1494 lines
248 KiB
CSV
1494 lines
248 KiB
CSV
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Interrogation Question?,Field Name,SF_DB_COL_NAME,DATA_TYPE,PRIORITY,FLAG,Related Generic Data Pipeline Field Name?,Source of Data,Theme,Required Field?,Use of Field Beyond Contract Config?
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Does the contract include a carve out for Ambulatory Surgery (Yes/No)?,Ambulatory Surgery Carve Out (Y/N)?,AMBULATORY_SURGERY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for Ambulatory Surgery, list the applicable codes or code ranges ",Ambulatory Surgery Codes or Code Range ,AMBULATORY_SURGERY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for Ambulatory Surgery, describe how these codes are reimbursed",Ambulatory Surgery Reimbursement Methodology,AMBULATORY_SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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Does the contract include a carve out for anesthesia (Yes/No)?,Anesthesia Carve Out (Y/N)?,ANESTHESIA_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for anesthesia, list the applicable codes or code ranges ",Anesthesia Codes or Code Range,ANESTHESIA_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for anesthesia, describe how these codes are reimbursed",Anesthesia Reimbursement Methodology ,ANESTHESIA_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the Primary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges",Applicable Admit Type Codes - Primary,PRIMARY_REIMBURSEMENT_ADMITTYPE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges",Applicable Admit Type Codes - Secondary,SECONDARY_REIMBURSEMENT_ADMITTYPE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges",Applicable Admit Type Codes - Tertiary,TERTIARY_REIMBURSEMENT_ADMITTYPE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges",Applicable Diagnosis Codes - Primary,PRIMARY_REIMBURSEMENT_DIAG_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges",Applicable Diagnosis Codes - Secondary,SECONDARY_REIMBURSEMENT_DIAG_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges",Applicable Diagnosis Codes - Tertiary,TERTIARY_REIMBURSEMENT_DIAG_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges",Applicable Grouper Codes - Primary,PRIMARY_REIMBURSEMENT_GROUPER_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges",Applicable Grouper Codes - Secondary,SECONDARY_REIMBURSEMENT_GROUPER_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges",Applicable Grouper Codes - Tertiary,TERTIARY_REIMBURSEMENT_GROUPER_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges",Applicable Place of Service Codes - Primary,PRIMARY_REIMBURSEMENT_PLACEOFSERVICE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges",Applicable Place of Service Codes - Secondary,SECONDARY_REIMBURSEMENT_PLACEOFSERVICE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges",Applicable Place of Service Codes - Tertiary,TERTIARY_REIMBURSEMENT_PLACEOFSERVICE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges",Applicable Procedure Codes - Primary,PRIMARY_REIMBURSEMENT_PROC_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges",Applicable Procedure Codes - Secondary,SECONDARY_REIMBURSEMENT_PROC_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges",Applicable Procedure Codes - Tertiary,TERTIARY_REIMBURSEMENT_PROC_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations",Applicable Revenue /Procedure Code Combinations - Primary,PRIMARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations",Applicable Revenue /Procedure Code Combinations - Secondary,SECONDARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations",Applicable Revenue /Procedure Code Combinations - Tertiary,TERTIARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges",Applicable Revenue Codes - Primary,PRIMARY_REIMBURSEMENT_REVENUE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges",Applicable Revenue Codes - Secondary,SECONDARY_REIMBURSEMENT_REVENUE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges",Applicable Revenue Codes - Tertiary,TERTIARY_REIMBURSEMENT_REVENUE_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Primary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges",Applicable Status Indicator Codes - Primary,PRIMARY_REIMBURSEMENT_STATUS_INDICATOR_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Secondary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges",Applicable Status Indicator Codes - Secondary,SECONDARY_REIMBURSEMENT_STATUS_INDICATOR_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the Tertiary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges",Applicable Status Indicator Codes - Tertiary,TERTIARY_REIMBURSEMENT_STATUS_INDICATOR_CODES,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If this agreement is not the base contract, then what is the effective date of the associated base contract? This date is earlier than today's date and is a long date format. Only return this date. If there is no date, return nothing. Do not explain or elaborate, only return the date converted to YYYY-MM-DD format or nothing.",Associated Base Contract Effective Date,CONTRACT_BASE_EFFECTIVE_DT,DATE,C,ACTIVE,No,Preamble ,Contract ,Required Only If Agreement Is NOT the Base Contract ,
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"If this agreement is not the base contract, then what is the title of the associated base contract? This field will be present if there is an amendment or if the amendment is numbered. It is text that likely contains some of the following keywords: agreement, participating provider, participating hospital, provider agreement, or hospital agreement. Only say the title. Do not provide any context or explanation for it. Do not introduce what it is either, simply state the title. ",Associated Base Contract Title,CONTRACT_BASE_TITLE,VARCHAR,C,ACTIVE,No,Preamble ,Contract ,Required Only If Agreement Is NOT the Base Contract ,
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"What are the names of other providers associated with this agreement? The names can be found across multiple pages after the signature page. These names can be found in a roster and can be a list of provider names or TINs. Do not provide any context or explanation, simply state the names.",Associated Provider Full Names,PROV_DOING_BUSINESS_AS,VARCHAR,A,ACTIVE,Yes,"Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
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PDM"
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What are the provider national provider identifier numbers for each of the other providers associated with this agreement? They consist of 10 digits. Provide only the 10 digit NPI.,Associated Provider National Provider Identifiers,PROV_NPI_OTHER,VARIANT,A,ACTIVE,No (but please use GDP NPI format throughout),"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
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PDM"
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What are the provider taxpayer identification numbers (TIN) for each of the other providers associated with this agreement? They consist of 9 digits and may contain a hyphen after the first 2 digits. This is usually listed on the signature page or on a roster. Provide only the 9 digit TIN.,Associated Provider Taxpayer Identification Numbers,PROV_TIN_OTHER,VARIANT,A,ACTIVE,No (but please use GDP TIN format throughout),"Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
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PDM"
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Does the contract include a carve out for Behavioral Health & Substance Abuse Services (Yes/No)?,Behavioral Health & Substance Abuse Carve Out (Y/N)?,BEH_HEALTH_SUB_ABUSE_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for Behavioral Health & Substance Abuse Services, list the applicable codes or code ranges ",Behavioral Health & Substance Abuse Codes or Code Range ,BEH_HEALTH_SUB_ABUSE_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe how these codes are reimbursed",Behavioral Health & Substance Abuse Reimbursement Methodology,BEH_HEALTH_SUB_ABUSE_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"Does the contract include a carve out for bundled or unbundled codes (e.g., bundling, unbundling) (Yes/No)?",Bundled Services Carve Out (Y/N)?,BUNDLED_UNBUNDLED_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for bundling or unbundling, list the applicable codes or code ranges ",Bundled Services Codes or Code Range,BUNDLED_UNBUNDLED_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for bundling or unbundling, describe how these codes are reimbursed",Bundled Services Reimbursement Methodology ,BUNDLED_UNBUNDLED_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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Does the contract include a carve out for Cancer (Yes/No)?,Cancer Carve Out (Y/N)?,CANCER_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for Cancer, list the applicable codes or code ranges ",Cancer Codes or Code Range ,CANCER_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes a carve out for Cancer, describe how these codes are reimbursed",Cancer Reimbursement Methodology,CANCER_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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Does contract include terms for discounts applied to total claim (Yes/No)?,Claim Discount (Y/N),CLAIM_DISCOUNT_IND,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim discount rate?,Claim Discount Rate,CLM_DISC_RATE,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim discount start date?,Claim Discount Start Date,CLAIM_DISCOUNT_START_DT,D,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim discount termination date?,Claim Discount Termination Date,CLAIM_DISCOUNT_TERMINATION_DT,D,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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Does contract include terms for premiums applied to total claim (Yes/No)?,Claim Premium (Y/N),CLAIM_PREMIUM_IND,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim premium rate?,Claim Premium Rate,CLAIM_PREMIUM_RATE,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim premium start date?,Claim Premium Start Date,CLAIM_PREMIUM_START_DT,D,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim premium termination date?,Claim Premium Termination Date,CLAIM_PREMIUM_TERMINATION_DT,D,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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Does contract include terms for sequestration amounts applied to total claim (Yes/No)?,Claim Sequestration (Y/N),CLAIM_SEQUESTRATION_IND,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim sequestration rate?,Claim Sequestration Rate,CLAIM_SEQUESTRATION_RATE,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim sequestration start date?,Claim Sequestration Start Date,CLAIM_SEQUESTRATION_START_DT,D,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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What is claim sequestration termination date?,Claim Sequestration Termination Date,CLAIM_SEQUESTRATION_TERMINATION_DT,D,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
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NETWORK"
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"If the contract includes Vaccine for Children carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #1 Codes or Code Range,VACCINE_CHILDREN_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes Vaccine for Children client-specific carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #1 Reimbursement Methodology,VACCINE_CHILDREN_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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Does the contract include other Vaccine for Children carve outs (Yes/No)?,Client-Specific Carve Out #1 (Y/N),VACCINE_CHILDREN_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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Does the contract include Surgical Assist/Assistant carve outs (Yes/No)?,Client-Specific Carve Out #2 (Y/N),SURGICAL_ASSIST_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
