Decision Models for Medical Claim Processing

DMCommunity.org Challenge May-2022 still has no submitted solutions. I knew that the problem is not as simple as it sounds because we, at OpenRules, have quite a few claim processing customers, whose decision models address similar and much more difficult problems. When I tried to create a decision model for this challenge, I quickly got a solution that still produced these errors while processing a test-claim:

[E71.313] cannot be reported together with [E72.3]
[E72.3] cannot be reported together with [E71.313]

But the challenge specifically required not to produce duplicate errors. Trying several decision modeling approaches, I built a few “tried-and-failed” decision models before I came up with two solutions which I feel comfortable enough to share here.

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