Policy Logic Extractor
Extraction Results
Source Documents
-
Process_Guide_-_APA__ADLTC_How_To_Guide_2.19.25.pdf
SuccessType: PDF Size: 17972.1 KB TokensTokens are the basic units of text that AI models process. A token is roughly 4 characters or 0.75 words on average.: 59592 Words: 36999
Extraction summary
Total rules
36
- 30 definition
- 5 eligibility
- 1 validation
Quality score
Fair
Overall status
Success
Validation Failed
The generated code has 2 errors. See the Syntax Validation section below for details.
The following 36 rules were extracted from your document:
Filter Rules
Showing 36 of 36 rules
Sort by:
-
new-cert-period-start-month-set-to-month-after-determination-date
definition A policy rule extracted from the document Low (60%)new-cert-period-start-month-set-to-month-after-determination-date
-
alert-cannot-be-used-as-death-verification
definition A policy rule extracted from the document Low (60%)alert-cannot-be-used-as-death-verification
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new-cert-period-start-month-set-to-month-after-current-cert-period-end
definition A policy rule extracted from the document Low (60%)new-cert-period-start-month-set-to-month-after-current-cert-period-end
-
verify-client-is-deceased
definition A policy rule extracted from the document Low (60%)verify-client-is-deceased
-
subtract-allocation-amounts-dollar-for-dollar-from-sponsor-income
definition A policy rule extracted from the document Low (60%)subtract-allocation-amounts-dollar-for-dollar-from-sponsor-income
-
deny-application-for-not-being-in-ssi-pay-status
definition A policy rule extracted from the document Low (60%)deny-application-for-not-being-in-ssi-pay-status
-
apply-full-deemed-income-amount-to-each-alien-without-proration
definition A policy rule extracted from the document Low (60%)apply-full-deemed-income-amount-to-each-alien-without-proration
-
do-not-update-name-in-eis
definition A policy rule extracted from the document Low (60%)do-not-update-name-in-eis
-
pend-case-for-ssi-application-pursuit-and-pay-status-using-p007
definition A policy rule extracted from the document Low (60%)pend-case-for-ssi-application-pursuit-and-pay-status-using-p007
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pend-case-for-ssi-application-pursuit-and-pay-status-using-p006
definition A policy rule extracted from the document Low (60%)pend-case-for-ssi-application-pursuit-and-pay-status-using-p006
-
update-apa-living-arrangement
definition A policy rule extracted from the document Low (60%)update-apa-living-arrangement
-
set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse
definition A policy rule extracted from the document Low (60%)set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse
-
register-sp-but-code-only-pi-as-in
definition A policy rule extracted from the document Low (60%)register-sp-but-code-only-pi-as-in
-
use-auth-screen-apas
definition A policy rule extracted from the document Low (60%)use-auth-screen-apas
-
residency-verification-required
definition A policy rule extracted from the document Low (60%)residency-verification-required
-
residency-verification-required
definition A policy rule extracted from the document Low (60%)residency-verification-required
-
slmb-covers-medicare-part-b-only
definition A policy rule extracted from the document Low (60%)slmb-covers-medicare-part-b-only
-
use-standalone-case-number
definition A policy rule extracted from the document Low (60%)use-standalone-case-number
-
set-benefit-start-date-to-application-month
definition A policy rule extracted from the document Low (60%)set-benefit-start-date-to-application-month
-
certify-for-12-months
definition A policy rule extracted from the document Low (60%)certify-for-12-months
-
set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse
definition A policy rule extracted from the document Low (60%)set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse
-
