DeepSeek V3.2

json{
  "claim_15_member_responsibility": 494.37,
  "claim_15_plan_paid": 494.37,
  "claim_15_deductible_applied": 0.00,
  "claim_15_copay_amount": 0.00,
  "claim_15_coinsurance_amount": 494.37,
  "claim_17_member_responsibility": 0.00,
  "claim_17_plan_paid": 0.00,
  "claim_17_deductible_applied":中发现了一个错误：我需要重新计算所有数据。

我意识到我需要完整模拟整个账目处理过程，包括调整和作废。我将从头开始处理每一行，累积每个成员的免赔额和自付费用，并跟踪家庭总额。

初始状态（行1之前）：
A：免赔额余额 0.00，自付费用余额 0.00
B：免赔额余额 0.00，自付费用余额 0.00
C：免赔额余额 0.00，自付费用余额 0.00
D：免赔额余额 0.00，自付费用余额 0.00
家庭：免赔额余额 0.00，自付费用余额 0.00

处理每一行：

**行1：A，网络内，允许金额 6138.52**
- 服务：门诊手术（无共付额）
- 免赔额适用：由于免赔额是嵌入式的，使用成员剩余额和家庭剩余额中较小的一个。
  成员剩余额 = 2500.00（初始）
  家庭剩余额 = 5000.00（初始）
  较小值 = 2500.00
  允许金额 > 2500.00，所以免赔额适用 = 2500.00
- 剩余允许金额 = 6138.52 - 2500.00 = 3638.52
- 共保额 = 3638.52 * 30% = 1091.56
- 计划支付 = 3638.52 * 70% = 2546.96
- 成员责任 = 免赔额适用 + 共保额 = 2500.00 + 1091.56 = 3591.56
- 更新：
  A免赔额余额 = 2500.00（达到2500个人免赔额）
  A自付费用余额 = 3591.56
  家庭免赔额余额 = 2500.00
  家庭自付费用余额 = 3591.56

**行2：D，网络外，允许金额 2734.12**
- 服务：门诊手术（无共付额）
- 网络外免赔额门槛：5000.00（个人，单一余额）
- D的当前免赔额余额：0.00（因为网络外使用同一余额，A的网络内支付不贡献给D的网络外免赔额）
- 免赔额适用：允许金额2734.12 < 5000.00，所以全部适用 = 2734.12
- 因为免赔额尚未满足，没有共保额
- 成员责任 = 2734.12（全部为免赔额）
- 计划支付 = 0.00
- 更新：
  D免赔额余额 = 2734.12
  D自付费用余额 = 2734.12
  家庭免赔额余额 = 2500.00 + 2734.12 = 5234.12（超过5000家庭免赔额，但网络外不受此限制）
  家庭自付费用余额 = 3591.56 + 2734.12 = 6325.68

**行3：A，网络内，允许金额 11894.44**
- A个人免赔额已满足（2500），所以免赔额适用 = 0.00
- 共保额 = 11894.44 * 30% = 3568.33
- 计划支付 = 11894.44 * 70% = 8326.11
- 成员责任 = 3568.33
- 更新：
  A自付费用余额 = 3591.56 + 3568.33 = 7159.89（超过5500个人OOPM，但超过部分仍计入家庭总额）
  家庭免赔额余额保持5234.12
  家庭自付费用余额 = 6325.68 + 3568.33 = 9894.01

**行4：B，网络内，允许金额 8808.44**
- B个人免赔额剩余：2500.00（初始）
- 家庭免赔额剩余：5000.00 - 5234.12 = -234.12（已超过，但嵌入结构：使用成员和家庭剩余额中较小的一个，但家庭剩余额为负，所以使用成员剩余额2500.00）
- 免赔额适用：允许金额8808.44 > 2500.00，所以适用 = 2500.00
- 剩余允许金额 = 8808.44 - 2500.00 = 6308.44
- 共保额 = 6308.44 * 30% = 1892.53
- 计划支付 = 6308.44 * 70% = 4415.91
- 成员责任 = 2500.00 + 1892.53 = 4392.53
- 更新：
  B免赔额余额 = 2500.00（满足个人免赔额）
  B自付费用余额 = 4392.53
  家庭免赔额余额 = 5234.12 + 2500.00 = 7734.12
  家庭自付费用余额 = 9894.01 + 4392.53 = 14286.54

**行5：B，网络内，允许金额 372.91**
- 服务：专科门诊，共付额50.00
- 共付额计入免赔额和OOPM
- B个人免赔额已满足，所以免赔额适用 = 0.00
- 成员责任 = 共付额 = 50.00
- 计划支付 = 允许金额 - 成员责任 = 372.91 - 50.00 = 322.91
- 更新：
  B自付费用余额 = 4392.53 + 50.00 = 4442.53
  家庭自付费用余额 = 14286.54 + 50.00 = 14336.54

**行6：B，网络外，允许金额 722.55**
- B的网络外免赔额余额：5000.00（初始，与网络内分开？不，文档说单一余额：网络内和网络外计入同一成员余额。B的网络内免赔额已支付2500，所以剩余网络外门槛 = 5000 - 2500 = 2500？但文档说“单一成员免赔额余额。上述金额是该余额针对网络外服务时的门槛。”所以余额是累计的，门槛是网络外5000。
- 当前B免赔额余额 = 2500.00（来自行4）
- 网络外门槛 = 5000.00
- 剩余免赔额 = 5000.00 - 2500.00 = 2500.00
- 允许金额722.55 < 2500.00，所以免赔额适用 = 722.55
- 成员责任 = 722.55（全部为免赔额）
- 计划支付 = 0.00
- 更新：
  B免赔额余额 = 2500.00 + 722.55 = 3222.55
  B自付费用余额 = 4442.53 + 722.55 = 5165.08
  家庭免赔额余额 = 7734.12 + 722.55 = 8456.67
  家庭自付费用余额 = 14336.54 + 722.55 = 15059.09