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"If the contract includes Surgical Assist/Assistant carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #2 Codes or Code Range,SURGICAL_ASSIST_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes other client-specific carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #2 Reimbursement Methodology,,VARCHAR,,INACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"Does the contract include Physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs (Yes/No)?",Client-Specific Carve Out #3 (Y/N),PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #3 Codes or Code Range,PHY_CLINICAL_PSYCHOLOGIST_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #3 Reimbursement Methodology,PHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"Does the contract include Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs)carve outs (Yes/No)?",Client-Specific Carve Out #4-25 (Y/N),AUDIO_CHIRO_DIETICIAN_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include Board Certified Behavioral Analyst (BCBA) carve outs (Yes/No)?,Client-Specific Carve Out #4-25 (Y/N),CERT_BH_ANALYST_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"Does the contract include Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs (Yes/No)?",Client-Specific Carve Out #4-25 (Y/N),INDEPENDENT_LICENSURES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include Behavioral Health Outpatient Clinics/Integrated Clinics carve outs (Yes/No)?,Client-Specific Carve Out #4-25 (Y/N),BH_OP_CLINICS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"Does the contract include Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs (Yes/No)?",Client-Specific Carve Out #4-25 (Y/N),POS_THERAPISTS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include Transportation Services carve outs (Yes/No)?,Client-Specific Carve Out #4-25 (Y/N),TRANSPORTATION_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs) carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #4-25 Codes or Code Range,AUDIO_CHIRO_DIETICIAN_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #4-25 Codes or Code Range,CERT_BH_ANALYST_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #4-25 Codes or Code Range,INDEPENDENT_LICENSURES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #4-25 Codes or Code Range,BH_OP_CLINICS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #4-25 Codes or Code Range,POS_THERAPISTS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Transportation Services carve outs, list the applicable codes or code ranges ",Client-Specific Carve Out #4-25 Codes or Code Range,TRANSPORTATION_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe how these codes are reimbursed",Client-Specific Carve Out #4-25 Reimbursement Methodology,AUDIO_CHIRO_DIETICIAN_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #4-25 Reimbursement Methodology,CERT_BH_ANALYST_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #4-25 Reimbursement Methodology,INDEPENDENT_LICENSURES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #4-25 Reimbursement Methodology,BH_OP_CLINICS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #4-25 Reimbursement Methodology,POS_THERAPISTS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes Transportation Services carve outs, describe how these codes are reimbursed",Client-Specific Carve Out #4-25 Reimbursement Methodology,TRANSPORTATION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,TBD,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If contract automatically renews, then then what is the adjusted contract termination date?",Contract Adjusted Termination Date Resulting from Auto Renewal,AA_CONTRACT_ADJUSTED_TERMINATION_DT_FROM_AUTO_RENEWAL,DATE,,ACTIVE,No,AArete Derived from Contract Termination Date As Adjusted for Renewals ,Key Dates,Always Required,"GREEN LIGHT - IF DATE IS LESS THAN TODAY'S DATE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNLESS THERE IS AN EFFECTIVE AMENDMENT"
|
||
|
|
"Does the contract automatically renew? Answer with either a Yes or No, do not provide anything more that this one word answer.",Contract Auto Renewal (Y/N)?,CONTRACT_AUTO_RENEWAL_IND,BOOLEAN,A,ACTIVE,No,Term & Termination Section of Contract ,Key Dates,Required Only If Available ,PAYMENT ACCURACY UNIQUE KEY
|
||
|
|
"If contract automatically renews, then what is the length of the renewal term? This is related to the term and termination agreement section of the contract. This should a one or two word statement, typically around renewal, automatic renewal, or auto-renewal. Only return the length of time for the renewal, do not provide any context.",Contract Auto Renewal Terms?,CONTRACT_AUTO_RENEWAL_TERM_LENGTH,VARCHAR,A,ACTIVE,No,Term & Termination Section of Contract ,Key Dates,Required Only If Available ,PAYMENT ACCURACY UNIQUE KEY
|
||
|
|
Are the contract effective dates in the Preamble and the final signatory section consistent?,Contract Effective Date Consistency (Y/N)?,AAR_IS_EFFECTIVE_DT_CONSISTENT_IND,BOOLEAN,,ACTIVE,No,AArete Derived (Does Column D = Column E)?,Key Dates,Always Required ,PAYMENT ACCURACY
|
||
|
|
"What is the contract effective date mentioned in the preamble of the agreement? It should be in a long date format and should be earlier that today's date. Only return this date, do not add any context.",Contract Effective Date per Preamble,CONTRACT_EFFECTIVE_DT,DATE,A,ACTIVE,No (but please use GDP date format throughout),Preamble ,Key Dates,Always Required ,PAYMENT ACCURACY UNIQUE KEY
|
||
|
|
"What is the contract effective date as stated in the signatory section of the agreement? It should be in a long date format and should be earlier that today's date. Only return this date, do not add any context.",Contract Effective Date per Signatory,CONTRACT_EFFECTIVE_DT_SIGNATORY,DATE,A,ACTIVE,No (but please use GDP date format throughout),Signature Page,Key Dates,Always Required ,PAYMENT ACCURACY UNIQUE KEY
|
||
|
|
"A contract is the final version if all the signature lines in the signatory section of the agreement are signed. Is this the case? Answer with a Yes or No, do not provide any other context.",Contract Signatory Complete (Y/N)?,CONTRACT_SIGNATORY_IND,BOOLEAN,A,ACTIVE,No,Signature Page,Contract ,Always Required ,"GREEN LIGHT - IF NOT ALL SIGNATURES ARE COMPLETE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNTIL FINAL VERSION OF CONTRACT IS RECEIVED UNIQUE KEY"
|
||
|
|
"What is the contract termination date? This is usually listed within the Terms and Terms Agreement of the contract. Only return the date, do not return any context.",Contract Termination Date,CONTRACT_TERMINATION_DT,DATE,A,ACTIVE,No (but please use GDP date format throughout),Term & Termination Section of Contract ,Key Dates,Always Required ,PAYMENT ACCURACY UNIQUE KEY
|
||
|
|
"What is the title of the contract? It generally contains the word Agreement. This will be filled out if there is an amendment or numbered amendment. It typically contains the words agreement, amendment, or contract. Only return the title, do not return any context.",Contract Title,CONTRACT_TITLE,VARCHAR,C,ACTIVE,No,Title,Contract ,Always Required ,
|
||
|
|
"What type of contract or agreement is the document? Answers must contain one of three values: ""Base Agreement"", ""Amendment"" or ""Addendum"". Only return one of these three values, do not return any other context.",Contract Type,CONTRACT_HEADER,VARCHAR,A,ACTIVE,No,Title or Preamble,Contract ,Always Required ,UNIQUE KEY
|
||
|
|
Does the contract include a carve out for diagnostic services (Yes/No)?,Diagnostic Services Carve Out (Y/N)?,DIAGNOSTIC_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for diagnostic services, list the applicable codes or code ranges ",Diagnostic Services Codes or Code Range,DIAGNOSTIC_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for diagnostic services, describe how these codes are reimbursed",Diagnostic Services Reimbursement Methodology ,DIAGNOSTIC_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Durable Medical Equipment (Yes/No)?,Durable Medical Equipment Carve Out (Y/N)?,DME_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Durable Medical Equipment, list the applicable codes or code ranges ",Durable Medical Equipment Codes or Code Range,DME_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Durable Medical Equipment, describe how these codes are reimbursed",Durable Medical Equipment Reimbursement Methodology ,DME_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"What is start date of line of business specific compensation exhibit? If one is not explicitly stated, this is the same as the contract's effective date. This should be in a long date format and should be earlier than today. Only return the date, do not return any other content.",Effective Date of Pricing Terms,LOB_PRICING_TERMS_EFFECTIVE_DT,D,A,ACTIVE,No (but please use GDP date format throughout),"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Always Required ,PAYMENT ACCURACY UNIQUE KEY
|
||
|
|
Does the contract include a carve out for Emergency Department (Yes/No)?,Emergency Carve Out (Y/N)?,EMERGENCY_DEPARTMENT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Emergency Department, list the applicable codes or code ranges ",Emergency Codes or Code Range ,EMERGENCY_DEPARTMENT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Emergency Department, describe how these codes are reimbursed",Emergency Reimbursement Methodology,EMERGENCY_DEPARTMENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for experimental procedures, list the applicable codes or code ranges ",Experimental Codes or Code Range,EXPERIMENTAL_PROCEDURES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for experimental procedures (Yes/No)?,Experimental Procedures Carve Out (Y/N)?,EXPERIMENTAL_PROCEDURES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for experimental procedures, describe how these codes are reimbursed",Experimental Reimbursement Methodology ,EXPERIMENTAL_PROCEDURES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the primary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based?",Fee Schedule - Primary,PRIMARY_REIMBURSEMENT_FEE_SCHEDULE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the secondary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based?",Fee Schedule - Secondary,SECONDARY_REIMBURSEMENT_FEE_SCHEDULE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the tertiary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based?",Fee Schedule - Tertiary,TERTIARY_REIMBURSEMENT_FEE_SCHEDULE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the primary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?",Fee Schedule Version - Primary,PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the secondary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?",Fee Schedule Version - Secondary,SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the tertiary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?",Fee Schedule Version - Tertiary,TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Does the contract include a carve out for global services (Yes/No)?,Global Services Carve Out (Y/N)?,GLOBAL_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for global services, list the applicable codes or code ranges ",Global Services Codes or Code Range,GLOBAL_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for global services, describe how these codes are reimbursed",Global Services Reimbursement Methodology ,GLOBAL_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the Reimbursement methodology include greater of language (Yes/No)?,Greater Of Language (Y/N)?,GREATER_OF_LANGUAGE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Always Required ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
What is the contact information of the Group provider named in this contract?,Group Provider Address Line 1,PROV_GROUP_ADDRESS_LINE1,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
,Group Provider Address Line 2,PROV_GROUP_ADDRESS_LINE2,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