register-sp-but-code-only-pi-as-in
definition A policy rule extracted from the document Low (60%)register-sp-but-code-only-pi-as-in
-
use-auth-screen-apmm
definition A policy rule extracted from the document Low (60%)use-auth-screen-apmm
-
benefit-shows-with-issuance-code-b-on-mebh
definition A policy rule extracted from the document Low (60%)benefit-shows-with-issuance-code-b-on-mebh
-
use-notice-code-m113
definition A policy rule extracted from the document Low (60%)use-notice-code-m113
-
use-notice-code-m805
definition A policy rule extracted from the document Low (60%)use-notice-code-m805
-
use-notice-code-m110
definition A policy rule extracted from the document Low (60%)use-notice-code-m110
-
use-notice-code-m804
definition A policy rule extracted from the document Low (60%)use-notice-code-m804
-
use-notice-code-m116
definition A policy rule extracted from the document Low (60%)use-notice-code-m116
-
use-notice-code-m816
definition A policy rule extracted from the document Low (60%)use-notice-code-m816
-
parent-ineligible-for-atap
eligibility Determines who qualifies for a benefit or service Low (60%)parent-ineligible-for-atap
-
client-ineligible-for-ia
eligibility Determines who qualifies for a benefit or service Low (60%)client-ineligible-for-ia
-
retro-eligibility-not-allowed
eligibility Determines who qualifies for a benefit or service Low (60%)retro-eligibility-not-allowed
-
allow-retro-eligibility-no-further-back-than-january
eligibility Determines who qualifies for a benefit or service Low (60%)allow-retro-eligibility-no-further-back-than-january
-
client-is-not-dual-eligible-with-apa-or-medicaid
eligibility Determines who qualifies for a benefit or service Low (60%)client-is-not-dual-eligible-with-apa-or-medicaid
-
initialize-and-authorize-into-current-system-month-and-check-mebh-screen
validation Specifies data requirements and verification checks Low (60%)initialize-and-authorize-into-current-system-month-and-check-mebh-screen
No Conflicts Detected
The extracted rules are consistent. No conflicts were found between the policy rules.
Referenced External Documents
The following external documents are referenced in this policy but were not included in the upload:
External External Documents (1)
-
7 AAC 40.375
Source text: "7 AAC 40.375"
Confidence: 70%
{
"_metadata": {
"source": "Policy logic extracted from: Process_Guide_-_APA__ADLTC_How_To_Guide_2.19.25.pdf",
"generator": "Policy Logic Extractor",
"format": "json-rules-engine"
},
"rules": [
{
"name": "MAGI New Cert Period Start Date",
"priority": 20,
"conditions": {
"all": [
{
"fact": "programType",
"operator": "equal",
"value": "MAGI"
}
]
},
"event": {
"type": "new-cert-period-start-month-set-to-month-after-determination-date",
"params": {
"ruleId": "rule-001",
"ruleName": "MAGI New Cert Period Start Date",
"consequence": "new_cert_period_start_month = month_after_determination_date",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
"sourceSection": "FIRST MONTH OF NEW CERT PERIOD",
"ruleType": "computation",
"calculationMethod": "month_after_determination"
}
}
},
{
"name": "SDX Client Deceased Alert Cannot Verify Death",
"priority": 150,
"conditions": {
"all": [
{
"fact": "alertType",
"operator": "equal",
"value": "SDX_CLIENT_DECEASED"
}
]
},
"event": {
"type": "alert-cannot-be-used-as-death-verification",
"params": {
"ruleId": "rule-002",
"ruleName": "SDX Client Deceased Alert Cannot Verify Death",
"consequence": "alert_cannot_be_used_as_death_verification; death_must_be_verified_through_other_means",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_How_To_Guide_CC_L&D_01_2025",
"sourceSection": "SDX_CLIENT_DECEASED",
"ruleType": "prohibition"
}
}
},
{
"name": "Non-MAGI Timely Review New Cert Period Start Date",
"priority": 20,
"conditions": {
"all": [
{
"fact": "programType",
"operator": "notEqual",
"value": "MAGI"
},
{
"fact": "reviewType",
"operator": "equal",
"value": "timely"
}
]
},
"event": {