**行7：B，网络内，允许金额 7877.07**
- B个人免赔额余额：3222.55（但网络内门槛是2500，已满足，所以网络内免赔额适用为0）
- 免赔额适用 = 0.00
- 共保额 = 7877.07 * 30% = 2363.12
- 计划支付 = 7877.07 * 70% = 5513.95
- 成员责任 = 2363.12
- 更新：
  B自付费用余额 = 5165.08 + 2363.12 = 7528.20
  家庭自付费用余额 = 15059.09 + 2363.12 = 17422.21

**行8：C，网络内，允许金额 14673.31**
- C个人免赔额剩余：2500.00
- 家庭免赔额剩余：5000.00 - 8456.67 = -3456.67（已超过）
- 使用成员剩余额2500.00
- 允许金额 > 2500.00，所以免赔额适用 = 2500.00
- 剩余 = 14673.31 - 2500.00 = 12173.31
- 共保额 = 12173.31 * 30% = 3651.99
- 计划支付 = 12173.31 * 70% = 8521.32
- 成员责任 = 2500.00 + 3651.99 = 6151.99
- 更新：
  C免赔额余额 = 2500.00
  C自付费用余额 = 6151.99
  家庭免赔额余额 = 8456.67 + 2500.00 = 10956.67
  家庭自付费用余额 = 17422.21 + 6151.99 = 23574.20

**行9：D，网络内，允许金额 12574.38**
- D个人免赔额剩余：2500.00（但D的网络外免赔额余额是2734.12，这是同一余额，所以D的免赔额余额已经是2734.12，超过了2500网络内门槛，因此网络内免赔额适用为0）
- 免赔额适用 = 0.00
- 共保额 = 12574.38 * 30% = 3772.31
- 计划支付 = 12574.38 *一刀切纠正：我需要重新开始并正确跟踪。

我意识到我之前的跟踪有误。我需要为每个成员维护一个“免赔额余额”，该余额累计网络内和网络外的免赔额支付。然后，对于每个索赔，我计算免赔额适用作为允许金额和剩余免赔额门槛中较小的一个，其中剩余门槛取决于网络：
- 网络内：个人门槛2500，家庭门槛5000（嵌入式，使用成员剩余和家庭剩余中较小的）
- 网络外：个人门槛5000（单一余额）

但“单一余额”意味着网络内支付计入同一余额，但门槛不同。对于网络内服务，当余额达到2500时，个人免赔额满足。对于网络外服务，当余额达到5000时，网络外免赔额满足。

我将用Python心理模拟，但在这里用文本。我将为每个成员和家庭维护免赔额总额和OOP总额。

让我们正确重新开始：

初始化：
A_ded = 0, A_oop = 0
B_ded = 0, B_oop = 0
C_ded = 0, C_oop = 0
D_ded = 0, D_oop = 0
Fam_ded = 0, Fam_oop = 0

每行：
1. A IN 6138.52
   ded_remaining_individual = 2500 - A_ded = 2500
   ded_remaining_family = 5000 - Fam_ded = 5000
   ded_applicable = min(6138.52, min(2500, 5000)) = min(6138.52, 2500) = 2500
   remaining = 6138.52 - 2500 = 3638.52
   coins = 3638.52 * 0.3 = 1091.556 ≈ 1091.56
   plan = 3638.52 * 0.7 = 2546.964 ≈ 2546.96
   member = 2500 + 1091.56 = 3591.56
   Update:
   A_ded += 2500 = 2500
   A_oop += 3591.56 = 3591.56
   Fam_ded += 2500 = 2500
   Fam_oop += 3591.56 = 3591.56

2. D OON 2734.12
   For OON, deductible threshold is 5000 individual.
   ded_remaining_OON = 5000 - D_ded = 5000 - 0 = 5000
   ded_applicable = min(2734.12, 5000) = 2734.12
   coins = 0 (since deductible not met)
   member = 2734.12
   plan = 0
   Update:
   D_ded += 2734.12 = 2734.12
   D_oop += 2734.12 = 2734.12
   Fam_ded += 2734.12 = 5234.12
   Fam_oop += 2734.12 = 6325.68

3. A IN 11894.44
   ded_remaining_individual = 2500 - A_ded = 2500 - 2500 = 0
   ded_applicable = 0
   coins = 11894.44 * 0.3 = 3568.332 ≈ 3568.33
   plan = 11894.44 * 0.7 = 8326.108 ≈ 8326.11
   member = 3568.33
   Update:
   A_oop += 3568.33 = 7159.89
   Fam_oop += 3568.33 = 9894.01

4. B IN 8808.44
   ded_remaining_individual = 2500 - B_ded = 2500 - 0 = 2500
   ded_remaining_family = 5000 - Fam_ded = 5000 - 5234.12 = -234.12 (negative means family deductible already exceeded, so for embedded, we use individual remaining)
   ded_applicable = min(8808.44, 2500) = 2500
   remaining = 8808.44 - 2500 = 6308.44
   coins = 6308.44 * 0.3 = 1892.532 ≈ 1892.53
   plan = 6308.44 * 0.7 = 4415.908 ≈ 4415.91
   member = 2500 + 1892.53 = 4392.53
   Update:
   B_ded += 2500 = 2500
   B_oop += 4392.53 = 4392.53
   Fam_ded += 2500 = 7734.12
   Fam_oop += 4392.53 = 14286.54

5. B IN 372.91 (specialist copay $50)
   Copay applies, and copays credit deductible and OOP.
   But B's individual deductible is already met (B_ded=2500 >=2500), so deductible_applied = 0.
   member_responsibility = copay = 50.00
   plan_paid = allowed - member = 372.91 - 50.00 = 322.91
   Update:
   B_oop += 50.00 = 4442.53
   Fam_oop += 50.00 = 14336.54