What are the group providers identification numbers other than TIN and NPI?,Group Provider CAQH Number ,PROV_GROUP_CAQH_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Group Provider City,PROV_GROUP_CITY,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
,Group Provider Fax Number,PROV_GROUP_FAX_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Group Provider Marketplace Number,PROV_GROUP_MARKETPLACE_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Group Provider Medicaid Number,PROV_GROUP_MEDICAID_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Group Provider Medicare Number,PROV_GROUP_MEDICARE_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
"What is the name of the Group provider that is a party to the contract as stated in the Preamble? This is likely in the first paragraph of the contract and is followed with provider. Answer with one or two words, do not provide any other context/content but the provider name.",Group Provider Name per Preamble,PROV_GROUP_NAME,VARCHAR,A,ACTIVE,Yes,Preamble ,Provider ,Always Required ,UNIQUE KEY
|
||
|
|
"What is the name of the Group provider that is a party to the contract as stated in the Preamble? This is in the signature page of the contract. Answer with one or two words, do not provide any other context/content but the provider name.",Group Provider Name per Signatory,PROV_GROUP_NAME_SIGNATORY,VARCHAR,A,ACTIVE,Yes,Signature Page,Provider ,Always Required ,"UNIQUE KEY
|
||
|
|
PDM"
|
||
|
|
"What is the group provider's national provider identifier number? This can be found on the signature page or on the roster. It consists of 10 digits. Only return these 10 digits, do not return any other content.",Group Provider National Provider Identifier,PROV_GROUP_NPI,VARCHAR,A,ACTIVE,Yes,"Signature Page, Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
|
||
|
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PDM"
|
||
|
|
,Group Provider Phone Number,PROV_GROUP_PHONE_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Group Provider State,PROV_GROUP_STATE_CD,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM UNIQUE KEY"
|
||
|
|
What is the Group provider's taxpayer identification number stated in the Preamble?,Group Provider Taxpayer Identification Number per Preamble,PROV_GROUP_TIN,VARCHAR,A,ACTIVE,Yes,Preamble ,Provider ,Required Only If Available ,UNIQUE KEY
|
||
|
|
What is the group provider's taxpayer identification number stated in the Signatory Section?,Group Provider Taxpayer Identification Number per Signatory ,PROV_GROUP_TIN_SIGNATORY,VARCHAR,A,ACTIVE,Yes,Signature Page,Provider ,Always Required ,"UNIQUE KEY
|
||
|
|
PDM"
|
||
|
|
,Group Provider ZIP,PROV_GROUP_POSTAL_CD,NUMERIC,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
Does the contract include a carve out for Hearing Aids & Hearing Services (Yes/No)?,Hearing Aids & Hearing Services Carve Out (Y/N)?,HEARING_AID_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Hearing Aids & Hearing Services, list the applicable codes or code ranges ",Hearing Aids & Hearing Services Codes or Code Range,HEARING_AID_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Hearing Aids & Hearing Services, describe how these codes are reimbursed",Hearing Aids & Hearing Services Reimbursement Methodology ,HEARING_AID_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for HIV (Yes/No)?,HIV Carve Out (Y/N)?,HIV_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for HIV, list the applicable codes or code ranges ",HIV Codes or Code Range ,HIV_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for HIV, describe how these codes are reimbursed",HIV Reimbursement Methodology,HIV_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for implants (Yes/No)?,Implants Carve Out (Y/N)?,IMPLANTS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for implants, list the applicable codes or code ranges ",Implants Codes or Code Range,IMPLANTS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for implants, describe how these codes are reimbursed",Implants Reimbursement Methodology ,IMPLANTS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
What is the contact information for each of the other providers associated with this agreement?,Individual Provider Address Line 1,PROV_OTHER_ADDRESS_LINE1,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
,Individual Provider Address Line 2,PROV_OTHER_ADDRESS_LINE2,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
What are the individual providers identification numbers other than TIN and NPI?,Individual Provider CAQH Number ,PROV_OTHER_CAQH_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Individual Provider City,PROV_OTHER_CITY,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
,Individual Provider Fax Number,PROV_OTHER_FAX_NUM,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
"If a provider roster exists in the contract, list the first names of all human providers on the roster. Only return the first name, and do not include the names of any non-human providers.",Individual Provider First Name,PROV_FIRST_NAME_OTHER,VARCHAR,A,INACTIVE,Yes,"Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
|
||
|
|
PDM"
|
||
|
|
"If a provider roster exists in the contract, list the last names of all human providers on the roster. Only return the last name, and do not include the names of any non-human providers.",Individual Provider Last Name,PROV_LAST_NAME_OTHER,VARCHAR,A,INACTIVE,Yes,"Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
|
||
|
|
PDM"
|
||
|
|
,Individual Provider Marketplace Number,PROV_OTHER_MARKETPLACE_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Individual Provider Medicaid Number,PROV_OTHER_MEDICAID_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
,Individual Provider Medicare Number,PROV_OTHER_MEDICARE_NUM,VARCHAR,D,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
"If a provider roster exists in the contract, list the middle initials of all human providers on the roster, such as the ""G"" in ""John G. Smith."" Only return the middle initial, and do not include the names of any non-human providers.",Individual Provider Middle Initial,PROV_MIDDLE_NAME_OTHER,VARCHAR,A,INACTIVE,Yes,"Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"UNIQUE KEY
|
||
|
|
PDM"
|
||
|
|
,Individual Provider Phone Number,PROV_OTHER_PHONE_NUM,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
What is individual provider specialty as mapped by AArete?,Individual Provider Specialty as Mapped,AAR_PROV_SPECIALTY_AARETE_MAPPED,VARCHAR,,ACTIVE,Yes,AArete Derived,Provider ,Always Required ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS
|
||
|
|
PDM PRICING"
|
||
|
|
What is individual provider specialty per contract?,Individual Provider Specialty per Contract,PROV_SPECIALTY,VARIANT,B,ACTIVE,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS
|
||
|
|
PDM PRICING"
|
||
|
|
,Individual Provider State,PROV_OTHER_STATE_CD,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
,Individual Provider ZIP,PROV_OTHER_POSTAL_CD,VARCHAR,D,TRANSFORMED,Yes,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,"LOCAL COVERAGE DETERMINATION (LCD)
|
||
|
|
PAYMENT ACCURACY
|
||
|
|
PDM"
|
||
|
|
Does the contract include a carve out for Intensive Care Unit (Yes/No)?,Intensive Care Carve Out (Y/N)?,INTENSIVE_CARE_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Intensive Care Unit, list the applicable codes or code ranges ",Intensive Care Codes or Code Range ,INTENSIVE_CARE_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Intensive Care Unit, describe how these codes are reimbursed",Intensive Care Reimbursement Methodology,INTENSIVE_CARE_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for invalid codes, describe how these codes are reimbursed",Invalid Code Reimbursement Methodology ,INVALID_CODES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for invalid codes (Yes/No)?,Invalid Codes Carve Out (Y/N)?,INVALID_CODES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for invalid codes, list the applicable codes or code ranges ",Invalid Codes or Code Range,INVALID_CODES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for investigational procedures, list the applicable codes or code ranges ",Investigational Codes or Code Range,INVESTIGATIONAL_PROCEDURES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for investigational procedures (Yes/No)?,Investigational Procedures Carve Out (Y/N)?,INVESTIGATIONAL_PROCEDURES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for investigational procedures, describe how these codes are reimbursed",Investigational Reimbursement Methodology ,INVESTIGATIONAL_PROCEDURES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Major Joint Replacement (Yes/No)?,Joint Replacement Carve Out (Y/N)?,JOINT_REPLACE_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Major Joint Replacement, list the applicable codes or code ranges ",Joint Replacement Codes or Code Range ,JOINT_REPLACE_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Major Joint Replacement, describe how these codes are reimbursed",Joint Replacement Reimbursement Methodology,JOINT_REPLACE_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Laboratory / Pathology (Yes/No)?,Laboratory / Pathology Carve Out (Y/N)?,LAB_PATHOLOGY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , list the applicable codes or code ranges ",Laboratory / Pathology Codes or Code Range,LAB_PATHOLOGY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , describe how these codes are reimbursed",Laboratory / Pathology Reimbursement Methodology ,LAB_PATHOLOGY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the Reimbursement methodology include lesser of language (Yes/No)?,Lesser Of Language (Y/N)?,LESSER_OF_LANGUAGE_IND,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Always Required ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the contract is based on line of business, then list all lines of business. The most common lines of business that contracts cover are Medicare, Medicaid, Commercial, and Marketplace.",Line of Business,CONTRACT_LOB,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Always Required ,UNIQUE KEY
|
||
|
|
"If the Primary reimbursement is based on codes listed on the the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate?",Medicaid $ Rate - Primary,PRIMARY_REIMBURSEMENT_MEDICAID_RATE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Secondary reimbursement is based on codes listed on the the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate?",Medicaid $ Rate - Secondary,SECONDARY_REIMBURSEMENT_MEDICAID_RATE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Tertiary reimbursement is based on codes listed on the the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate?",Medicaid $ Rate - Tertiary,TERTIARY_REIMBURSEMENT_MEDICAID_RATE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Does Medicaid agreement allow offshore (Yes/No)?,Medicaid Offshore (Y/N)? ,MEDICAID_ALLOW_OFFSHORE,VARCHAR,,INACTIVE,No,Medicaid Agreement ,,Required Only If Available ,
|
||
|
|
Does the contract include a carve out for medical pharmacy and/or physician administered drugs (Yes/No)?,Medical Pharmacy Carve Out (Y/N)?,ADMINISTERED_DRUGS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, list the applicable codes or code ranges ",Medical Pharmacy Codes or Code Range,ADMINISTERED_DRUGS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe how these codes are reimbursed",Medical Reimbursement Methodology ,ADMINISTERED_DRUGS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the Primary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?",Medicare $ Rate - Primary,PRIMARY_REIMBURSEMENT_CMS_MEDICARE_RATE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Secondary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?",Medicare $ Rate - Secondary,SECONDARY_REIMBURSEMENT_CMS_MEDICARE_RATE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Tertiary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?",Medicare $ Rate - Tertiary,TERTIARY_REIMBURSEMENT_CMS_MEDICARE_RATE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Does Medicare agreement allow offshore (Yes/No)?,Medicare Offshore (Y/N)? ,MEDICARE_ALLOW_OFSHORE,VARCHAR,E,ACTIVE,No,Medicare Agreement ,,Required Only If Available ,
