network-decision-example-indeterminate

NetworkDecision Example (indeterminate)

{
    "status": "INDETERMINATE",
    "rules": [
        {
            "uuid": "ab280ee0-5f66-4076-9d1b-255d5f0024e3",
            "name": "Rule 1: Aetna | MA, NY, WA | PPO | Hooli Health | Pied Piper - INN",
            "status": "IN_NETWORK",
            "notes": "Requires manual review",
            "metadata": {
                "selfPay": false,
                "priority": 1,
                "packageId": "123456"
            },
            "startDate": "2026-10-01",
            "endDate": "2027-10-01",
            "conditions": [
                {
                    "key": "payerId",
                    "operator": "EQUAL",
                    "values": ["V404110"]
                },
                {
                    "key": "payerName",
                    "operator": "INCLUDE",
                    "values": ["Aetna"]
                },
                {
                    "key": "state",
                    "operator": "EQUAL",
                    "values": ["MA", "NY", "WA"]
                },
                {
                    "key": "insuranceTypeCodes",
                    "operator": "INCLUDE",
                    "values": ["PR"]
                },
                {
                    "key": "planName",
                    "operator": "INCLUDE",
                    "values": ["PPO"]
                },
                {
                    "key": "relatedEntites",
                    "operator": "INCLUDE",
                    "values": ["Hooli Health"]
                },
                {
                    "key": "groupNumber",
                    "operator": "EQUAL",
                    "values": ["123456-123-12345"]
                },
                {
                    "key": "groupName",
                    "operator": "INCLUDE",
                    "values": ["Pied Piper"]
                }
            ]
        },
        {
            "uuid": "ea703d40-a073-454e-ae3e-3931e8e2cf5a",
            "name": "Rule 2: UnitedHealthcare | HMO | Hooli Health - OON",
            "status": "OUT_OF_NETWORK",
            "conditions": [
                {
                    "key": "payerName",
                    "operator": "INCLUDE",
                    "values": ["UnitedHealthcare", "United Healthcare"]
                },
                {
                    "key": "insuranceTypeCodes",
                    "operator": "NOT_INCLUDE",
                    "values": ["HM"]
                },
                {
                    "key": "relatedEntites",
                    "operator": "INCLUDE",
                    "values": ["Hooli Health"]
                }
            ]
        }
    ]
}