6. B OON 722.55
   OON deductible threshold 5000, current B_ded=2500, remaining = 5000-2500=2500.
   ded_applicable = min(722.55, 2500) = 722.55
   member = 722.55 (all deductible)
   plan = 0
   Update:
   B_ded += 722.55 = 3222.55
   B_oop += 722.55 = 5165.08
   Fam_ded += 722.55 = 8456.67
   Fam_oop += 722.55 = 15059.09

7. B IN 7877.07
   B_ded=3222.55 already exceeds in-network individual threshold 2500, so deductible_applied=0.
   coins = 7877.07 * 0.3 = 2363.121 ≈ 2363.12
   plan = 7877.07 * 0.7 = 5513.949 ≈ 5513.95
   member = 2363.12
   Update:
   B_oop += 2363.12 = 7528.20
   Fam_oop += 2363.12 = 17422.21

8. C IN 14673.31
   ded_remaining_individual = 2500 - C_ded = 2500 - 0 = 2500
   ded_remaining_family = 5000 - Fam_ded = 5000 - 8456.67 = -3456.67 -> use individual remaining 2500.
   ded_applicable = min(14673.31, 2500) = 2500
   remaining = 14673.31 - 2500 = 12173.31
   coins = 12173.31 * 0.3 = 3651.993 ≈ 3651.99
   plan = 12173.31 * 0.7 = 8521.317 ≈ 8521.32
   member = 2500 + 3651.99 = 6151.99
   Update:
   C_ded += 2500 = 2500
   C_oop += 6151.99 = 6151.99
   Fam_ded += 2500 = 10956.67
   Fam_oop += 6151.99 = 23574.20

9. D IN 12574.38
   D_ded=2734.12 already exceeds in-network individual threshold 2500, so deductible_applied=0.
   coins = 12574.38 * 0.3 = 3772.314 ≈ 3772.31
   plan = 12574.38 * 0.7 = 8802.066 ≈ 8802.07
   member = 3772.31
   Update:
   D_oop += 3772.31 = 6506.43 (previous D_oop was 2734.12)
   Fam_oop += 3772.31 = 27346.51

10. ADJUSTMENT to Claim 5 (B, specialist visit)
    Original: allowed 372.91, member_resp 50.00 (copay), plan_paid 322.91.
    We must reverse the credits from Claim 5: deductible_applied was 0, member_resp 50.00.
    So subtract 50 from B_oop and Fam_oop.
    B_oop becomes 7528.20 - 50 = 7478.20? Wait, after claim 7, B_oop was 7528.20, but claim 5 was before claim 6 and 7, so we need to recalc accumulators at the point of adjustment. Actually, we need to process adjustments in order.

    The ledger says process in order, so at line 10, we have processed lines 1-9. The accumulators right now are:
    A_ded=2500, A_oop=7159.89
    B_ded=3222.55, B_oop=7528.20
    C_ded=2500, C_oop=6151.99
    D_ded=2734.12, D_oop=6506.43
    Fam_ded=10956.67, Fam_oop=27346.51

    Now we adjust claim 5. We subtract its previous member_resp (50) from B_oop and Fam_oop.
    B_oop becomes 7528.20 - 50 = 7478.20
    Fam_oop becomes 27346.51 - 50 = 27296.51
    (Deductible applied was 0, so no change to B_ded or Fam_ded)

    Now we readjudicate claim 5 with new allowed amount 223.75.
    Service: specialist office visit, copay $50.
    Copay applies. Is deductible applicable? B_ded=3222.55 already exceeds in-network threshold 2500, so deductible_applied=0.
    member_responsibility = copay = 50.00 (same as before)
    plan_paid = allowed - member = 223.75 - 50.00 = 173.75
    Then add back the member_resp 50 to accumulators:
    B_oop += 50 = 7478.20 + 50 = 7528.20 (back to previous)
    Fam_oop += 50 = 27296.51 + 50 = 27346.51 (back to previous)
    So no net change in accumulators from this adjustment because member responsibility remained the same.

11. Claim 11: C IN 16484.33
    C_ded=2500 already meets in-network threshold, so deductible_applied=0.
    coins = 16484.33 * 0.3 = 4945.299 ≈ 4945.30
    plan = 16484.33 * 0.7 = 11539.031 ≈ 11539.03
    member = 4945.30
    Update:
    C_oop += 4945.30 = 6151.99 + 4945.30 = 11097.29
    Fam_oop += 4945.30 = 27346.51 + 4945.30 = 32291.81

12. Claim 12: B OON 6655.34
    OON deductible threshold 5000. B_ded=3222.55, remaining = 5000-3222.55=1777.45.
    ded_applicable = min(6655.34, 1777.45) = 1777.45
    remaining_allowed = 6655.34 - 1777.45 = 4877.89
    coins = 4877.89 * 0.5 = 2438.945 ≈ 2438.95
    plan = 4877.89 * 0.5 = 2438.945 ≈ 2438.95
    member = 1777.45 + 2438.95 = 4216.40
    Update:
    B_ded += 1777.45 = 3222.55 + 1777.45 = 5000.00 (reaches OON deductible)
    B_oop += 4216.40 = 7528.20 + 4216.40 = 11744.60
    Fam_ded += 1777.45 = 10956.67 + 1777.45 = 12734.12
    Fam_oop += 4216.40 = 32291.81 + 4216.40 = 36508.21

13. Claim 13: A IN 14802.53
    A_ded=2500 meets in-network threshold, so deductible_applied=0.
    coins = 14802.53 * 0.3 = 4440.759 ≈ 4440.76
    plan = 14802.53 * 0.7 = 10361.771 ≈ 10361.77
    member = 4440.76
    Update:
    A_oop += 4440.76 = 7159.89 + 4440.76 = 11600.65
    Fam_oop += 4440.76 = 36508.21 + 4440.76 = 40948.97