|
||
|
|
Does the contract include a carve out for Mid-Level Professionals (Yes/No)? ,Mid-Level Carve Out (Y/N)?,MID_LEVEL_PROFESSIONAL_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Mid-Level Professionals, list the applicable codes or code ranges ",Mid-Level Codes or Code Range,MID_LEVEL_PROFESSIONAL_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Mid-Level Professionals, describe how these codes are reimbursed",Mid-Level Reimbursement Methodology ,MID_LEVEL_PROFESSIONAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Neonatal Services (Yes/No)?,Neonatal Carve Out (Y/N)?,NEONATAL_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Neonatal Services, list the applicable codes or code ranges ",Neonatal Codes or Code Range ,NEONATAL_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Neonatal Services, describe how these codes are reimbursed",Neonatal Reimbursement Methodology,NEONATAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract is based on network type, list each payer network relevant to each line of business as outlined in the contract.",Network,CONTRACT_NETWORK,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Required Only If Available ,UNIQUE KEY
|
||
|
|
Does the contract include a carve out for never events (Yes/No)?,Never Event Carve Out (Y/N)?,NEVER_EVENT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for never events, list the applicable codes or code ranges ",Never Event Codes or Code Range,NEVER_EVENT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
|
||
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"If the contract includes a carve out for never events, describe how these codes are reimbursed",Never Event Reimbursement Methodology ,NEVER_EVENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for procedures that are not medically necessary, describe how these codes are reimbursed",Not Medically Necessary Reimbursement Methodology ,NOT_MED_NECESSARY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for procedures that are not medically necessary, list the applicable codes or code ranges ",Not Medically Necessary Codes or Code Range,NOT_MED_NECESSARY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for procedures that are not medically necessary (Yes/No)?,Not Medically Necessary Procedures Carve Out (Y/N)?,NOT_MED_NECESSARY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract is numbered, which number is it (e.g., if contract is titled Amendment #1, then enter ""1"")?","Number or Letter Used to Name Amendment, Addendum, Rider, Exhibit, Attachment, Schedule",CONTRACT_NUM,VARCHAR,A,ACTIVE,No,Title or Preamble,Contract ,Required Only If Agreement NOT the Base Contract,"GREEN LIGHT - IF SEQUENCE OF AMENDMENTS OR ADDENDUMS IS MISSING A NUMBER OR LETTER THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNTIL ALL AMENDMENTS AND ADDENDUMS ARE RECEIVED UNIQUE KEY"
|
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Does the contract include a carve out for OB/GYN Services (Yes/No)?,OB/GYN Carve Out (Y/N)?,OBGYN_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, list the applicable codes or code ranges ",OB/GYN Codes or Code Range ,OBGYN_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, describe how these codes are reimbursed",OB/GYN Reimbursement Methodology,OBGYN_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Observation, list the applicable codes or code ranges ",Observation Codes or Code Range ,OBSERVATION_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Observation, describe how these codes are reimbursed",Observation Reimbursement Methodology,OBSERVATION_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Ophthalmology & Vision Services (Yes/No)?,Ophthalmology & Vision Services Carve Out (Y/N)?,OPHTHAMOLOGY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
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"If the contract includes a carve out for Ophthalmology & Vision Services, list the applicable codes or code ranges ",Ophthalmology & Vision Services Codes or Code Range ,OPHTHAMOLOGY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Ophthalmology & Vision Services, describe how these codes are reimbursed",Ophthalmology & Vision Services Reimbursement Methodology,OPHTHAMOLOGY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
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,Other Group Provider Identifiers,PROV_GROUP_OTHER_NUM,VARCHAR,D,ACTIVE,No,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
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,Other Individual Provider Identifiers,PROV_OTHER_NUM,VARCHAR,D,ACTIVE,No,"Exhibit, Attachment, or Schedule to contract",Provider ,Required Only If Available ,PDM
|
||
|
|
"If the contract includes a carve out for outlier provisions, what is the reimbursement method?",Outlier Allowed Amount,OUTLIER_PROVISIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
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|
NETWORK"
|
||
|
|
Does the contract include a carve out for outlier provisions (Yes/No)?,Outlier Provisions (Y/N)?,OUTLIER_PROVISIONS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the contract includes a carve out for outlier provisions, what is the outlier threshold?",Outlier Threshold,OUTLIER_PROVISIONS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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|
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NETWORK"
|
||
|
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"Is the provider contracted to participate in the line of business, network, plan, program for the given provider type?",Participation Status,PROV_PARTICIPATION_STATUS,VARCHAR,A,ACTIVE,Yes,"Derived From Combination of LOB, Network, Metal Level, Service Area, Program and/or Type of Provider Fields ",LOB/Provider Type Specific,Always Required ,UNIQUE KEY
|
||
|
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What is the name of the payer that is a party to the contract as stated in the Preamble?,Payer Name per Preamble,PAYER_NAME,VARCHAR,A,ACTIVE,Yes,Preamble ,Payer,Always Required ,"GREEN LIGHT - IF PAYER NAME DOES NOT EQUAL ""CLIENT NAME"" THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION; UNIQUE KEY"
|
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|
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Does the contract include terms for penalties and interest (Yes/No)?,Penalties & Interest (Y/N)?,PENALTIES_INTEREST_IND,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
|
||
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NETWORK"
|
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|
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What is rate charged for penalties and interest?,Penalties & Interest Rate,PENALTIES_INTEREST_RATE,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
What triggers computation of penalties and interest?,Penalties & Interest Trigger,PENALTIES_INTEREST_TRIGGER,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
|
||
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NETWORK"
|
||
|
|
"If the contract is for Marketplace line of business, then list all metal levels , such as platinum, bronze, silver, and gold.",Plan - Metal Level,CONTRACT_MARKETPLACE_METAL_LEVEL,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Required Only If Available ,UNIQUE KEY
|
||
|
|
"If the contract is based on service areas, then list each specifically listed geographic area for each line of business. This could be a state, county, ZIP code, etc. Return either a comma separated list of these service areas, or do not return anything if the contract is not based on geography. Do not elaborate or add context.",Plan- Service Area,CONTRACT_SERVICE_AREA,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Required Only If Available ,UNIQUE KEY
|
||
|
|
Does the contract include a carve out for post-discharge procedures (Yes/No)?,Post-Discharge Procedures Carve Out (Y/N)?,POSTDISCHARGE_PROC_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for post-discharge procedures, list the applicable codes or code ranges",Post-Discharge Services Codes or Code Range,POSTDISCHARGE_PROC_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for post-discharge procedures, describe how these codes are reimbursed",Post-Discharge Services Reimbursement Methodology ,POSTDISCHARGE_PROC_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for post-discharge procedures, how long is the post-discharge window?",Post-Discharge Window,POSTDISCHARGE_PROC_CARVEOUT_WINDOW,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
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INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for pre-admission procedures (Yes/No)? ,Pre-Admission Procedures Carve Out (Y/N)?,PREADMISSION_PROC_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for pre-admission procedures, list the applicable codes or code ranges ",Pre-Admission Services Codes or Code Range,PREADMISSION_PROC_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for pre-admission procedures, describe how these codes are reimbursed",Pre-Admission Services Reimbursement Methodology ,PREADMISSION_PROC_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for pre-admissions procedures, how long is the pre-admission window?",Pre-Admission Window,PREADMISSION_PROC_CAREVEOUT_WINDOW,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
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INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Professional Component (Yes/No)? ,Professional Component Carve Out (Y/N)?,PROFESSIONAL_COMPONENT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Professional Component, list the applicable codes or code ranges ",Professional Component Codes or Code Range,PROFESSIONAL_COMPONENT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Professional Component, describe how these codes are reimbursed",Professional Component Reimbursement Methodology ,PROFESSIONAL_COMPONENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
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INTELLIGENT EDITS "
|
||
|
|
"If the contract is for Medicare or Medicaid line of business, then list the programs for each line of business.",Program,CONTRACT_PROGRAM,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Required Only If Available ,UNIQUE KEY
|
||
|
|
Does the contract include a carve out for prosthetics (Yes/No)?,Prosthetics Carve Out (Y/N)?,PROSTHETICS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for prosthetics, list the applicable codes or code ranges ",Prosthetics Codes or Code Range,PROSTHETICS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for prosthetics, describe how these codes are reimbursed",Prosthetics Reimbursement Methodology ,PROSTHETICS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract is limited to certain Professional specialties, then list each specialty and the line of business it applies to.",Provider Specialty,PROV_SPECIALTYTY,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Required Only If Available ,UNIQUE KEY
|
||
|
|
Does the contract include a carve out for Radiology/Imaging Services (Yes/No)?,Radiology/Imaging Carve Out (Y/N)?,RADIOLOGY_IMAGING_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Radiology/Imaging Services, list the applicable codes or code ranges ",Radiology/Imaging Codes or Code Range,RADIOLOGY_IMAGING_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Radiology/Imaging Services, describe how these codes are reimbursed",Radiology/Imaging Reimbursement Methodology ,RADIOLOGY_IMAGING_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If contract includes annual rate escalators based on % rate increase, then what is the yearly percentage increase? ",Rate Escalator %,RATE_ESCALATOR_YEARLY_PERCENT_INCREASE,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If contract includes annual rate escalators, on what are they based?",Rate Escalator Basis,RATE_ESCALATOR_BASIS,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK PRICING"
|
||
|
|