"type": "new-cert-period-start-month-set-to-month-after-current-cert-period-end",
"params": {
"ruleId": "rule-003",
"ruleName": "Non-MAGI Timely Review New Cert Period Start Date",
"consequence": "new_cert_period_start_month = month_after_current_cert_period_end_date",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
"sourceSection": "FIRST MONTH OF NEW CERT PERIOD / REGISTRATION PROCESS STEPS FOR EARLY APA/ME REVIEWS",
"ruleType": "computation",
"calculationMethod": "month_after_current_cert_period_end",
"reviewClassification": "timely"
}
}
},
{
"name": "SDX Client Deceased - Verify Death",
"priority": 140,
"conditions": {
"all": [
{
"fact": "alertType",
"operator": "equal",
"value": "SDX_CLIENT_DECEASED"
}
]
},
"event": {
"type": "verify-client-is-deceased",
"params": {
"ruleId": "rule-004",
"ruleName": "SDX Client Deceased - Verify Death",
"consequence": "verify_client_is_deceased",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_How_To_Guide_CC_L&D_01_2025",
"sourceSection": "SDX_CLIENT_DECEASED",
"ruleType": "procedural",
"step": 2,
"verificationMethods": [
"INME_13",
"INME_14",
"Obituary",
"Collateral_Contacts",
"Burial_Application"
]
}
}
},
{
"name": "SSI Recipients Ineligible for ATAP",
"priority": 100,
"conditions": {
"all": [
{
"fact": "parentReceivesSsi",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "parent-ineligible-for-atap",
"params": {
"ruleId": "rule-005",
"ruleName": "SSI Recipients Ineligible for ATAP",
"consequence": "parent_ineligible_for_atap",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_process_guide_2025.pdf",
"sourceSection": "ATAP WITH APA - SSI Recipients",
"ruleType": "disqualification",
"reference": "ATAP MS 754-8, 758-6"
}
}
},
{
"name": "Dollar-for-Dollar Allocation Reduction of Sponsor Income",
"priority": 20,
"conditions": {
"all": [
{
"fact": "sponsorGrossIncome",
"operator": "greaterThan",
"value": 0
},
{
"fact": "calculationContext",
"operator": "equal",
"value": "alien_deeming_allocation"
}
]
},
"event": {
"type": "subtract-allocation-amounts-dollar-for-dollar-from-sponsor-income",
"params": {
"ruleId": "rule-006",
"ruleName": "Dollar-for-Dollar Allocation Reduction of Sponsor Income",
"consequence": "subtract_allocation_amounts_dollar_for_dollar_from_sponsor_income",
"confidence": 0.97,
"sourceDocument": "APA_ADLTC_How-To_Process_Guide",
"sourceSection": "APA MS 460-5B",
"ruleType": "computation",
"reductionMethod": "dollar_for_dollar"
}
}
},
{
"name": "APA Application Denial - Pended Case Not in SSI Pay Status",
"priority": 75,
"conditions": {
"all": [
{
"fact": "alertType",
"operator": "equal",
"value": "SDX_TERMINATED"
},
{
"fact": "caseType",
"operator": "equal",
"value": "APA_APP"
},
{
"fact": "caseWasPended",
"operator": "equal",
"value": true
},
{
"fact": "caseSsiInPayStatus",
"operator": "equal",
"value": false
}
]
},
"event": {
"type": "deny-application-for-not-being-in-ssi-pay-status",
"params": {
"ruleId": "rule-007",
"ruleName": "APA Application Denial - Pended Case Not in SSI Pay Status",
"consequence": "deny_application_for_not_being_in_SSI_pay_status",
"confidence": 0.97,
"sourceDocument": "APA_ADLTC_process_guide_CC_LD_01_2025",
"sourceSection": "SDX-TERMINATED-STEP-5a",
"ruleType": "eligibility",
"caseType": "APA_APP",
"action": "deny",
"reason": "not_in_SSI_pay_status"
}
}
},
{
"name": "No Proration of Deemed Income for Multiple Aliens",
"priority": 20,
"conditions": {
"all": [
{
"fact": "sponsorNumberOfFinanciallyResponsibleAliens",
"operator": "greaterThan",
"value": 1
},
{
"fact": "calculationContext",
"operator": "equal",
"value": "alien_deeming"
}
]
},
"event": {
"type": "apply-full-deemed-income-amount-to-each-alien-without-proration",
"params": {
"ruleId": "rule-008",
"ruleName": "No Proration of Deemed Income for Multiple Aliens",
"consequence": "apply_full_deemed_income_amount_to_each_alien_without_proration",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_How-To_Process_Guide",
