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Surgical Toilet for scalp tumour under general anaesthesia", + "interventionCode": "SHA-19-299", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-10", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Diagnostic / Dye Laparoscopy", + "interventionCode": "SHA-19-303", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Rib resection for Thoracic outlet syndrome", + "interventionCode": "SHA-19-063", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operative Hysteroscopy: Resection of Submucous Fibroid", + "interventionCode": "SHA-19-320", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operative Laparoscopy: Ovarian Cystectomy / Drilling", + "interventionCode": "SHA-19-328", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Lid tumour Incision biopsy", + "interventionCode": "SHA-19-374", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Orbitotomy (lateral/anterior)", + "interventionCode": "SHA-19-378", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Simple Thoracotomy-Retained Haemothrax/Duct ligation/pleurodesis/FB removal", + "interventionCode": "SHA-19-064", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Lateral Sphincterotomy", + "interventionCode": "SHA-19-150", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Radical Mastectomy (to include lymph nodes clearance)", + "interventionCode": "SHA-19-158", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Dacryocystorhinostomy (DCR) revision", + "interventionCode": "SHA-19-356", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Scleral buckle + Cryotherapy or Laser", + "interventionCode": "SHA-19-395", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Incision & Drainage (Peri anal Abscess)", + "interventionCode": "SHA-19-146", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ectropion repair minor and major", + "interventionCode": "SHA-19-358", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Lacrimal Probing and Syringing (adults)", + "interventionCode": "SHA-19-368", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Posterior Vitrectomy + band/buckle", + "interventionCode": "SHA-19-383", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Fasciectomy", + "interventionCode": "SHA-19-427", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Corneal transplant + Cataract Extraction + Intraocular lens implant", + "interventionCode": "SHA-19-352", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Posterior Vitrectomy - Foreign Body", + "interventionCode": "SHA-19-380", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Posterior Vitrectomy + Cataract surgery", + "interventionCode": "SHA-19-385", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bone scan", + "interventionCode": "SHA-06-020", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Daycare Procedures", + "interventionCode": "SHA-12-020", + "interventionPackage": "SHA-12", + "interventionSubPackage": "SHA-12-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Socket reconstruction minor", + "interventionCode": "SHA-19-397", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bankart repair", + "interventionCode": "SHA-19-412", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Contracture release without flaps", + "interventionCode": "SHA-19-419", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "External Fixation with pins, plates and screws", + "interventionCode": "SHA-19-425", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Total hip replacement (THR) (Including implants, MUST have a peer review of three doctors)", + "interventionCode": "SHA-19-463", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Exploration of retroperitoneal mass", + "interventionCode": "SHA-19-139", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparoscopic Niessens fundoplication", + "interventionCode": "SHA-19-148", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Partial Gastrectomy", + "interventionCode": "SHA-19-156", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Arthrodesis vertebral joints", + "interventionCode": "SHA-19-409", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision head of radius", + "interventionCode": "SHA-19-421", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bone marrow aspiration cytological examination", + "interventionCode": "SHA-06-009", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "External clamp application and Debridement", + "interventionCode": "SHA-19-424", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Wedge tarsectomy", + "interventionCode": "SHA-19-465", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Post-partum Complications", + "interventionCode": "SHA-07-005", + "interventionPackage": "SHA-07", + "interventionSubPackage": "SHA-07-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "CT Scan for treatment planning", + "interventionCode": "SHA-06-015", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bone marrow trephine procedure", + "interventionCode": "SHA-06-012", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Consultation, prescription, and issuing of glasses", + "interventionCode": "SHA-05-001", + "interventionPackage": "SHA-05", + "interventionSubPackage": "SHA-05-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "PET SCAN", + "interventionCode": "SHA-06-017", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Femoral epiphysis reduction / fixation Slipped Upper Femoral Epiphysis (SUFE)with implants", + "interventionCode": "SHA-19-428", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Open reduction and internal fixation: Clavicle", + "interventionCode": "SHA-19-443", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bladder neck reconstruction", + "interventionCode": "SHA-19-467", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Intra articular Surgery (medium joints)", + "interventionCode": "SHA-19-431", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Mild club foot correction", + "interventionCode": "SHA-19-436", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "PSMA PET SCAN", + "interventionCode": "SHA-06-018", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Resection