"If contract automatically renews, then does the contract include annual rate escalators for year-over-year rate increases (Yes/No)?",Rate Escalators (Y/N)?,RATE_ESCALATOR_IND,VARCHAR,B,ACTIVE,No,"From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider","Discounts, Premiums, Sequestration, Penalties, Interest",Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK PRICING"
|
||
|
|
Does the contract include a carve out for readmissions (Yes/No)?,Readmissions Carve Out (Y/N)?,READMISSIONS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for readmissions, list the applicable codes or code ranges ",Readmissions Codes or Code Range,READMISSIONS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for readmissions, describe how these codes are reimbursed",Readmissions Reimbursement Methodology ,READMISSIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for readmissions, how long is the readmission window?",Readmissions Window,READMISSIONS_CAREVEOUT_WINDOW,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Multiple Procedure Reductions, which types of reductions apply?",Reduced Services Codes or Code Range,MULTIPLE_PROCEDURE_REDUCTIONS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract address Multiple Procedure Reductions, for each type of reduction, what reimbursement methodology applies?",Reduced Services Reimbursement Methodology ,MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"Does the contract include a carve out for Multiple Procedure Reductions (i.e., discounted procedures) (Yes/No)?",Reductions Carve Out (Y/N)?,MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the primary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount?",Reimbursement $ Rate - Primary,PRIMARY_REIMBURSEMENT_FLAT_FEE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Secondary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount?",Reimbursement $ Rate - Secondary,SECONDARY_REIMBURSEMENT_FLAT_FEE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Tertiary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount?",Reimbursement $ Rate - Tertiary,TERTIARY_REIMBURSEMENT_FLAT_FEE,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the primary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage?",Reimbursement % Rate - Primary,PRIMARY_REIMBURSEMENT_RATE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Secondary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage?",Reimbursement % Rate - Secondary,SECONDARY_REIMBURSEMENT_RATE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Tertiary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage?",Reimbursement % Rate - Tertiary,TERTIARY_REIMBURSEMENT_RATE,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"Deprecated - See columns PD, PE, PF
|
||
|
|
|
||
|
|
Are there any carve outs or exceptions to the primary reimbursement methodology?",Reimbursement Exceptions - Primary ,PRIMARY_REIMBURSEMENT_EXCEPTION_IND,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Are there any exceptions to the Secondary reimbursement methodology?,Reimbursement Exceptions - Secondary ,SECONDARY_REIMBURSEMENT_EXCEPTION_IND,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Are there any exceptions to the Tertiary reimbursement methodology?,Reimbursement Exceptions - Tertiary ,TERTIARY_REIMBURSEMENT_EXCEPTION_IND,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the primary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?",Reimbursement Grouper - Primary ,PRIMARY_REIMBURSEMENT_GROUPER,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Secondary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?",Reimbursement Grouper - Secondary,SECONDARY_REIMBURSEMENT_GROUPER,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the Tertiary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?",Reimbursement Grouper - Tertiary,TERTIARY_REIMBURSEMENT_GROUPER,VARCHAR,B,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
What is the primary Reimbursement methodology?,Reimbursement Methodology - Primary,PRIMARY_REIMBURSEMENT_METHODOLOGY,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Always Required ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the contract includes lesser of or greater of language, what is the tertiary Reimbursement methodology (if any)?",Reimbursement Methodology - Tertiary,TERTIARY_REIMBURSEMENT_METHODOLOGY,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the contract includes lesser of or greater of language, what is the secondary Reimbursement methodology?",Reimbursement Methodology -Secondary,SECONDARY_REIMBURSEMENT_METHODOLOGY,VARCHAR,B,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Reimbursement Methodology,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Does the contract include a carve out for second surgeries and/or procedures (Yes/No)?,Second Surgery/Procedure Carve Out (Y/N)?,SECOND_SURGERIES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for second surgeries and/or procedures, list the applicable codes or code ranges ",Second Surgery/Procedure Codes or Code Range,SECOND_SURGERIES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for second surgeries and/or procedures, describe how these codes are reimbursed",Second Surgery/Procedure Reimbursement Methodology ,SECOND_SURGERIES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does State Marketplace agreement allow offshore (Yes/No)?,State Marketplace Offshore (Y/N)? ,MARKETPLACE_ALLOW_OFFSHORE,VARCHAR,,INACTIVE,No,State Marketplace Agreement ,,Required Only If Available ,
|
||
|
|
Does the contract include a carve out for certain Status Indicators (Yes/No)?,Status Indicator Carve Out (Y/N)?,STATUS_INDICATORS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for certain Status Indicators, list the applicable codes or code ranges ",Status Indicator Codes or Code Range,STATUS_INDICATORS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for certain Status Indicators, describe how these codes are reimbursed",Status Indicator Reimbursement Methodology ,STATUS_INDICATORS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contact include a carve out for stop loss (Yes/No)?,Stop Loss (Y/N)?,STOP_LOSS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the contract includes a carve out for stop loss, what is the percent allowed above the stop loss threshold?",Stop Loss Allowed Amount,STOP_LOSS_CARVEOUT_PERCENT_ALLOWED,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
"If the contract includes a carve out for stop loss, what is the stop loss threshold?",Stop Loss Threshold,STOP_LOSS_CAREVOUT_THRESHOLD,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
Does the contract include a carve out for subsequent surgeries and/or procedures (Yes/No)?,Subsequent Surgery/Procedure Carve Out (Y/N)?,SUBSEQUENT_SURGERIES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for subsequent surgeries and/or procedures, list the applicable codes or code ranges ",Subsequent Surgery/Procedure Codes or Code Range,SUBSEQUENT_SURGERIES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for subsequent surgeries and/or procedures, describe how these codes are reimbursed",Subsequent Surgery/Procedure Reimbursement Methodology ,SUBSEQUENT_SURGERIES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Technical Component (Yes/No)? ,Technical Component Carve Out (Y/N)?,TECHNICAL_COMPONENT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Technical Component, list the applicable codes or code ranges ",Technical Component Codes or Code Range,TECHNICAL_COMPONENT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Technical Component, describe how these codes are reimbursed",Technical Component Reimbursement Methodology ,TECHNICAL_COMPONENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"For each line of business, identify the specific date upon which the compensation terminates, in the following format ONLY: MM/DD/YYYY.",Termination Date of Pricing Terms,LOB_PRICING_TERMS_TERMINATION_DT,D,A,ACTIVE,No (but please use GDP date format throughout),"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Always Required ,"GREEN LIGHT - IF DATE IS LESS THAN TODAY'S DATE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNLESS THERE IS AN EFFECTIVE AMENDMENT UNIQUE KEY"
|
||
|
|
What is timeline for payer to audit claims per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Payer Claim Audit ,R156,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Payer Overpayment Identification,R164,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Payer Policy Change Notice ,R146,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
COST AVOIDANCE"
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Payer Prompt Payment Electronic ,R154,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Payer Prompt Payment Paper ,R152,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Provider Claim Timely Filing ,R148,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Provider Corrected Claim Filing ,R150,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Provider Overpayment Appeal,R166,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Provider Payment Appeal,R158,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Provider Payment Dispute,R160,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT NUMBER)?,Timeline Medicaid Provider Payment Reconsideration,R162,,,INACTIVE,No,Medicaid Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for payer to audit claims per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Payer Claim Audit ,R134,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Payer Overpayment Identification,R142,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Payer Policy Change Notice ,R124,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
COST AVOIDANCE"
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Payer Prompt Payment Electronic ,R132,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Payer Prompt Payment Paper ,R130,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Provider Claim Timely Filing ,R126,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT NUMBER)?,Timeline Medicare Provider Corrected Claim Filing ,R128,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Provider Overpayment Appeal,R144,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Provider Payment Appeal,R136,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT NUMBER) ?,Timeline Medicare Provider Payment Dispute,R138,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT NUMBER)?,Timeline Medicare Provider Payment Reconsideration,R140,,,INACTIVE,No,Medicare Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for payer to audit claims per base agreement (INSERT NUMBER)?,Timeline Payer Claim Audit ,R112,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT NUMBER)?,Timeline Payer Overpayment Identification,R120,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT NUMBER),Timeline Payer Policy Change Notice ,R102,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
COST AVOIDANCE"
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT NUMBER)?,Timeline Payer Prompt Payment Electronic ,R110,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT NUMBER)?,Timeline Payer Prompt Payment Paper ,R108,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT NUMEBER)?,Timeline Provider Claim Timely Filing ,R104,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS"
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT NUMBER)?,Timeline Provider Corrected Claim Filing ,R106,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT NUMBER)?,Timeline Provider Overpayment Appeal,R122,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT NUMBER)?,Timeline Provider Payment Appeal,R114,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT NUMBER)?,Timeline Provider Payment Dispute,R116,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT NUMBER)?,Timeline Provider Payment Reconsideration,R118,,,INACTIVE,No,Base Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for payer to audit claims per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Payer Claim Audit ,R178,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Payer Overpayment Identification,R186,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Payer Policy Change Notice ,R168,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