"sourceSection": "APA MS 460-2B",
"ruleType": "computation",
"prorationProhibited": true
}
}
},
{
"name": "Prohibition - Do Not Update Name Without Proof",
"priority": 150,
"conditions": {
"all": [
{
"fact": "alertType",
"operator": "equal",
"value": "SVES_DOB_SSN_CONFLICT"
},
{
"fact": "proofOfNameReceived",
"operator": "equal",
"value": false
}
]
},
"event": {
"type": "do-not-update-name-in-eis",
"params": {
"ruleId": "rule-009",
"ruleName": "Prohibition - Do Not Update Name Without Proof",
"consequence": "do_not_update_name_in_EIS",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_How-To_Process_Guide_CC_LD_01_2025",
"sourceSection": "SVES DOB/SSN CONFLICT - Step 5",
"ruleType": "prohibition"
}
}
},
{
"name": "APA Application Pend - Case Not Pended and SSI Pay Status Needed",
"priority": 60,
"conditions": {
"all": [
{
"fact": "alertType",
"operator": "equal",
"value": "SDX_TERMINATED"
},
{
"fact": "caseType",
"operator": "equal",
"value": "APA_APP"
},
{
"fact": "caseWasPended",
"operator": "equal",
"value": false
},
{
"fact": "caseSsiInPayStatusNeeded",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "pend-case-for-ssi-application-pursuit-and-pay-status-using-p007",
"params": {
"ruleId": "rule-010",
"ruleName": "APA Application Pend - Case Not Pended and SSI Pay Status Needed",
"consequence": "pend_case_for_SSI_application_pursuit_and_pay_status_using_P007",
"confidence": 0.97,
"sourceDocument": "APA_ADLTC_process_guide_CC_LD_01_2025",
"sourceSection": "SDX-TERMINATED-STEP-5b",
"ruleType": "procedural",
"caseType": "APA_APP",
"action": "pend",
"form": "P007",
"pendDurationDays": 30
}
}
},
{
"name": "APA Ongoing Pend - Case Not Pended and SSI Pay Status Needed",
"priority": 60,
"conditions": {
"all": [
{
"fact": "alertType",
"operator": "equal",
"value": "SDX_TERMINATED"
},
{
"fact": "caseType",
"operator": "equal",
"value": "APA_ONGOING"
},
{
"fact": "caseWasPended",
"operator": "equal",
"value": false
},
{
"fact": "caseSsiInPayStatusNeeded",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "pend-case-for-ssi-application-pursuit-and-pay-status-using-p006",
"params": {
"ruleId": "rule-011",
"ruleName": "APA Ongoing Pend - Case Not Pended and SSI Pay Status Needed",
"consequence": "pend_case_for_SSI_application_pursuit_and_pay_status_using_P006",
"confidence": 0.97,
"sourceDocument": "APA_ADLTC_process_guide_CC_LD_01_2025",
"sourceSection": "SDX-TERMINATED-STEP-5b",
"ruleType": "procedural",
"caseType": "APA_ONGOING",
"action": "pend",
"form": "P006",
"pendDurationDays": 30
}
}
},
{
"name": "TA Recipients Ineligible for IA",
"priority": 100,
"conditions": {
"all": [
{
"fact": "clientReceivesTa",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "client-ineligible-for-ia",
"params": {
"ruleId": "rule-012",
"ruleName": "TA Recipients Ineligible for IA",
"consequence": "client_ineligible_for_ia",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_process_guide_2025.pdf",
"sourceSection": "ATAP WITH APA - TA and IA Eligibility",
"ruleType": "disqualification",
"reference": "APA MS 426-9"
}
}
},
{
"name": "QMB No Retro Eligibility",
"priority": 100,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
}
]
},
"event": {
"type": "retro-eligibility-not-allowed",
"params": {
"ruleId": "rule-013",
"ruleName": "QMB No Retro Eligibility",
"consequence": "retro_eligibility_not_allowed",
"confidence": 0.99,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
"ruleType": "eligibility",
"retroEligibility": false
}
}
},
{
"name": "Update APA Living Arrangement When ATAP Opens or Closes",
"priority": 30,
"conditions": {
"all": [
{
"fact": "atapCaseStatusChanged",
"operator": "equal",
"value": true
},
{
"fact": "atapCaseNewStatus",
"operator": "in",
"value": [
"opened",
"closed"
]
}
]
},
"event": {
"type": "update-apa-living-arrangement",
"params": {
"ruleId": "rule-014",
"ruleName": "Update APA Living Arrangement When ATAP Opens or Closes",
"consequence": "update_apa_living_arrangement",