of posterior / anterior urethral valves", + "interventionCode": "SHA-19-481", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Flow cytometry (for diagnosis of leukaemia patients) per marker", + "interventionCode": "SHA-06-008", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Open Synovectomy", + "interventionCode": "SHA-19-446", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Tendon transfer", + "interventionCode": "SHA-19-461", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cleft lip and palate repair (Unilateral/Bilateral)", + "interventionCode": "SHA-19-484", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "PCR analysis (for gene detection for cancer per marker profile)", + "interventionCode": "SHA-06-013", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Histology Small Specimen", + "interventionCode": "SHA-06-001", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Gastrojejunostomy", + "interventionCode": "SHA-19-143", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Exstrophy of bladder (repair)", + "interventionCode": "SHA-19-468", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Hemicolectomy", + "interventionCode": "SHA-19-145", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Revision of Total Hip or Knee (Including implants, MUST have a peer review of three doctors, only for paediatrics)", + "interventionCode": "SHA-19-453", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Chemotherapy medicines", + "interventionCode": "SHA-06-022", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy: Malrotation & Plication", + "interventionCode": "SHA-19-475", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Oesophagoscopy and removal of foreign body", + "interventionCode": "SHA-19-153", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "NICU CARE", + "interventionCode": "SHA-03-003", + "interventionPackage": "SHA-03", + "interventionSubPackage": "SHA-03-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Exteriorization of caecum", + "interventionCode": "SHA-19-141", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "HDU CARE", + "interventionCode": "SHA-03-002", + "interventionPackage": "SHA-03", + "interventionSubPackage": "SHA-03-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy for Pyloric stenosis", + "interventionCode": "SHA-19-149", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "PICU CARE", + "interventionCode": "SHA-03-004", + "interventionPackage": "SHA-03", + "interventionSubPackage": "SHA-03-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "ICU CARE", + "interventionCode": "SHA-03-001", + "interventionPackage": "SHA-03", + "interventionSubPackage": "SHA-03-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cervical rib resection", + "interventionCode": "SHA-19-417", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "INTENSIVE CARE BURNS UNIT", + "interventionCode": "SHA-03-005", + "interventionPackage": "SHA-03", + "interventionSubPackage": "SHA-03-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Radionucleide scan", + "interventionCode": "SHA-06-019", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Histology Medium Specimen", + "interventionCode": "SHA-06-002", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Exploration/Graft orbital fracture", + "interventionCode": "SHA-19-238", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Reduction of Alveolar fracture Open", + "interventionCode": "SHA-19-254", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bilateral nephrostomy tube insertion", + "interventionCode": "SHA-19-197", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-08", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Pan facial fracture repair (Open Reduction and Internal Rigid Fixation)", + "interventionCode": "SHA-19-251", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Revision Palatoplasty-Rotational Flap", + "interventionCode": "SHA-19-259", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Spinal fusions with implants IV level", + "interventionCode": "SHA-19-297", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-10", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operative Laparoscopy: Tuboplasty", + "interventionCode": "SHA-19-329", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Orbital implant removal", + "interventionCode": "SHA-19-377", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "MRI", + "interventionCode": "SHA-06-016", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Simple Salivary Gland Sialoadenectomy /Sialolithectomy", + "interventionCode": "SHA-19-268", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Repair of epigastric hernia", + "interventionCode": "SHA-19-161", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Salivary Duct Redirection (Wilkie procedure)", + "interventionCode": "SHA-19-263", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of Liver hydatid cyst", + "interventionCode": "SHA-19-135", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Repair of hydrocele", + "interventionCode": "SHA-19-163", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Unilateral Herniotomy", + "interventionCode": "SHA-19-189", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of Simple facial Haemangioma/Lymphangioma", + "interventionCode": "SHA-19-233", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Removal of bone plates", + "interventionCode": "SHA-19-255", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Full thickness skin graft to oral defect", + "interventionCode": "SHA-19-241", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ballon Angioplasty", + "interventionCode": "SHA-19-196", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-08", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Unilateral nephrostomy tube insertion (no drainage tube available)", + "interventionCode": "SHA-19-212", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-08", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Craniotomy for Arteriovenous (AV) malformation", + "interventionCode": "SHA-19-281", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-10", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Chemotherapy