Team Feedback — WHEN/THEN/Example Framework

Overview

Feedback to the platform team must be implementable without a single clarifying question: explicit condition + explicit behavior + evidence.

Core principle: write the condition as the error you SEE, never the cause you assume. "If MCO fails" forces eng to investigate what an MCO is; "el check automático da failed" does not.

When to Use

• New platform rules (eligibility, insurance, copay behavior)
• Bug reports
• Feature requests
• NOT for: strategy discussions, prose emails, customer-facing messages

The Output Contract

The message consists of, in order:

1. One template block per rule (below)
2. Optionally, ONE line starting with Nota: flagging a concern for eng to consider

Nothing else. No intro paragraphs, no root-cause analysis, no recommendations to "investigate first" — the rule as observed is the deliverable; a concern is one Nota: line.

WHEN (condición):
Insurance = [Trading Partner ID] ([nombre])
Y [el error/estado que se ve en la plataforma]

THEN (comportamiento):
[acción concreta]

Ejemplo (evidencia):
[clínica], paciente/check [ID]

Rules

1. Insurance = Trading Partner ID, always. The TPID is the same across all clinics; display names are not. Name goes in parentheses for readability only. If the TPID is unknown, ask the user — never guess or substitute the name.
2. Condition = observed error/state, exactly as seen in the platform UI (e.g., "el check automático da failed", "la insurance tiene más de un copay").
3. THEN = one concrete action the platform should take (retry with X, choose Y, allow Z).
4. Evidence required: clinic + patient ID or check ID. If missing, ask for it.
5. Feature requests state the behavior, never a question or timeline ask: "Cuando los usuarios crean un Prior Auth, permitir agregar modifiers a los CPT codes."
6. Language: match the user's draft language (team usually writes Spanish); keep WHEN/THEN keywords as-is.
7. Output as plain copy-paste-ready text — no markdown formatting in the message itself.

Example: Before → After

Raw feedback:

"if MCO fails, run with straight Medicaid. [Clinic A]: 00000000-0000-0000-0000-000000000001"

Formatted:

WHEN (condición):
Insurance = 68049 (Peach State Health Plan)
Y el check automático da failed

THEN (comportamiento):
Reintentar el check con Insurance = QBZJV

Ejemplo (evidencia):
[Clinic A], paciente 00000000-0000-0000-0000-000000000001

Example: Non-Insurance Rule (Copays)

WHEN (condición):
La insurance tiene más de un copay

THEN (comportamiento):
Elegir el copay cuyo mensaje contenga "freestanding"

Ejemplo (evidencia):
[Clinic B], check 00000000-0000-0000-0000-000000000002

Known Trading Partner IDs

Payer	TPID	Notes
Peach State Health Plan (GA Medicaid MCO)	68049	On failed check → retry with QBZJV
Georgia straight Medicaid	QBZJV	Fallback payer for 68049

Add new mappings here as they come up.

Common Mistakes

Mistake	Fix
Insurance referenced by name only	Always TPID; name in parentheses
Condition written as assumed cause ("if MCO fails")	Condition = visible error ("el check da failed")
Root-cause essay or pushback instead of the rule	Template block + at most one Nota: line
Feature request as a question or timeline ask	State the behavior: "Cuando [acción], [comportamiento]"
No evidence	Clinic + patient/check ID, always