"confidence": 0.97,
"sourceDocument": "APA_ADLTC_process_guide_2025.pdf",
"sourceSection": "ATAP WITH APA - Update APA Living Arrangement",
"ruleType": "procedural",
"triggerEvents": [
"ATAP_opened",
"ATAP_closed"
]
}
}
},
{
"name": "QMB Household Size",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
}
]
},
"event": {
"type": "set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse",
"params": {
"ruleId": "rule-015",
"ruleName": "QMB Household Size",
"consequence": "set_household_size_to_1_if_PI_only_or_2_if_PI_and_spouse",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
"ruleType": "procedural",
"householdSizeOptions": [
1,
2
]
}
}
},
{
"name": "QMB Spouse Registration and Coding",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
},
{
"fact": "householdHasSpouse",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "register-sp-but-code-only-pi-as-in",
"params": {
"ruleId": "rule-016",
"ruleName": "QMB Spouse Registration and Coding",
"consequence": "register_SP_but_code_only_PI_as_in",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
"ruleType": "procedural"
}
}
},
{
"name": "QMB Auth Screen - Dual Eligible",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
},
{
"fact": "clientIsDualEligibleWithApa",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "use-auth-screen-apas",
"params": {
"ruleId": "rule-017",
"ruleName": "QMB Auth Screen - Dual Eligible",
"consequence": "use_auth_screen_APAS",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
"ruleType": "procedural",
"authScreen": "APAS"
}
}
},
{
"name": "APA Applicant Residency Verification Required",
"priority": 30,
"conditions": {
"all": [
{
"fact": "personProgram",
"operator": "equal",
"value": "APA"
},
{
"fact": "personStatus",
"operator": "equal",
"value": "applicant"
}
]
},
"event": {
"type": "residency-verification-required",
"params": {
"ruleId": "rule-018",
"ruleName": "APA Applicant Residency Verification Required",
"consequence": "residency_verification_required",
"confidence": 0.99,
"sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
"sourceSection": "verifying_ak_residency",
"ruleType": "verification"
}
}
},
{
"name": "APA Recipient Residency Verification Only If Questionable",
"priority": 40,
"conditions": {
"all": [
{
"fact": "personProgram",
"operator": "equal",
"value": "APA"
},
{
"fact": "personStatus",
"operator": "equal",
"value": "recipient"
},
{
"fact": "personResidencyIsQuestionable",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "residency-verification-required",
"params": {
"ruleId": "rule-019",
"ruleName": "APA Recipient Residency Verification Only If Questionable",
"consequence": "residency_verification_required",
"confidence": 0.97,
"sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
"sourceSection": "verifying_ak_residency",
"ruleType": "verification"
}
}
},
{
"name": "SLMB Coverage - Medicare Part B Only",
"priority": 20,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "slmb-covers-medicare-part-b-only",
"params": {
"ruleId": "rule-020",
"ruleName": "SLMB Coverage - Medicare Part B Only",
"consequence": "SLMB_covers_Medicare_Part_B_only",
"confidence": 0.99,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "benefit_coverage"
}
}
},
{
"name": "SLMB Case Numbering - Standalone",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "use-standalone-case-number",
"params": {
"ruleId": "rule-021",
"ruleName": "SLMB Case Numbering - Standalone",
"consequence": "use_standalone_case_number",
"confidence": 0.99,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural"
}
}
},
{
"name": "SLMB Benefit Start Date",
"priority": 20,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "set-benefit-start-date-to-application-month",
"params": {
"ruleId": "rule-022",
"ruleName": "SLMB Benefit Start Date",
"consequence": "set_benefit_start_date_to_application_month",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "eligibility_date"
}
}
},
{