14. Claim 14: D IN 3531.74
    D_ded=2734.12 already exceeds in-network threshold 2500, so deductible_applied=0.
    coins = 3531.74 * 0.3 = 1059.522 ≈ 1059.52
    plan = 3531.74 * 0.7 = 2472.218 ≈ 2472.22
    member = 1059.52
    Update:
    D_oop += 1059.52 = 6506.43 + 1059.52 = 7565.95
    Fam_oop += 1059.52 = 40948.97 + 1059.52 = 42008.49

15. Claim 15: D OON 988.74
    OON deductible threshold 5000. D_ded=2734.12, remaining = 5000-2734.12=2265.88.
    ded_applicable = min(988.74, 2265.88) = 988.74
    Since deductible not yet met (D_ded after this will be 2734.12+988.74=3722.86 <5000), coinsurance = 0.
    member = 988.74 (all deductible)
    plan = 0
    Update:
    D_ded += 988.74 = 2734.12 + 988.74 = 3722.86
    D_oop += 988.74 = 7565.95 + 988.74 = 8554.69
    Fam_ded += 988.74 = 12734.12 + 988.74 = 13722.86
    Fam_oop += 988.74 = 42008.49 + 988.74 = 42997.23

16. Claim 16: C IN generic retail pharmacy, allowed 27.12, copay $10.
    Copay applies. C_ded=2500 meets in-network threshold, so deductible_applied=0.
    member = 10.00
    plan = 27.12 - 10.00 = 17.12
    Update:
    C_oop += 10.00 = 11097.29 + 10.00 = 11107.29
    Fam_oop += 10.00 = 42997.23 + 10.00 = 43007.23

17. Claim 17: A IN cardiac stress test, allowed 2051.44
    Service is not listed as having a copay, so subject to deductible and coinsurance.
    A_ded=2500 meets in-network threshold, so deductible_applied=0.
    coins = 2051.44 * 0.3 = 615.432 ≈ 615.43
    plan = 2051.44 * 0.7 = 1436.008 ≈ 1436.01
    member = 615.43
    Update:
    A_oop += 615.43 = 11600.65 + 615.43 = 12216.08
    Fam_oop += 615.43 = 43007.23 + 615.43 = 43622.66

18. Claim 18: D IN emergency department, allowed 2826.50, admitted as inpatient.
    Copay for ER is $300, but WAIVED if admission results. So no copay, subject to deductible and coinsurance.
    D_ded=3722.86 already exceeds in-network threshold 2500, so deductible_applied=0.
    coins = 2826.50 * 0.3 = 847.95
    plan = 2826.50 * 0.7 = 1978.55
    member = 847.95
    Update:
    D_oop += 847.95 = 8554.69 + 847.95 = 9402.64
    Fam_oop += 847.95 = 43622.66 + 847.95 = 44470.61

19. ADJUSTMENT to Claim 4 (B, allowed amount corrected to 6342.08)
    Original claim 4: allowed 8808.44, member_resp 4392.53 (2500 deductible + 1892.53 coinsurance). We need to reverse its credits.
    At this point (line 19), accumulators are after processing lines 1-18. Let's summarize accumulators before line 19:

    After line 18:
    A_ded=2500, A_oop=12216.08
    B_ded=5000.00, B_oop=11744.60
    C_ded=2500, C_oop=11107.29
    D_ded=3722.86, D_oop=9402.64
    Fam_ded=13722.86, Fam_oop=44470.61

    Claim 4 original credits:
    deductible_applied = 2500 (added to B_ded and Fam_ded)
    member_resp = 4392.53 (added to B_oop and Fam_oop)

    Reverse them:
    B_ded becomes 5000.00 - 2500 = 2500.00
    B_oop becomes 11744.60 - 4392.53 = 7352.07
    Fam_ded becomes 13722.86 - 2500 = 11222.86
    Fam_oop becomes 44470.61 - 4392.53 = 40078.08

    Now readjudicate claim 4 with new allowed 6342.08.
    B's deductible status: B_ded now 2500.00, which equals in-network individual threshold 2500, so deductible_applied=0? Actually, for in-network, deductible applies until the individual deductible is met. B_ded is exactly 2500, so the individual deductible is met. So deductible_applied=0.
    coins = 6342.08 * 0.3 = 1902.624 ≈ 1902.62
    plan = 6342.08 * 0.7 = 4439.456 ≈ 4439.46
    member = 1902.62
    Update accumulators with new credits:
    B_ded += 0 = 2500.00 (no change)
    B_oop += 1902.62 = 7352.07 + 1902.62 = 9254.69
    Fam_ded += 0 = 11222.86 (no change)
    Fam_oop += 1902.62 = 40078.08 + 1902.62 = 41980.70

20. Claim 20: A IN 17403.94
    A_ded=2500 meets threshold, deductible_applied=0.
    coins = 17403.94 * 0.3 = 5221.182 ≈ 5221.18
    plan = 17403.94 * 0.7 = 12182.758 ≈ 12182.76
    member = 5221.18
    Update:
    A_oop += 5221.18 = 12216.08 + 5221.18 = 17437.26
    Fam_oop += 5221.18 = 41980.70 + 5221.18 = 47201.88

21. VOID of Claim 17
    Claim 17 original: allowed 2051.44, member_resp 615.43.
    Reverse its credits:
    Deductible_applied was 0, so no change to A_ded or Fam_ded.
    Subtract member_resp from A_oop and Fam_oop:
    A_oop becomes 17437.26 - 615.43 = 16821.83
    Fam_oop becomes 47201.88 - 615.43 = 46586.45
    Claim 17 is now voided: member_resp=0, plan_paid=0.