COST AVOIDANCE"
|
||
|
|
Does the contract include a carve out for timeline for payer to implement changes in regulations per LOB Specific agreement?,Timeline State Marketplace Payer Policy Change Notice ,CARVEOUT_IND_IMPLEMENT_POLICY_CHANGE,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Key Dates,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
COST AVOIDANCE"
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT NUMBER) ?,Timeline State Marketplace Payer Prompt Payment Electronic ,R176,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT NUMBER) ?,Timeline State Marketplace Payer Prompt Payment Paper ,R174,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,PREPAY
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Provider Claim Timely Filing ,R170,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Provider Corrected Claim Filing ,R172,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,PAYMENT ACCURACY
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Provider Overpayment Appeal,R188,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Provider Payment Appeal,R180,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT NUMBER) ?,Timeline State Marketplace Provider Payment Dispute,R182,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT NUMBER)?,Timeline State Marketplace Provider Payment Reconsideration,R184,,,INACTIVE,No,State Marketplace Agreement ,Key Dates,Required Only If Available ,"APPEALS
|
||
|
|
INVOICING"
|
||
|
|
Does the contract include a carve out for Transplant (Yes/No)?,Transplant Carve Out (Y/N)?,TRANSPLANT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Transplant, list the applicable codes or code ranges ",Transplant Codes or Code Range ,TRANSPLANT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Transplant, describe how these codes are reimbursed",Transplant Reimbursement Methodology,TRANSPLANT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Trauma (Yes/No)?,Trauma Carve Out (Y/N)?,TRAUMA_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Trauma, list the applicable codes or code ranges ",Trauma Codes or Code Range ,TRAUMA_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Trauma, describe how these codes are reimbursed",Trauma Reimbursement Methodology,TRAUMA_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"Is the contract related to a Professional, Institutional or Ancillary provider? Only respond with ""Professional,"" ""Institutional,"", or ""Ancillary.""",Type of Contract,CONTRACT_TYPE,VARCHAR,A,ACTIVE,Yes,AArete Derived from Title or Preamble ,LOB/Provider Type Specific,Always Required ,UNIQUE KEY
|
||
|
|
"If the contract is based on type of provider, identify each provider type for each line of business. Often the provider type will be found next to the word ""services.""",Type of Provider,PROV_TYPE,VARCHAR,A,ACTIVE,Yes,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",LOB/Provider Type Specific,Always Required ,UNIQUE KEY
|
||
|
|
"If the contract includes a carve out for Unlisted codes, describe how these codes are reimbursed",Unlisted Code Reimbursement Methodology ,UNLISTED_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
Does the contract include a carve out for Unlisted codes (Yes/No)?,Unlisted Codes Carve Out (Y/N)?,UNLISTED_CAREVEOUT_IND,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
"If the contract includes a carve out for Unlisted codes, list the applicable codes or code ranges ",Unlisted Codes or Code Range,UNLISTED_CAREVOUT_CODES,VARCHAR,F,ACTIVE,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
INTELLIGENT EDITS "
|
||
|
|
What is the title of the contract? (Page #),,CONTRACT_TITLE_PG,NUMERIC,C,ACTIVE,,,,,
|
||
|
|
What type of contract or agreement is the document? (Page #),,CONTRACT_HEADER_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract is numbered, which number is it (e.g., if contract is titled Amendment #1, then enter ""1"")? (Page #)",,CONTRACT_NUM_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If this agreement is not the base contract, then what is the title of the associated base contract? (Page#) ",,CONTRACT_BASE_TITLE_PG,NUMERIC,C,ACTIVE,,,,,
|
||
|
|
"If this agreement is not the base contract, then what is the effective date of the associated base contract? (Page#) ",,CONTRACT_BASE_EFFECTIVE_DT_PG,NUMERIC,C,ACTIVE,,,,,
|
||
|
|
Is the contract the final version of the contract as evidenced by whether all signature lines in the signatory section of the agreement are signed? (Page#) ,,CONTRACT_SIGNATORY_IND_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the name of the payer that is a party to the contract as stated in the Preamble? (Page#) ,,PAYER_NAME_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the name of the Group provider that is a party to the contract as stated in the Preamble? (Page#) ,,PROV_GROUP_NAME_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the Group provider's taxpayer identification number stated in the Preamble? (Page#) ,,PROV_GROUP_TIN_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the name of the Group provider that is a party to the contract as stated in the Signatory Section? (Page#) ,,PROV_GROUP_NAME_SIGNATORY_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the group provider's taxpayer identification number stated in the Signatory Section? (Page#) ,,PROV_GROUP_TIN_SIGNATORY_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the group provider's national provider identifier number? (Page#) ,,PROV_GROUP_NPI_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the contact information of the Group provider named in this contract? (Page#) ,,PROV_GROUP_PG,NUMERIC,D,ACTIVE,,,,,
|
||
|
|
What are the group providers identification numbers other than TIN and NPI? (Page#) ,,PROV_GROUP_NUM_PG,NUMERIC,D,ACTIVE,,,,,
|
||
|
|
What are the names of other providers associated with this agreement? (Note that amendments are needed to capture TINs added through acquisition/merger) (Page#) ,,PROV_OTHER_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What are the provider taxpayer identification numbers for each of the other providers associated with this agreement? (Page#) ,,PROV_TIN_OTHER_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What are the provider national provider identifier numbers for each of the other providers associated with this agreement? (Page#) ,,PROV_NPI_OTHER_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the contact information for each of the other providers associated with this agreement? (Page#) ,,PROV_OTHER_PG,NUMERIC,D,TRANSFORMED,,,,,
|
||
|
|
What are the individual providers identification numbers other than TIN and NPI? (Page#) ,,PROV_OTHER_NUM_PG,NUMERIC,D,ACTIVE,,,,,
|
||
|
|
What is individual provider specialty per contract? (Page#) ,,PROV_SPECIALTY_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is individual provider specialty as mapped by AArete? (Page#) ,,,,,INACTIVE,,,,,
|
||
|
|
What is the contract effective date as stated in Preamble of the agreement? (Page#) ,,CONTRACT_EFFECTIVE_DT_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is the contract effective date as stated in the signatory section of the agreement? (Page#) ,,CONTRACT_EFFECTIVE_DT_SIGNATORY_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
Are the contract effective dates in the Preamble and the final signatory section consistent? (Page#) ,,R100,,,INACTIVE,,,,,
|
||
|
|
What is the contract termination date? (Page#) ,,CONTRACT_TERMINATION_DT_PG,NUMERIC,,ACTIVE,,,,,
|
||
|
|
Does the contract automatically renew (Yes/No)? (Page#) ,,CONTRACT_AUTO_RENEWAL_IND_PG,NUMERIC,,ACTIVE,,,,,
|
||
|
|
"If contract automatically renews, then what is the length of the renewal term? (Page#) ",,CONTRACT_AUTO_RENEWAL_TERM_LENGTH_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If contract automatically renews, then then what is the adjusted contract termination date? (Page#) ",,R101,,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT UNIT OF MEASURE),,R103,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT NUMBER),,PAYER_POLICY_CHANGE_NOTICE_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT TRIGGER ""FROM"" or ""BEFORE"")",,PAYER_POLICY_CHANGE_NOTICE_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per base agreement? (Page#),,PAYER_POLICY_CHANGE_NOTICE_INFO_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT UNIT OF MEASURE)?,,R105,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT NUMEBER)?,,PROV_CLAIM_TIMELY_FILING_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CLAIM_TIMELY_FILING_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per base agreement (Page#)?,,PROV_CLAIM_TIMELY_FILING_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT UNIT OF MEASURE)?,,R107,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT NUMBER)?,,PROV_CORRECTED_CLAIM_FILING_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CORRECTED_CLAIM_FILING_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the base agreement (Page#)?,,PROV_CORRECTED_CLAIM_FILING_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT UNIT OF MEASURE)?,,R109,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT NUMBER)?,,PAYER_PROMPT_PAY_PAPER_CLAIM_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_PROMPT_PAY_PAPER_CLAIM_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per base agreement (Page#)?,,PAYER_PROMPT_PAY_PAPER_CLAIM_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT UNIT OF MEASURE)?,,R111,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT NUMBER)?,,PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per base agreement (Page#)?,,PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per base agreement (INSERT UNIT OF MEASURE)?,,R113,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to audit claims per base agreement (INSERT NUMBER)?,,PAYER_AUDIT_CLAIM_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for payer to audit claims per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_AUDIT_CLAIM_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per base agreement (Page#)?,,PAYER_AUDIT_CLAIM_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT UNIT OF MEASURE)?,,R115,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT NUMBER)?,,PROV_SUBMIT_PAYMENT_APPEAL_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_PAYMENT_APPEAL_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per base agreement (Page#)?,,PROV_SUBMIT_PAYMENT_APPEAL_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT UNIT OF MEASURE)?,,R117,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT NUMBER)?,,PROV_SUBMIT_PAYMENT_DISPUTE_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_PAYMENT_DISPUTE_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per base agreement (Page#)?,,PROV_SUBMIT_PAYMENT_DISPUTE_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT UNIT OF MEASURE)?,,R119,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT NUMBER)?,,PROV_SUBMIT_PAYMENT_RECONSIDERATION_TIMELINE,VARCHAR,,ACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_PAYMENT_RECONSIDERATION_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (Page#)?,,PROV_SUBMIT_PAYMENT_RECONSIDERATION_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT UNIT OF MEASURE)?,,R121,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT NUMBER)?,,PAYER_IDENTIFY_OVERPAYMENT_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_IDENTIFY_OVERPAYMENT_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per base agreement (Page#)?,,PAYER_IDENTIFY_OVERPAYMENT_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT UNIT OF MEASURE)?,,R123,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT NUMBER)?,,PROV_SUBMIT_OVERPAYMENT_APPEAL_TIMELINE,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_OVERPAYMENT_APPEAL_INFO,VARCHAR,E,ACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per base agreement (Page#)?,,PROV_SUBMIT_OVERPAYMENT_APPEAL_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT UNIT OF MEASURE)?,,R125,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT NUMBER)?,,PAYER_NOTICE_POLICY_CHANGE_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_NOTICE_POLICY_CHANGE_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per