"name": "SLMB Retro Eligibility - Limited to January",
"priority": 25,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
},
{
"fact": "caseRetroEligibilityRequested",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "allow-retro-eligibility-no-further-back-than-january",
"params": {
"ruleId": "rule-023",
"ruleName": "SLMB Retro Eligibility - Limited to January",
"consequence": "allow_retro_eligibility_no_further_back_than_January",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "eligibility",
"retroEligibility": true,
"retroLimit": "January of current year"
}
}
},
{
"name": "SLMB Not Dual Eligible",
"priority": 100,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "client-is-not-dual-eligible-with-apa-or-medicaid",
"params": {
"ruleId": "rule-024",
"ruleName": "SLMB Not Dual Eligible",
"consequence": "client_is_not_dual_eligible_with_APA_or_Medicaid",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "eligibility"
}
}
},
{
"name": "SLMB Certification Period",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "certify-for-12-months",
"params": {
"ruleId": "rule-025",
"ruleName": "SLMB Certification Period",
"consequence": "certify_for_12_months",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural",
"certificationPeriodMonths": 12
}
}
},
{
"name": "SLMB Household Size",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse",
"params": {
"ruleId": "rule-026",
"ruleName": "SLMB Household Size",
"consequence": "set_household_size_to_1_if_PI_only_or_2_if_PI_and_spouse",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural",
"householdSizeOptions": [
1,
2
]
}
}
},
{
"name": "SLMB Spouse Registration and Coding",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
},
{
"fact": "householdHasSpouse",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "register-sp-but-code-only-pi-as-in",
"params": {
"ruleId": "rule-027",
"ruleName": "SLMB Spouse Registration and Coding",
"consequence": "register_SP_but_code_only_PI_as_in",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural"
}
}
},
{
"name": "SLMB Auth Screen",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "use-auth-screen-apmm",
"params": {
"ruleId": "rule-028",
"ruleName": "SLMB Auth Screen",
"consequence": "use_auth_screen_APMM",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural",
"authScreen": "APMM"
}
}
},
{
"name": "SLMB Paid Benefits Issuance Code",
"priority": 20,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
},
{
"fact": "benefitIsPaid",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "benefit-shows-with-issuance-code-b-on-mebh",
"params": {
"ruleId": "rule-029",
"ruleName": "SLMB Paid Benefits Issuance Code",
"consequence": "benefit_shows_with_issuance_code_B_on_MEBH",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural",
"issuanceCode": "B"
}
}
},
{
"name": "SLMB Final Action - Check MEBH Screen",
"priority": 10,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
}
]
},
"event": {
"type": "initialize-and-authorize-into-current-system-month-and-check-mebh-screen",
"params": {
"ruleId": "rule-031",
"ruleName": "SLMB Final Action - Check MEBH Screen",
"consequence": "initialize_and_authorize_into_current_system_month_and_check_MEBH_screen",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural"
}
}
},
{
"name": "SLMB Notice Code - Application Approved",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
},
{
"fact": "caseAction",
"operator": "equal",
"value": "APPLICATION"
},
{
"fact": "caseStatus",
"operator": "equal",
"value": "APPROVED"
}
]
},
"event": {
"type": "use-notice-code-m113",
"params": {
"ruleId": "rule-032",
"ruleName": "SLMB Notice Code - Application Approved",
"consequence": "use_notice_code_M113",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural",
"noticeCode": "M113"
}
}
},
{
"name": "SLMB Notice Code - Renewal Approved",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "SLMB"
},
{
"fact": "caseAction",
"operator": "equal",
"value": "RENEWAL"
},