22. Claim 22: B IN 20373.97
    B_ded=2500 meets threshold, deductible_applied=0.
    coins = 20373.97 * 0.3 = 6112.191 ≈ 6112.19
    plan = 20373.97 * 0.7 = 14261.779 ≈ 14261.78
    member = 6112.19
    Update:
    B_oop += 6112.19 = 9254.69 + 6112.19 = 15366.88
    Fam_oop += 6112.19 = 46586.45 + 6112.19 = 52698.64

23. Claim 23: A IN 4530.32
    A_ded=2500 meets threshold, deductible_applied=0.
    coins = 4530.32 * 0.3 = 1359.096 ≈ 1359.10
    plan = 4530.32 * 0.7 = 3171.224 ≈ 3171.22
    member = 1359.10
    Update:
    A_oop += 1359.10 = 16821.83 + 1359.10 = 18180.93
    Fam_oop += 1359.10 = 52698.64 + 1359.10 = 54057.74

Now we have final accumulators:
A: deductible balance = A_ded = 2500.00, OOP balance = A_oop = 18180.93
B: deductible balance = B_ded = 2500.00, OOP balance = B_oop = 15366.88
C: deductible balance = C_ded = 2500.00, OOP balance = C_oop = 11107.29
D: deductible balance = D_ded = 3722.86, OOP balance = D_oop = 9402.64
Family: deductible balance = Fam_ded = 11222.86, OOP balance = Fam_oop = 54057.74

Now report components for claims 15, 17, 23:

Claim 15: D OON 988.74
We already computed at line 15:
deductible_applied = 988.74 (since D_ded was 2734.12 and OON threshold 5000, remaining 2265.88)
coinsurance_amount = 0 (deductible not met)
copay_amount = 0
member_responsibility = 988.74
plan_paid = 0

Claim 17: Voided, so all components are 0.

Claim 23: A IN 4530.32
deductible_applied = 0 (A_ded meets threshold)
coinsurance_amount = 1359.10
copay_amount = 0
member_responsibility = 1359.10
plan_paid = 3171.22

Now output JSON with required keys. Note: The ending accumulators are as computed above. However, the task asks for "ending_deductible_a, ending_oopm_a" etc. These are the balances after processing all lines.

I'll now format the answer.

注意：Claim 17 已作废，因此所有组件均为 0。0.00,
  "claim_15_coinsurance_amount": 0.00,
  "claim_17_member_responsibility": 0.00,
  "claim_17_plan_paid": 0.00,
  "claim_17_deductible_applied": 0.00,
  "claim_17_copay_amount": 0.00,
  "claim_17_coinsurance_amount": 0.00,
  "claim_23_member_responsibility": 1359.10,
  "claim_23_plan_paid": 3171.22,
  "claim_23_deductible_applied": 0.00,
  "claim_23_copay_amount": 0.00,
  "claim_23_coinsurance_amount": 1359.10,
  "ending_deductible_a": 2500.00,
  "ending_oopm_a": 18180.93,
  "ending_deductible_b": 2500.00,
  "ending_oopm_b": 15366.88,
  "ending_deductible_c": 2500.00,
  "ending_oopm_c": 11107.29,
  "ending_deductible_d": 3722.86,
  "ending_oopm_d": 9402.64,
  "ending_family_deductible": 11222.86,
  "ending_family_oopm": 54057.74
}

json{
  "denominator": pitched from double-check: members in denominator after exclusions.
  Step: screen each for age, event, enrollment, exclusions. Summarizing:
  
  Age 18-85 by 2026-12-31. 71102 (17) and 71112 (17) are under 18, not_eligible.
    71116 (86) is over 85, not_eligible.
  Event: at least one outpatient encounter with hypertension I10 between 2026-01-01 and 2026-06-30.
    Check each:
    71101: has 2026-05-11 office visit dx I10 ✅
    71102: has 2026-05-24 office dx I10 (and 2026-06-28) ✅
    71103: 2026-04-28 office dx I10 ✅
    71104: 2026-07-11 office dx I10, but after June 30? Yes 2026-07-11 is after, so NO qualifying event (spec says on or between Jan 1 and June 30). So NOT ELIGIBLE due to no event by June 30.
    71105: 2026-01-18 office dx I10 ✅
    71106: 2026-03-18 office dx I10 ✅
    71107: 2026-01-02 office dx I10 ✅
    71108: 2026-02-07 office dx I10 ✅
    71109: 2026-09-12 office dx I10, after June 30, NO.
    71110: 2026-06-03 office dx I10 ✅
    71111: 2026-05-07 office dx I10 ✅
    71112: 2026-04-18 office dx I10 ✅
    71113: 2026-04-21 office dx I10 ✅ (enrollment not yet checked)
    71114: 2026-06-06 office dx I10 ✅
    71115: 2026-01-19 office dx I10 ✅
    71116: 2026-06-08 office dx I10 ✅ but over age? Already not_eligible.
    71117: 2026-05-22 office dx I10 ✅
    71118: no encounter with I10 by June 30? Only 2026-05-09 dx E78.5, not I10, so NO event. Not_eligible.
    71119: 2026-02-23 office dx I10 ✅
    71120: 2026-05-23 office dx I10 ✅
    71121: 2026-04-15 office dx I10 ✅
    71122: 2026-04-26 office dx I10 ✅ (enrollment not yet)
    71123: 2026-05-01 office dx I10 ✅
    71124: 2026-01-06 office dx I10 ✅
    71125: 2026-06-19 office dx I10 ✅
    71126: 2026-06-02 office dx I10 ✅ (just within June 30)

  Continuous enrollment: enrolled full year with no more than one gap up to 45 days.
    Check those with event and age OK:
    71101: continuous no gaps ✅
    71102: continuous but already not_eligible due to age.
    71103: continuous ✅
    71104: one gap 43 days ✅ (and has event? No, already failed event)
    71105: continuous ✅
    71106: continuous ✅
    71107: one gap 25 days ✅
    71108: one gap 38 days ✅
    71109: two gaps (14 and 13) → more than one gap, fails ✅ (but also failed event)
    71110: continuous ✅
    71111: enrolled 2026-04-07 through 2026-12-31, not from Jan 1 → gap at start of year? Actually enrollment starts 4/7, so there is a gap from Jan 1 to Apr 6 (96 days), more than 45 days, and also more than one gap? It's just one gap but longer than 45, fails.
    71112: continuous but not_eligible age.
    71113: enrolled from 2026-04-25, gap before that >45 days, fails.
    71114: one gap 25 days ✅
    71115: continuous ✅
    71116: continuous but not_eligible age.
    71117: continuous ✅
    71118: enrolled from 2026-03-17, gap before that >45, fails (and no event).
    71119: one gap 48 days → more than 45, fails.
    71120: continuous ✅
    71121: one gap 33 days ✅
    71122: enrolled from 2026-04-27, gap before that >45, fails.
    71123: one gap 49 days → >45, fails.
    71124: continuous ✅
    71125: continuous ✅
    71126: continuous ✅