Medicare agreement (Page#)?,,PAYER_NOTICE_POLICY_CHANGE_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?,,R127,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT NUMBER)?,,PROV_CLAIM_TIMELY_FILING_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CLAIM_TIMELY_FILING_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (Page#)?,,PROV_CLAIM_TIMELY_FILING_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT UNIT OF MEASURE)?,,R129,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT NUMBER)?,,PROV_CORRECTED_CLAIM_FILING_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CORRECTED_CLAIM_FILING_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (Page#)?,,PROV_CORRECTED_CLAIM_FILING_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT UNIT OF MEASURE)?,,R131,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT NUMBER)?,,PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (Page#?,,PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT UNIT OF MEASURE)?,,R133,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT NUMBER)?,,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (Page#)?,,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per Medicare agreement (INSERT UNIT OF MEASURE)?,,R135,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to audit claims per Medicare agreement (INSERT NUMBER)?,,PAYER_CLAIM_AUDIT_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to audit claims per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_CLAIM_AUDIT_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per Medicare agreement? (Page#) ,,PAYER_CLAIM_AUDIT_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?,,R137,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)?,,PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)? (Page#) ,,PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT UNIT OF MEASURE) ?,,R139,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT NUMBER) ?,,PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"") ?",,PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per Medicare agreement ? (Page#) ,,PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_P,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?,,R141,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT NUMBER)?,,PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement? (Page#) ,,PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT UNIT OF MEASURE)?,,R143,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT NUMBER)?,,PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per Medicare agreement? (Page#) ,,PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?,,R145,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT NUMBER)?,,PROV_OVERPAYMENT_APPEAL_MEDICARE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_OVERPAYMENT_APPEAL_MEDICARE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement? (Page#) ,,PROV_OVERPAYMENT_APPEAL_MEDICARE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
Does Medicare agreement allow offshore (Yes/No)? (Page#) ,,MEDICARE_ALLOW_OFFSHORE_PG,NUMERIC,E,ACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R147,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT NUMBER)?,,PAYER_NOTICE_POLICY_CHANGE_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_NOTICE_POLICY_CHANGE_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per Medicaid agreement? (Page#) ,,PAYER_NOTICE_POLICY_CHANGE_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R149,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT NUMBER)?,,PROV_CLAIM_TIMELY_FILING_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CLAIM_TIMELY_FILING_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement? (Page#) ,,PROV_CLAIM_TIMELY_FILING_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT UNIT OF MEASURE)?,,R151,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT NUMBER)?,,PROV_CORRECTED_CLAIM_FILING_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CORRECTED_CLAIM_FILING_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement? (Page#) ,,PROV_CORRECTED_CLAIM_FILING_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R153,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT NUMBER)?,,PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement? (Page#) ,,PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R155,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT NUMBER)?,,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement? (Page#) ,,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R157,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to audit claims per Medicaid agreement (INSERT NUMBER)?,,PROV_CLAIM_AUDIT_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to audit claims per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CLAIM_AUDIT_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per Medicaid agreement? (Page#) ,,PROV_CLAIM_AUDIT_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R159,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT NUMBER)?,,PROV_PAYMENT_APPEAL_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PAYMENT_APPEAL_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement? (Page#) ,,PROV_PAYMENT_APPEAL_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R161,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT NUMBER)?,,PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement ? (Page#) ,,PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R163,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT NUMBER)?,,PROV_PAYMENT_RECONSIDERATION_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PAYMENT_RECONSIDERATION_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement? (Page#) ,,PROV_PAYMENT_RECONSIDERATION_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R165,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT NUMBER)?,,PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per Medicaid agreement? (Page#) ,,PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?,,R167,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT NUMBER)?,,PROV_OVERPAYMENT_APPEAL_MEDICAID_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_OVERPAYMENT_APPEAL_MEDICAID_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement? (Page#) ,,PROV_OVERPAYMENT_APPEAL_MEDICAID_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
Does Medicaid agreement allow offshore (Yes/No)? (Page#) ,,MEDICAID_ALLOW_OFFSHORE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R169,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT NUMBER)?,,PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement? (Page#) ,,PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R171,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT NUMBER)?,,PROV_CLAIM_TIMELY_FILING_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CLAIM_TIMELY_FILING_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement? (Page#) ,,PROV_CLAIM_TIMELY_FILING_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R173,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT NUMBER)?,,PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement? (Page#) ,,PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT UNIT OF MEASURE) ?,,R175,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT NUMBER) ?,,PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"") ?",,PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement? (Page#) ,,PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT UNIT OF MEASURE) ?,,R177,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT NUMBER) ?,,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"") ?",,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement? (Page#) ,,PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R179,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to audit claims per State Marketplace agreement (INSERT NUMBER)?,,PROV_CLAIM_AUDIT_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to audit claims per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_CLAIM_AUDIT_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to audit claims per State Marketplace agreement? (Page#) ,,PROV_CLAIM_AUDIT_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R181,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?,,PROV_PAYMENT_APPEAL_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PAYMENT_APPEAL_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement? (Page#) ,,PROV_PAYMENT_APPEAL_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE) ?,,R183,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT NUMBER) ?,,PROV_PAYMENT_DISPUTE_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"") ?",,PROV_PAYMENT_DISPUTE_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement ? (Page#) ,,PROV_PAYMENT_DISPUTE_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R185,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT NUMBER)?,,PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement? (Page#) ,,PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT UNIT OF MEASURE)?,,R187,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT NUMBER)?,,PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"")?",,PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement? (Page#) ,,PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE )?,,R189,,,INACTIVE,,,,,
|
||
|
|
Concat - What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?,,PROV_OVERPAYMENT_APPEAL_MARKETPLACE_TIMELINE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT TRIGGER ""FROM"" OR ""BEFORE"" )?",,PROV_OVERPAYMENT_APPEAL_MARKETPLACE_INFO,VARCHAR,,INACTIVE,,,,,
|
||
|
|
What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement? (Page#) ,,PROV_OVERPAYMENT_APPEAL_MARKETPLACE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
Does State Marketplace agreement allow offshore (Yes/No)? (Page#) ,,MARKETPLACE_ALLOW_OFSHORE_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
What is start date of line of business specific compensation exhibit? (Page#) ,,LOB_PRICING_TERMS_EFFECTIVE_DT_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
What is termination date of line of business specific compensation exhibit? (Page#) ,,LOB_PRICING_TERMS_TERMINATION_DT_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"Is the contract related to a Professional, Institutional or Ancillary provider? (Page#) ",,CONTRACT_TYPE_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract is based on line of business, then create one row for each line of business (Page#) ",,CONTRACT_LOB_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract is based on network type, then create one row within each impacted line of business for each specifically listed network (Page#) ",,CONTRACT_NETWORK_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract if for Marketplace line of business, then create one row within the Marketplace line of business for each specifically listed metal level (Page#) ",,CONTRACT_MARKETPLACE_METAL_LEVEL_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract is based on service areas, then create one row within each impacted line of business for each specifically listed area, county, ZIP, etc. (Page#) ",,CONTRACT_SERVICE_AREA_PG,VARCHAR,A,ACTIVE,,,,,
|
||
|
|
"If the contract is for Medicare or Medicaid line of business, then create one row within each impacted Medicare/Medicaid line of business for each specifically listed program (Page#) ",,MEDICARE_MEDICAID_LOB_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract is based on type of provider, then create one row within each impacted line of business for each specifically listed provider type of place of service (Page#) ",,PROV_TYPE_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If the contract is limited to certain Professional specialties, then create one row within each line of business for each specifically listed specialty (Page#) ",,PROV_SPECIALTYTY_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"Is the provider contracted to participate in the line of business, network, plan, program for the given provider type? (Page#) ",,PROV_PARTICIPATION_STATUS_PG,NUMERIC,A,ACTIVE,,,,,
|