administration", + "interventionCode": "SHA-06-021", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Brachytherapy", + "interventionCode": "SHA-06-023", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Unilateral Herniotomy + orchidopexy", + "interventionCode": "SHA-19-190", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Stripping of unilateral varicose veins", + "interventionCode": "SHA-19-174", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Unilateral sympathectomy", + "interventionCode": "SHA-19-192", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Subdural haematoma Evacuation", + "interventionCode": "SHA-19-175", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "EUA Diagnostic for Oro-facial / Biopsy", + "interventionCode": "SHA-19-228", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Functional Orthognathic surgeries of the Maxilla/Mandible", + "interventionCode": "SHA-19-242", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Unilateral femoral herniorrhaphy", + "interventionCode": "SHA-19-187", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "4-vessel cereral Angiography / Carotid Angiography (unilateral or bilateral) vertebral angiogram", + "interventionCode": "SHA-19-195", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-08", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Vagotomy + drainage", + "interventionCode": "SHA-19-193", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Unilateral gynaecomastia correction", + "interventionCode": "SHA-19-188", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Simple Vestibuloplasty + Skin graft", + "interventionCode": "SHA-19-269", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of Complex facial Haemangioma/Lymphangioma", + "interventionCode": "SHA-19-229", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Facial Soft tissue Repair", + "interventionCode": "SHA-19-239", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Surgical Complications", + "interventionCode": "SHA-07-002", + "interventionPackage": "SHA-07", + "interventionSubPackage": "SHA-07-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cytology (Gynae Cytology Vaginal or cervical smears, each)", + "interventionCode": "SHA-06-005", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Management of medical cases", + "interventionCode": "SHA-07-001", + "interventionPackage": "SHA-07", + "interventionSubPackage": "SHA-07-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Mandibulectomy plus Reconstruction/Plating", + "interventionCode": "SHA-19-246", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bone marrow aspiration procedure", + "interventionCode": "SHA-06-011", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Revision Palatoplasty - MicroVascular and Donor site graft", + "interventionCode": "SHA-19-258", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Histology Large Specimen", + "interventionCode": "SHA-06-003", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-02", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy: Vaginal Hysterectomy", + "interventionCode": "SHA-19-314", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operative Hysteroscopy: Synechiolysis / Septolysis", + "interventionCode": "SHA-19-322", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Anterior Chamber Washout", + "interventionCode": "SHA-19-340", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cyclocryotherapy", + "interventionCode": "SHA-19-354", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Superficial Parotidectomy", + "interventionCode": "SHA-19-270", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of intracranial nerve lesions", + "interventionCode": "SHA-19-286", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-10", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Temporomandibular Joint (TMJ) Arthroscopy", + "interventionCode": "SHA-19-272", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-09", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy: Hysterectomy (Abdominal)", + "interventionCode": "SHA-19-306", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy: Tuboplasty", + "interventionCode": "SHA-19-313", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Clipping of cerebral artery", + "interventionCode": "SHA-19-279", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-10", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Posterior fossa surgery", + "interventionCode": "SHA-19-292", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-10", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operative Hysteroscopy: Endometrial Ablation", + "interventionCode": "SHA-19-319", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Repair of rectovaginal fistula", + "interventionCode": "SHA-19-332", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Corneal cross-linking", + "interventionCode": "SHA-19-351", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Posterior Vitrectomy + Delamination + Oil", + "interventionCode": "SHA-19-386", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ptosis repair/revision", + "interventionCode": "SHA-19-389", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Retinopexy (Silicon Oil/Gas Insertion)", + "interventionCode": "SHA-19-393", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cyclophotocoagulation", + "interventionCode": "SHA-19-355", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Dacryocystorhinostomy (DCR)/Fistulectomy", + "interventionCode": "SHA-19-357", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Tendon transfer", + "interventionCode": "SHA-19-180", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Intravitreal Antibiotics/Steroid", + "interventionCode": "SHA-19-364", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Lid tumour Excision biopsy", + "interventionCode": "SHA-19-373", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Pupilloplasty", + "interventionCode": "SHA-19-392", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Trabeculectomy + Phacoemulsification cataract surgery", + "interventionCode": "SHA-19-400", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Above knees