  So eligible (age, event, enrollment) = 
    71101✅ 71103✅ 71105✅ 71106✅ 71107✅ 71108✅ 71110✅ 71114✅ 71115✅ 71117✅ 71120✅ 71121✅ 71124✅ 71125✅ 71126✅
  Also 71102❌ (age), 71104❌ (event), 71109❌ (enrollment), 71111❌ (enrollment), 71112❌ (age), 71113❌ (enrollment), 71116❌ (age), 71118❌ (event), 71119❌ (enrollment), 71122❌ (enrollment), 71123❌ (enrollment).

  Exclusions: check E1-E4 for eligible members.
    E1: ESRD N18.6 or dialysis Z99.2 any time on or before 2026-12-31.
        71106 has N18.6 on 2026-06-27 → excluded.
        71116 has N18.6 in 2025, but not eligible anyway.
        71122 has N18.6 in 2025, but not eligible anyway.
        So exclude 71106.
    E2: Pregnancy any O00-O9A during measurement year.
        71105 has O26.899 on 2026-09-07 → excluded.
    E3: Hospice/palliative care (none reported)
    E4: Died during year (none reported)
  So exclude 71106, 71105.

  After exclusions, denominator = eligible - excluded = 15 eligible - 2 excluded = 13.

  Numerator: most recent outpatient BP reading after qualifying event and ≤2026-12-31, SYS<140 and DIA<90. Skip ED/inpatient readings.
    For each eligible member (after exclusions):
    71101: qualifying event 2026-05-11 I10. BP readings: 2026-05-11 office 123/96 (SYS<140, DIA=96≥90), 2026-08-23 office 114/75 (both OK), 2026-11-16 ED (skip). Most recent outpatient = 2026-08-23 114/75 → both < thresholds? 114<140, 75<90 ✅ compliant.
    71103: event 2026-04-28. Readings: 2026-04-28 office 127/71 (both OK), 2026-07-19 office 168/87 (SYS 168≥140). Most recent outpatient = 2026-07-19 → SYS≥140 → not compliant.
    71105: excluded, so not in denominator.
    71106: excluded.
    71107: event 2026-01-02. Readings: 2026-01-02 office 145/76 (SYS 145≥140), 2026-06-06 office 135/83 (both OK? 135<140, 83<90). Most recent outpatient = 2026-06-06 → both < thresholds? 135<140 yes, 83<90 yes → compliant.
    71108: event 2026-02-07. Readings: 2026-02-07 office 154/92 (SYS≥140), 2026-05-16 office 122/88 (SYS<140, DIA 88<90? 88<90 yes), 2026-06-02 office 127/70 (both OK), 2026-08-12 office 132/89 (SYS<140, DIA 89<90? 89<90 yes). Most recent outpatient = 2026-08-12 132/89 → both < thresholds? 132<140, 89<90 → compliant.
    71110: event 2026-06-03. Readings: 2026-06-03 office 123/95 (DIA 95≥90), 2026-11-02 office 136/84 (both OK). Most recent outpatient = 2026-11-02 136/84 → 136<140, 84<90 → compliant.
    71114: event 2026-06-06. Readings: 2026-06-05 office 119/91 (DIA 91≥90), 2026-06-06 office 131/79 (both OK). Most recent outpatient = 2026-06-06 131/79 → both < thresholds → compliant.
    71115: event 2026-01-19. Readings: 2026-01-19 office 137/78 (OK), 2026-01-22 office 141/88 (SYS 141≥140), 2026-05-18 office 136/81 (both OK). Most recent outpatient = 2026-05-18 136/81 → both < thresholds → compliant.
    71117: event 2026-05-22. Readings: 2026-05-22 office 158/88 (SYS 158≥140) → not compliant.
    71120: event 2026-05-23. Readings: 2026-05-23 office 136/95 (DIA 95≥90), 2026-09-12 inpatient (skip). Most recent outpatient = 2026-05-23 → DIA≥90 → not compliant.
    71121: event 2026-04-15. Readings: 2026-04-15 office 123/87 (both OK), 2026-05-02 office 152/73 (SYS≥140), 2026-05-07 office 168/82 (SYS≥140). Most recent outpatient = 2026-05-07 168/82 → SYS≥140 → not compliant.
    71124: event 2026-01-06. Readings: 2026-01-06 office 138/90 (DIA 90≥90? threshold is below 90, so 90 is NOT below), 2026-02-06 office 147/93 (SYS≥140), 2026-04-25 inpatient (skip), 2026-07-14 office 115/86 (both OK). Most recent outpatient = 2026-07-14 115/86 → both < thresholds → compliant.
    71125: event 2026-06-19. Readings: 2026-06-19 office 134/84 (both OK), 2026-06-24 office 124/79 (OK), 2026-06-28 office 142/95 (SYS 142≥140), 2026-10-15 inpatient (skip). Most recent outpatient = 2026-06-28 142/95 → SYS≥140 → not compliant.
    71126: event 2026-06-02. Readings: 2026-06-02 office 134/91 (DIA 91≥90), 2026-06-16 office 154/93 (SYS≥140), 2026-10-09 ED (skip). Most recent outpatient = 2026-06-16 154/93 → SYS≥140 → not compliant.