{
"fact": "caseStatus",
"operator": "equal",
"value": "APPROVED"
}
]
},
"event": {
"type": "use-notice-code-m805",
"params": {
"ruleId": "rule-033",
"ruleName": "SLMB Notice Code - Renewal Approved",
"consequence": "use_notice_code_M805",
"confidence": 0.97,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
"ruleType": "procedural",
"noticeCode": "M805"
}
}
},
{
"name": "QMB Notice Code - Application Approved With Medicaid",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
},
{
"fact": "caseAction",
"operator": "equal",
"value": "APPLICATION"
},
{
"fact": "caseStatus",
"operator": "equal",
"value": "APPROVED"
},
{
"fact": "clientHasMedicaid",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "use-notice-code-m110",
"params": {
"ruleId": "rule-034",
"ruleName": "QMB Notice Code - Application Approved With Medicaid",
"consequence": "use_notice_code_M110",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
"ruleType": "procedural",
"noticeCode": "M110"
}
}
},
{
"name": "QMB Notice Code - Renewal Approved With Medicaid",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
},
{
"fact": "caseAction",
"operator": "equal",
"value": "RENEWAL"
},
{
"fact": "caseStatus",
"operator": "equal",
"value": "APPROVED"
},
{
"fact": "clientHasMedicaid",
"operator": "equal",
"value": true
}
]
},
"event": {
"type": "use-notice-code-m804",
"params": {
"ruleId": "rule-035",
"ruleName": "QMB Notice Code - Renewal Approved With Medicaid",
"consequence": "use_notice_code_M804",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
"ruleType": "procedural",
"noticeCode": "M804"
}
}
},
{
"name": "QMB Notice Code - Application Approved Without Medicaid",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
},
{
"fact": "caseAction",
"operator": "equal",
"value": "APPLICATION"
},
{
"fact": "caseStatus",
"operator": "equal",
"value": "APPROVED"
},
{
"fact": "clientHasMedicaid",
"operator": "equal",
"value": false
}
]
},
"event": {
"type": "use-notice-code-m116",
"params": {
"ruleId": "rule-036",
"ruleName": "QMB Notice Code - Application Approved Without Medicaid",
"consequence": "use_notice_code_M116",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
"ruleType": "procedural",
"noticeCode": "M116"
}
}
},
{
"name": "QMB Notice Code - Renewal Approved Without Medicaid",
"priority": 30,
"conditions": {
"all": [
{
"fact": "clientProgram",
"operator": "equal",
"value": "QMB"
},
{
"fact": "caseAction",
"operator": "equal",
"value": "RENEWAL"
},
{
"fact": "caseStatus",
"operator": "equal",
"value": "APPROVED"
},
{
"fact": "clientHasMedicaid",
"operator": "equal",
"value": false
}
]
},
"event": {
"type": "use-notice-code-m816",
"params": {
"ruleId": "rule-037",
"ruleName": "QMB Notice Code - Renewal Approved Without Medicaid",
"consequence": "use_notice_code_M816",
"confidence": 0.95,
"sourceDocument": "caseworker_process_guide_APA.pdf",
"sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
"ruleType": "procedural",
"noticeCode": "M816"
}
}
}
]
}Use arrow keys to scroll through the code when focused on this region.
Retry Extraction
The extraction results require review. You can retry with increased resources.
Quality Score:
60/100
Issues Found:
- Acceptable quality extraction (score: 3.4/5.0) with 11 issues
- Reference integrity: 46% valid (1199 dangling references)
- Conflict status: 0 high, 118 medium conflicts
60
Quality: Fair
11 errors
10 warnings
This extraction has 11 errors that may affect rule accuracy.
- Coverage 25
- Completeness 50
- Conflict N/A
- Accuracy 75
Syntax Validation
2 errorsJSON-RULES-ENGINE syntax validation failed with 2 errors
| Type | Location | Message |
|---|---|---|
| syntax | — | |
| syntax | — |
Rule Review
36 rules extracted and ready for review. Review each rule to approve, reject, or edit before finalizing your policy logic.
Start ReviewDownloads the extracted policy rules as a .json file for json-rules-engine
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