Comments (5)
Agree on this one too.
from price-transparency-guide.
Agree as well. For professional claims most contracts don't care what the service code is, the one exception being some Urgent Care contracts that have a special fee schedule for some procedures done in an Urgent Care facility code 20. The same procedure done in a different facility such as a doctors off code 11 under that contract uses a standard "don't care about facility type" rate.
For Institutional claims they basically break down to Inpatient, Outpatient, and Ambulatory Surgical Center.
My thoughts recently aside from a service code array would be for Professional leave service code blank when it doesn't matter and when it does specify the service code. For Institutional something as simple as INP for Inpatient, OTP for Outpatient and ASC for Ambulatory Surgical Center would suffice with the option of leaving service code blank for Institutional as well when it does not apply.
from price-transparency-guide.
Institutional claims have a TOB (Type of Bill) where the first digit is always 0 (by custom not used and 3-digit codes are universally used) second is type of facility 1 = hospital 2 = SNF etc. The 3rd digit is 1=Inpatient 3 = Outpatient.
AMBSURG is a type of facility INPAT/OUTPT is type of care, they don't mix
Most contracts don't have POS differentials, it should be mandatory only if there is a differential for example if a virtual visit is paid differently than a in-person visit
from price-transparency-guide.
billing_class
has been introduced some time ago to address this issue. Closing.
from price-transparency-guide.
billing_class does not address the issue, billing_class professional still has place of service as a mandatory field. This assumes all physician contracts have POS differrentials, a lot of plans are entering the entire list of POS codes in an aray for each code in the fee schedule to be compliant (if the contract does not specify POS it is valid for all POS and since there is no ALL-POS let's put them all in an array is the thinking) which is making the files unnecessarily large.
Please read and understand the issue fully and ask for comments before unilaterally closing issues
from price-transparency-guide.
Related Issues (20)
- Disjoint of version numbers between this site and the CMS Validator HOT 1
- Reading a Transparency File is NP Complete
- Cosmetic: wrong MS-DRG Grouper Version specified in In Network schema's billing_code_type_version "For example"
- MRF Validator - Schema file 'schema/schema.json' not found HOT 2
- Do allowed_amounts include the participants' cost? HOT 3
- In-network bundled code type enums
- How to display Tiered Networks HOT 1
- Update documentation for billing_code_type_version
- How did ya'll import the JSON files to SSMS? HOT 1
- Provider reference location link is not working in example file HOT 1
- How do I report BCBS non-compliance? HOT 11
- Reporting as files is poor design HOT 1
- Who to address an issue with unavailable files HOT 1
- Data from the provider Medica is partially not accessible HOT 1
- [deleted]
- Questions re: in_network schema
- CSTM-ALL descriptions are inconsistent
- Errors during Cigna file processing HOT 2
- Aetna Allowed Amounts Issue HOT 1
- HPT Online Validator HOT 1
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from price-transparency-guide.