INDUSTRY FIELD GUIDE
HMO medical center plan and site directory data for AI
A center may use several plan directories with similar provider names, sites and effective periods.
NAICS 621491 · HMO Medical Centers
A center may use several plan directories with similar provider names, sites and effective periods. CMS publishes Medicare network adequacy resources. An HMO medical center can test whether software retrieves the right entry without making a real coverage determination. CMS network adequacy resources
Invent two plans and a clinic with separate locations. Include a new directory version that moves a service to another site under one plan only. Ask which entry applies on an invented date and what source supports it. Add a plan with no current listing so the model must preserve the gap.
Keep actual claims, member records, contracts, referral rules and live directories out of the sample. Use independent copy and leave eligibility and coverage decisions to qualified staff.
Describe a fictional network directory sample
Original Fiund exercise
A plan-specific site revision cannot update every similar clinic entry
An original fictional network directory uses two plan aliases, abstract clinic locations and administrative service labels. It contains no member, claim, contract or live directory.
| Record | Source | What it records |
|---|---|---|
| HN1 | Plan A versions | Clinic C, service S: site North through day 9; approved directory revision moves S to South from day 10. |
| HN2 | Plan B entry | Clinic C, service S: North remains listed during days 1–20. No cross-plan change rule. |
| HN3 | Plan C archive | Only expired day-1–5 C/North listing supplied. Requested review day 12; no current C entry or appointment evidence. |
Question for the model
Which day-12 listings are supported for Plans A and B, and what can be concluded for C or actual coverage?
Show the reference answer and checks
HN1 supports South for Plan A's day-12 S entry, while HN2 independently retains North for Plan B. The shared clinic name does not transfer A's revision to B. HN3 supplies no current Plan C listing for day 12, leaving a directory gap rather than proof of exclusion. These fictional listings do not establish an individual's eligibility, coverage, referral permission or appointment availability.
- Applying one plan's site change across all directories with the same clinic name.
- Treating an expired or absent listing as a complete coverage determination.
Fields to preserve
- Plan, clinic, service and site
- Defines the exact entry.
- Effective interval and revision source
- Selects the dated listing.
- Current-source gap and availability evidence
- Limits downstream claims.
Test another case
Add Plan C's current entry for a different service. Require S's directory gap to remain rather than matching only the clinic.
Use independently written dummy directories. Exclude claims, member records, contracts and real referral rules; qualified staff retain coverage decisions.
Discuss a contribution
Describe the sources you control, the task they could support and what has already been checked. Use the existing-data assessment for an archive or the collection brief for a new recording project. The contributor agreement defines Fiund’s licensing authority and compensation. A guide or fictional exercise does not establish an accepted collection or a sale.