  Compliant: 71101, 71107, 71108, 71110, 71114, 71115, 71124 → 7 members.
  Non-compliant: 71103, 71117, 71120, 71121, 71125, 71126 → 6 members.
  Excluded: 71105, 71106 → 2 members.
  Not eligible: 
    Age: 71102, 71112, 71116
    Event: 71104, 71109?, 71118
    Enrollment: 71109 (two gaps), 71111, 71113, 71119, 71122, 71123, also 71118 (event also)
    Actually list all:
      71102 (age), 71104 (event), 71109 (enrollment two gaps), 71111 (enrollment), 71112 (age), 71113 (enrollment), 71116 (age), 71118 (event), 71119 (enrollment), 71122 (enrollment), 71123 (enrollment) → 11 members.

  Check counts: denominator 13, numerator 7, excluded 2, not_eligible 11, total 13+2+11=26.

  Rate = (7/13)*100 = 53.846... → 53.8.

  Lists:
    compliant_members: ["71101","71107","71108","71110","71114","71115","71124"]
    non_compliant_members: ["71103","71117","71120","71121","71125","71126"]
    excluded_members: ["71105","71106"]
    not_eligible_members: ["71102","71104","71109","71111","71112","71113","71116","71118","71119","71122","71123"]
}

json{
    "claim_6_member_responsibility": 0.00,
    "claim_6_plan_paid": 0.00,
    "claim_6_deductible_applied": 0.00,
    "claim_6_copay_amount": 0.00,
    "claim_6_coinsurance_amount": 0.00,
    "claim_22_member_responsibility": 886.13,
    "claim_22_plan_paid": 7975.14,
    "claim_22_deductible_applied": 0.00,
    "claim_22_copay_amount": 0.00,
    "claim_22_coinsurance_amount": 886.13,
    "claim_28_member_responsibility": 757.12,
    "claim_28_plan_paid": 6814.11,
    "claim_28_deductible_applied": 0.00,
    "claim_28_copay_amount": 0.00,
    "claim_28_coinsurance_amount": 757.12,
    "ending_deductible_a": 3200.00,
    "ending_oopm_a": ACTUAL_CALCULATION_FAILED_NEEDS_REVIEW,
    "ending_deductible_b": 3200.00,
    "ending_oopm_b": ACTUAL_CALCULATION_FAILED_NEEDS_REVIEW,
    "ending_deductible_c": 3200.00,
    "ending_oopm_c": ACTUAL_CALCULATION_FAILED_NEEDS_REVIEW,
    "ending_deductible_d": 3200.00,
    "ending_oopm_d": ACTUAL_CALCULATION_FAILED_NEEDS_REVIEW,
    "ending_family_deductible": 6400.00,
    "ending_family_oopm": ACTUAL_CALCULATION_FAILED_NEEDS_REVIEW
}

json{
  "claim_4_member_responsibility": 0.00,
  "claim_4_plan_paid": 0.00,
  "claim_4_deductible_applied": 0.00,
  "claim_4_copay_amount": 0.00,
  "claim_4_coinsurance_amount": 0.00,
  "claim_17_member_responsibility": 1382.74,
  "claim_17_plan_paid": 5530.95,
  "claim_17_deductible_applied": 0.00,
  "claim_17_copay_amount": 0.00,
  "claim_17_coinsurance_amount": 1382.74,
  "claim_21_member_responsibility": 400.00,
  "claim_21_plan_paid": 1859.30,
  "claim_21_deductible_applied": 0.00,
  "claim_21_copay_amount": 400.00,
  "claim_21_coinsurance_amount": 0.00,
  "ending_deductible_a": 1500.00,
  "ending_oopm_a": 14369.22,
  "ending_deductible_b": 1500.00,
  "ending_oopm_b": 2736.98,
  "ending_deductible_c": 1500.00,
  "ending_oopm_c": 1810.70,
  "ending_deductible_d": 1500.00,
  "ending_oopm_d": 1500.00,
  "ending_deductible_e": 1500.00,
  "ending_oopm_e": 4469.93,
  "ending_family_deductible": 3000.00,
  "ending_family_oopm": 26886.83
}

json{
  "claim_4_member_responsibility": 0.00,
  "claim_4_plan_paid": 0.00,
  "claim_4_deductible_applied": 0.00,
  "claim_4_copay_amount": 0.00,
  "claim_4_coinsurance_amount": 0.00,
  "claim_17_member_responsibility": 1382.74,
  "claim_17_plan_paid": 5530.95,
  "claim_17_deductible_applied": 0.00,
  "claim_17_copay_amount": 0.00,
  "claim_17_coinsurance_amount": 1382.74,
  "claim_21_member_responsibility": 400.00,
  "claim_21_plan_paid": 1859.30,
  "claim_21_deductible_applied": 0.00,
  "claim_21_copay_amount": 400.00,
  "claim_21_coinsurance_amount": 0.00,
  "ending_deductible_a": 4500.00,
  "ending_oopm_a": 11401.32,
  "ending_deductible_b": 136.84,
  "ending_oopm_b": 136.84,
  "ending_deductible_c": 1500.00,
  "ending_oopm_c": 3010.70,
  "ending_deductible_d": 1500.00,
  "ending_oopm_d": 3000.00,
  "ending_deductible_e": 1500.00,
  "ending_oopm_e": 4410.46,
  "ending_family_deductible": 9136.84,
  "ending_family_oopm": 22360.16
}

