bcb1a10fe6
- New CoverageFlag enum: SUPPLY_LAPSED, VISIT_REQUIRED, TRANSFER_PENDING, RENEWAL_CRITICAL/ELEVATED/SOON, RESUPPLY_READY, ACTIVE - Doc state machine: 5-item payer-dependent status per patient (SWO, Visit, PECOS, PA, Diagnosis) with cascade chain - Confirm Visit endpoint: staff enters prescriber-confirmed date, persisted in Supabase confirmed_visits table, survives all future CSV imports - Supabase migration: 001_add_confirmed_visits.sql (run manually in SQL editor) - Frontend: Badge rebuilt for 8 flags, DocStatusBar 5-dot display, ConfirmVisitModal, expandable WorklistTable rows - Legal: LOI, NDA, BAA drafts at pitch/legal/ for Nixon Law Group review - Compliance docs: privacy policy, incident response, data handling - CSV generator: market_data.json + PA/NJ generator scripts - 15/15 tests passing Co-Authored-By: Claude Sonnet 4.6 <noreply@anthropic.com>
73 lines
2.4 KiB
JSON
73 lines
2.4 KiB
JSON
{
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"_comment": "Wear-day rules by device type and payer. Updated 2026-06-07. Run quarterly review per compliance checklist.",
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"devices": {
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"dexcom_g6": {
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"display_name": "Dexcom G6",
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"sensor_wear_days": 10,
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"transmitter_wear_days": 90,
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"components": ["sensor", "transmitter"]
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},
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"dexcom_g7": {
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"display_name": "Dexcom G7",
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"sensor_wear_days": 10,
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"components": ["sensor"]
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},
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"freestyle_libre_2": {
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"display_name": "FreeStyle Libre 2",
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"sensor_wear_days": 14,
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"components": ["sensor"]
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},
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"freestyle_libre_3": {
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"display_name": "FreeStyle Libre 3",
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"sensor_wear_days": 14,
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"components": ["sensor"]
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},
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"omnipod_5": {
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"display_name": "Omnipod 5",
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"pod_wear_days": 3,
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"sensor_wear_days": 14,
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"components": ["pod", "sensor"]
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}
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},
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"payer_rules": {
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"medicare": {
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"visit_renewal_days": 180,
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"refill_window_days": 30,
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"pa_required": false,
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"pecos_required": true,
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"_note": "Medicare FFS. PA not required (CGM coverage expansion 2023). Face-to-face visit required every 6 months. CMS-1828-F: suppliers at >=90% affirmation rate may qualify for PA exemption from June 1, 2026.",
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"covered_devices": ["dexcom_g6", "dexcom_g7", "freestyle_libre_2", "freestyle_libre_3"]
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},
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"medicare_advantage": {
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"visit_renewal_days": 180,
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"refill_window_days": 30,
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"pa_required": true,
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"pecos_required": true,
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"_note": "Medicare Advantage — PA required, varies by plan. Verify plan-specific rules.",
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"covered_devices": ["dexcom_g6", "dexcom_g7", "freestyle_libre_2", "freestyle_libre_3"]
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},
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"medicaid": {
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"visit_renewal_days": 180,
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"refill_window_days": 30,
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"pa_required": true,
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"pecos_required": false,
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"_note": "PA required — Keystone First, UPMC Health Plan, Highmark BCBS require PA. NJ FamilyCare, Horizon BCBS NJ require PA.",
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"covered_devices": []
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},
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"commercial": {
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"visit_renewal_days": 180,
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"refill_window_days": 30,
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"pa_required": true,
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"pecos_required": false,
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"_note": "Commercial payer rules vary by plan. PA required by default — verify per plan.",
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"covered_devices": []
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},
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"default": {
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"visit_renewal_days": 180,
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"refill_window_days": 30,
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"pa_required": true,
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"pecos_required": false,
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"covered_devices": []
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}
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}
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}
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