Amputation", + "interventionCode": "SHA-19-405", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Carpal tunnel decompression", + "interventionCode": "SHA-19-416", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Meniscus repair", + "interventionCode": "SHA-19-434", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Osteotomy and implants", + "interventionCode": "SHA-19-448", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Retinopexy (Silicon Oil/Gas Removal)", + "interventionCode": "SHA-19-394", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Scleral buckle removal", + "interventionCode": "SHA-19-396", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Chondroplasty", + "interventionCode": "SHA-19-418", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Open reduction and internal fixation: Femur", + "interventionCode": "SHA-19-444", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy: Tumours", + "interventionCode": "SHA-19-476", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Thyroidectomy", + "interventionCode": "SHA-19-181", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Squint Surgeries (all)", + "interventionCode": "SHA-19-398", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Above elbow Amputation", + "interventionCode": "SHA-19-404", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Anterior Cruciate Ligament (ACL)/ Posterior Cruciate Ligament (PCL) repair", + "interventionCode": "SHA-19-406", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bone grafting", + "interventionCode": "SHA-19-415", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Angle plating fracture neck of femur", + "interventionCode": "SHA-19-407", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of intervertebral disc", + "interventionCode": "SHA-19-422", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Illizarov procedure", + "interventionCode": "SHA-19-429", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Rotator cuff repair", + "interventionCode": "SHA-19-454", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Laparotomy: Intestinal resection + anastomosis", + "interventionCode": "SHA-19-473", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ptosis Surgery: Anterior levator repair/resection, frontalis sling suspension", + "interventionCode": "SHA-19-390", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Below elbow Amputation", + "interventionCode": "SHA-19-413", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Below knees Amputation", + "interventionCode": "SHA-19-414", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Total knee replacement (TKR) (Including implants, MUST have a peer review of three doctors)", + "interventionCode": "SHA-19-464", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Trabeculectomy + Small Incision Cataract surgery", + "interventionCode": "SHA-19-401", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Trabeculotomy/Goniotomy", + "interventionCode": "SHA-19-403", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-12", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Posterior Sagittal Anorectalplasty (PSARP) for anorectal malformation (Low ARM)", + "interventionCode": "SHA-19-489", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Nephro-ureterectomy", + "interventionCode": "SHA-19-511", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Orchidectomy & excision of spermatic cord", + "interventionCode": "SHA-19-517", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Arthrotomy", + "interventionCode": "SHA-19-411", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision head of fibula", + "interventionCode": "SHA-19-420", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Extra articular repair of joint ligament and implants", + "interventionCode": "SHA-19-426", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Intra articular Surgery (large joints)", + "interventionCode": "SHA-19-433", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Subacromial decompression", + "interventionCode": "SHA-19-456", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Tendon repair (others)", + "interventionCode": "SHA-19-459", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-13", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Biliary atresia (Kasai Kimura procedures, Porto – enterostomy)", + "interventionCode": "SHA-19-466", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-14", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Advancement flaps (CANCERS/TRAUMA)", + "interventionCode": "SHA-19-483", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Rotation flaps", + "interventionCode": "SHA-19-492", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-15", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Bilateral re-implantation of ureter into bladder", + "interventionCode": "SHA-19-495", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Combined abdominal and vaginal operations on bladder", + "interventionCode": "SHA-19-497", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of Unilateral lower ureter and re-implantation", + "interventionCode": "SHA-19-508", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Open Prostatectomy", + "interventionCode": "SHA-19-512", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Retropubic suspension of bladder neck", + "interventionCode": "SHA-19-537", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Urethroplasty simple", + "interventionCode": "SHA-19-546", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Repair of hiatus hernia", + "interventionCode": "SHA-19-162", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Stripping of bilateral varicose veins", + "interventionCode": "SHA-19-173", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ureteroscopic extraction of calculus in ureter flexible", + "interventionCode": "SHA-19-543", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Segmental resection of breast under general anesthesia for oncology cases", + "interventionCode": "SHA-19-169", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Splenectomy", + "interventionCode": "SHA-19-172", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operative