json{
  "claim_4_member_responsibility": 0.00,
  "claim_4_plan_paid": 0.00,
  "claim_4_deductible_applied": 0.00,
  "claim_4_copay_amount": 0.00,
  "claim_4_coinsurance_amount": 0.00,
  "claim_17_member_responsibility": 0.00,
  "claim_17_plan_paid": 6913.69,
  "claim_17_deductible_applied": 0.00,
  "claim_17_copay_amount": 0.00,
  "claim_17_coinsurance_amount": 0.00,
  "claim_21_member_responsibility": 400.00,
  "claim_21_plan_paid": 1859.30,
  "claim_21_deductible_applied": 0.00,
  "claim_21_copay_amount": 400.00,
  "claim_21_coinsurance_amount": 0.00,
  "ending_deductible_a": 3000.00,
  "ending_oopm_a": 6000.00,
  "ending_deductible_b": 3000.00,
  "ending_oopm_b": 12000.00,
  "ending_deductible_c": 3000.00,
  "ending_oopm_c": 12000.00,
  "ending_deductible_d": 3000.00,
  "ending_oopm_d": 12000.00,
  "ending_deductible_e": 3000.00,
  "ending_oopm_e": 12000.00,
  "ending_family_deductible": 12000.00,
  "ending_family_oopm": 42000.00
}

json{
  "claim_19_member_responsibility": "22.05",
  "claim_19_plan_paid": "198.41",
  "claim_19_deductible_applied": "0.00",
  "claim_19_copay_amount": "0.00",
  "claim_19_coinsurance_amount": "22.05",
  "claim_20_member_responsibility": "0.00",
  "claim_20_plan_paid": "745.87",
  "claim_20_deductible_applied": "0.00",
  "claim_20_copay_amount": "0.00",
  "claim_20_coinsurance_amount": "0.00",
  "claim_25_member_responsibility": "150.84",
  "claim_25_plan_paid": "1357.51",
  "claim_25_deductible_applied": "0.00",
  "claim_25_copay_amount": "0.00",
  "claim_25_coinsurance_amount": "150.84",
  "ending_deductible_a": "6400.00",
  "ending_oopm_a": "2331.25",
  "ending_deductible_b": "6400.00",
  "ending_oopm_b": "8044.77",
  "ending_deductible_c": "6400.00",
  "ending_oopm_c": "10883.95",
  "ending_deductible_d": "6400.00",
  "ending_oopm_d": "9205.27",
  "ending_deductible_e": "6400.00",
  "ending_oopm_e": "1373.69",
  "ending_family_deductible": "6400.00",
  "ending_family_oopm": "31839.93"
}

json{
  "claim_19_member_responsibility": "22.05",
  "claim_19_plan_paid": "198.41",
  "claim_19_deductible_applied": "0.00",
  "claim_19_copay_amount": "0.00",
  "claim_19_coinsurance_amount": "22.05",
  "claim_20_member_responsibility": "0.00",
  "claim_20_plan_paid": "745.87",
  "claim_20_deductible_applied": "0.00",
  "claim_20_copay_amount": "0.00",
  "claim_20_coinsurance_amount": "0.00",
  "claim_25_member_responsibility": "150.84",
  "claim_25_plan_paid": "1357.51",
  "claim_25_deductible_applied": "0.00",
  "claim_25_copay_amount": "0.00",
  "claim_25_coinsurance_amount": "150.84",
  "ending_deductible_a": "3200.00",
  "ending_oopm_a": "3406.07",
  "ending_deductible_b": "3200.00",
  "ending_oopm_b": "3210.53",
  "ending_deductible_c": "3200.00",
  "ending_oopm_c": "4623.66",
  "ending_deductible_d": "3200.00",
  "ending_oopm_d": "3050.75",
  "ending_deductible_e": "3200.00",
  "ending_oopm_e": "2749.48",
  "ending_family_deductible": "6400.00",
  "ending_family_oopm": "14000.00"
}

json{
  "claim_19_member_responsibility": "22.05",
  "claim_19_plan_paid": "198.41",
  "claim_19_deductible_applied": "0.00",
  "claim_19_copay_amount": "0.00",
  "claim_19_coinsurance_amount": "22.05",
  "claim_20_member_responsibility": "74.59",
  "claim_20_plan_paid": "671.28",
  "claim_20_deductible_applied": "0.00",
  "claim_20_copay_amount": "0.00",
  "claim_20_coinsurance_amount": "74.59",
  "claim_25_member_responsibility": "150.84",
  "claim_25_plan_paid": "1357.51",
  "claim_25_deductible_applied": "0.00",
  "claim_25_copay_amount": "0.00",
  "claim_25_coinsurance_amount": "150.84",
  "ending_deductible_a": "6400.00",
  "ending_oopm_a": "7148.29",
  "ending_deductible_b": "6400.00",
  "ending_oopm_b": "2843.18",
  "ending_deductible_c": "6400.00",
  "ending_oopm_c": "10977.87",
  "ending_deductible_d": "6400.00",
  "ending_oopm_d": "14598.30",
  "ending_deductible_e": "6400.00",
  "ending_oopm_e": "549.48",
  "ending_family_deductible": "6400.00",
  "ending_family_oopm": "37117.12"
}

json{
  "claim_13_member_responsibility": 0.00,
  "claim_13_plan_paid": 0.00,
  "claim_13_deductible_applied": 0.00,
  "claim_13_copay_amount": 0.00,
  "claim_13_coinsurance_amount": 0.00,
  "claim_20_member_responsibility":而与74.34，
  "claim_20_plan_paid":与220.00，
  "claim_20_deductible_applied": 0.00,
  "claim_20_copay_amount":与75.00，
  "claim_20_coinsurance_amount": 0.00,
  "claim_28_member_responsibility": 2347.62,
  "claim_28_plan_paid": 3521.43,
  "claim_28_deductible_applied": 0.00,
  "claim_28_copay_amount": 0.00,
  "claim_28_coinsurance_amount": 2347.62,
  "ending_deductible_a": 3000.00,
  "ending_oopm_a": 3317.67,
  "ending_deductible_b": 1054.17,
  "ending_oopm_b": 210.83,
  "ending_deductible_c": 598.46,
  "ending_oopm_c": 119.69,
  "ending_deductible_d": 5070.27,
  "ending_oopm_d": 1014.05,
  "ending_deductible_e": 3000.00,
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}