Hysteroscopy: Avulsion of Endometrial Polyps", + "interventionCode": "SHA-19-317", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-11", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Excision of Thyroglossal cyst", + "interventionCode": "SHA-19-138", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Tendon Repair: Achilles tendon", + "interventionCode": "SHA-19-177", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Total Gastrectomy", + "interventionCode": "SHA-19-182", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Haemorrhoidectomy", + "interventionCode": "SHA-19-144", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Simple Mastectomy", + "interventionCode": "SHA-19-170", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Tracheostomy", + "interventionCode": "SHA-19-184", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-07", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Ultrasound-guided abdominal and peripheral biopsies", + "interventionCode": "SHA-19-207", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-08", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Open pyeloplasty", + "interventionCode": "SHA-19-513", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Operation on varicocele laparoscopic", + "interventionCode": "SHA-19-515", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-16", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Cardiac/Respiratory Arrest", + "interventionCode": "SHA-01-003", + "interventionPackage": "SHA-01", + "interventionSubPackage": "SHA-01-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Full Blood Count", + "interventionCode": "SHA-06-029", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Urea / Electrolytes / Creatinine", + "interventionCode": "SHA-06-030", + "interventionPackage": "SHA-06", + "interventionSubPackage": "SHA-06-SC-01", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Retrieval of Foreign bodies", + "interventionCode": "SHA-19-023", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Right and Left Catheterization", + "interventionCode": "SHA-19-024", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-04", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Coarctation of Aorta repair with graft", + "interventionCode": "SHA-19-037", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Coarctation of Aorta repair without graft", + "interventionCode": "SHA-19-038", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Splenorenal shunt", + "interventionCode": "SHA-19-066", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Thoracoscopy", + "interventionCode": "SHA-19-068", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Thoracoscopy/Mediastinoscopy with biopsy", + "interventionCode": "SHA-19-069", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + }, + { + "interventionName": "Thoracotomy -Diaphragmatic Hernia with a mesh", + "interventionCode": "SHA-19-070", + "interventionPackage": "SHA-19", + "interventionSubPackage": "SHA-19-SC-05", + "interventionDescription": null, + "insuranceSchemes": [] + } + ] +} \ No newline at end of file diff --git a/packages/esm-billing-app/src/hooks/useInterventions.ts b/packages/esm-billing-app/src/hooks/useInterventions.ts index ea82027b..5d4f814b 100644 --- a/packages/esm-billing-app/src/hooks/useInterventions.ts +++ b/packages/esm-billing-app/src/hooks/useInterventions.ts @@ -22,6 +22,23 @@ export const toQueryParams = (q: Record) => { ); }; +type Data = { + status: string; + data: Array<{ + interventionName: string; + interventionCode: string; + interventionPackage: string; + interventionSubPackage: string; + interventionDescription?: string; + insuranceSchemes: Array<{ + rules: Array<{ + ruleName: string; + ruleCode: string; + value: string; + }>; + }>; + }>; +}; export const useInterventions = (filters: InterventionsFilter) => { const fetcher = (url: string) => { return openmrsFetch(url, { @@ -36,29 +53,33 @@ export const useInterventions = (filters: InterventionsFilter) => { }); }; - const url = `${restBaseUrl}/insuranceclaims/claims/interventions/query${toQueryParams(filters)}`; - const { isLoading, error, data } = useSWR< - FetchResponse<{ - status: string; - data: Array<{ - interventionName: string; - interventionCode: string; - interventionPackage: string; - interventionSubPackage: string; - interventionDescription?: string; - }>; - }> - >(url, fetcher); + const url = `${restBaseUrl}/kenyaemr/sha-interventions${toQueryParams({ + ...filters, + synchronize: false, + })}`; + const { isLoading, error, data } = useSWR<{ data: Data }>(url, async (url: string) => { + const payload = require('./payload.json'); + return { data: payload }; + }); + return { isLoading, - interventions: (data?.data?.data ?? []).map( - ({ interventionCode, interventionName, interventionPackage, interventionSubPackage, interventionDescription }) => + interventions: (data?.data as Data | undefined)?.data + ?.filter((d) => d.interventionPackage === filters.package_code) + ?.map( ({ interventionCode, - subCategoryBenefitsPackage: interventionSubPackage, interventionName, - } as SHAIntervention), - ), + interventionPackage, + interventionSubPackage, + interventionDescription, + }) => + ({ + interventionCode, + subCategoryBenefitsPackage: interventionSubPackage, + interventionName, + } as SHAIntervention), + ), error, }; }; diff --git a/packages/esm-billing-app/src/hooks/usePackages.ts b/packages/esm-billing-app/src/hooks/usePackages.ts index 372ded62..9a3769ec 100644 --- a/packages/esm-billing-app/src/hooks/usePackages.ts +++ b/packages/esm-billing-app/src/hooks/usePackages.ts @@ -7,16 +7,13 @@ import { Package } from '../types'; * @returns */ const usePackages = () => { - const url = `${restBaseUrl}/insuranceclaims/claims/benefit-package`; + const url = `${restBaseUrl}/kenyaemr/sha-benefits-package?synchronize=false`; - const { data, isLoading, error } = useSWR>>( - url, - openmrsFetch, - ); + const { data, isLoading, error } = useSWR>(url, openmrsFetch); return { isLoading, - packages: (data?.data ?? []).map( + packages: (data?.data.shaBenefitsPackage ? JSON.parse(data?.data.shaBenefitsPackage) : []).map( (category) => ({ uuid: `${category.code}`,