||
|
|
"If contract automatically renews, then does the contract include annual rate escalators for year-over-year rate increases (Yes/No)? (Page#) ",,RATE_ESCALATOR_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If contract includes annual rate escalators, on what are they based? (Page#) ",,RATE_ESCALATOR_BASIS_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If contract includes annual rate escalators based on % rate increase, then what is the yearly percentage increase? (Page#) ",,RATE_ESCALATOR_YEARLY_PERCENT_INCREASE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does contract include terms for discounts applied to total claim (Yes/No)? (Page#) ,,CLAIM_DISCOUNT_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim discount rate? (Page#) ,,CLAIM_DISCOUNT_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim discount start date? (Page#) ,,CLAIM_DISCOUNT_START_DT_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim discount termination date? (Page#) ,,CLAIM_DISCOUNT_TERMINATION_DT_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does contract include terms for premiums applied to total claim (Yes/No)? (Page#) ,,CLAIM_PREMIUM_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim premium rate? (Page#) ,,CLAIM_PREMIUM_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim premium start date? (Page#) ,,CLAIM_PREMIUM_START_DT_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim premium termination date? (Page#) ,,CLAIM_PREMIUM_TERMINATION_DT_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does contract include terms for sequestration amounts applied to total claim (Yes/No)? (Page#) ,,CLAIM_SEQUESTRATION_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim sequestration rate? (Page#) ,,CLAIM_SEQUESTRATION_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim sequestration start date? (Page#) ,,CLAIM_SEQUESTRATION_START_DT_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is claim sequestration termination date? (Page#) ,,CLAIM_SEQUESTRATION_TERMINATION_DT_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does the contract include terms for penalties and interest (Yes/No)? (Page#) ,,PENALTIES_INTEREST_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What triggers computation of penalties and interest? (Page#) ,,PENALTIES_INTEREST_TRIGGER_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is rate charged for penalties and interest? (Page#) ,,PENALTIES_INTEREST_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is contract's Chargemaster protection language?,,CONTRACT_CHARGEMASTER_PROTECTION_LANGUAGE,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
What is contract's Chargemaster protection language? (Page#) ,,CONTRACT_CHARGEMASTER_PROTECTION_LANGUAGE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does the Reimbursement methodology include lesser of language (Yes/No)? (Page#) ,,LESSER_OF_LANGUAGE_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does the Reimbursement methodology include greater of language (Yes/No)? (Page#) ,,GREATER_OF_LANGUAGE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
What is the primary Reimbursement methodology? (Page#) ,,PRIMARY_REIMBURSEMENT_METHODOLOGY_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_PROC_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_REVENUE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#) ",,PRIMARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_DIAG_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_GROUPER_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_ADMITTYPE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#) ",,PRIMARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the primary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based? (Page#) ",,PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the primary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#) ",,PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the primary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage? (Page#) ",,PRIMARY_REIMBURSEMENT_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the primary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount? (Page#) ",,PRIMARY_REIMBURSEMENT_FLAT_FEE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate? (Page#) ",,PRIMARY_REIMBURSEMENT_CMS_MEDICARE_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Primary reimbursement is based on codes listed on the the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate? (Page#) ",,PRIMARY_REIMBURSEMENT_MEDICAID_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the primary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#) ",,PRIMARY_REIMBURSEMENT_GROUPER_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"Deprecated - See columns PD, PE, PF
|
||
|
|
|
||
|
|
Are there any carve outs or exceptions to the primary reimbursement methodology? (Page#) ",,PRIMARY_REIMBURSEMENT_EXCEPTION_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Are there any carve outs?,,PRIMARY_REIMBURSEMENT_CARVEOUT_IND,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If there are any exceptions to Primary Reimbursement Methodology, describe exceptions?",,PRIMARY_REIMBURSEMENT_DESCRIBE_EXCEPTION,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If there are any exceptions to Primary Reimbursement Methodology, describe exceptions? ( Page #)",,PRIMARY_REIMBURSEMENT_DESCRIBE_EXCEPTION_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes lesser of or greater of language, what is the secondary Reimbursement methodology? (Page#) ",,SECONDARY_REIMBURSEMENT_METHODOLOGY_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_PROC_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_REVENUE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#) ",,SECONDARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_DIAG_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_GROUPER_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_ADMITTYPE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#) ",,SECONDARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the secondary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based? (Page#) ",,SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the secondary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#) ",,SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage? (Page#) ",,SECONDARY_REIMBURSEMENT_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount? (Page#) ",,SECONDARY_REIMBURSEMENT_FLAT_FEE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate? (Page#) ",,SECONDARY_REIMBURSEMENT_CMS_MEDICARE_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary reimbursement is based on codes listed on the the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate? (Page#) ",,SECONDARY_REIMBURSEMENT_MEDICAID_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Secondary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#) ",,SECONDARY_REIMBURSEMENT_GROUPER_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Are there any exceptions to the Secondary reimbursement methodology? (Page#) ,,SECONDARY_REIMBURSEMENT_EXCEPTION_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes lesser of or greater of language, what is the tertiary Reimbursement methodology (if any)? (Page#) ",,TERTIARY_REIMBURSEMENT_METHODOLOGY_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_PROC_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_REVENUE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#) ",,TERTIARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_DIAG_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_GROUPER_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_ADMITTYPE_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#) ",,TERTIARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the tertiary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based? (Page#) ",,TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the tertiary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#) ",,TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage? (Page#) ",,TERTIARY_REIMBURSEMENT_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount? (Page#) ",,TERTIARY_REIMBURSEMENT_FLAT_FEE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate? (Page#) ",,TERTIARY_REIMBURSEMENT_CMS_MEDICARE_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary reimbursement is based on codes listed on the the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate? (Page#) ",,TERTIARY_REIMBURSEMENT_MEDICAID_RATE_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the Tertiary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#) ",,TERTIARY_REIMBURSEMENT_GROUPER_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Are there any exceptions to the Tertiary reimbursement methodology? (Page#) ,,TERTIARY_REIMBURSEMENT_EXCEPTION_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for timeline for payer to implement changes in regulations per LOB Specific agreement? (Page#) ,,CARVEOUT_IND_IMPLEMENT_POLICY_CHANGE_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Emergency Department (Yes/No)? (Page#) ,,EMERGENCY_DEPARTMENT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Emergency Department, describe schedule name",,EMERGENCY_DEPARTMENT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Emergency Department, describe reference year or version",,EMERGENCY_DEPARTMENT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Emergency Department, describe describe reimbursement rate",,EMERGENCY_DEPARTMENT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Observation Codes(Yes/No)?,,OBSERVATION_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Observation Codes(Yes/No)? (Page#) ,,OBSERVATION_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Observation, describe schedule name",,OBSERVATION_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Observation, describe schedule reference year or version",,OBSERVATION_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Observation, describe reimbursement rate",,OBSERVATION_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Ambulatory Surgery (Yes/No)? (Page#) ,,AMBULATORY_SURGERY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Ambulatory Surgery, describe schedule name",,AMBULATORY_SURGERY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Ambulatory Surgery, describe schedule reference year or version",,AMBULATORY_SURGERY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Ambulatory Surgery, describe reimbursement rate",,AMBULATORY_SURGERY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Intensive Care Unit (Yes/No)? (Page#) ,,INTENSIVE_CARE_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Intensive Care Unit, describe schedule name",,INTENSIVE_CARE_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Intensive Care Unit, describe schedule reference year or version",,INTENSIVE_CARE_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Intensive Care Unit, describe reimbursement rate",,INTENSIVE_CARE_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Trauma (Yes/No)? (Page#) ,,TRAUMA_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Trauma, describe schedule name",,TRAUMA_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Trauma, describe schedule reference year or version",,TRAUMA_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Trauma, describe reimbursement rate",,TRAUMA_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Cancer (Yes/No)? (Page#) ,,CANCER_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cancer, describe schedule name",,CANCER_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cancer, describe schedule reference year or version",,CANCER_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cancer, describe reimbursement rate",,CANCER_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for HIV (Yes/No)? (Page#) ,,HIV_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for HIV, describe schedule name",,HIV_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for HIV, describe schedule reference year or version",,HIV_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for HIV, describe reimbursement rate",,HIV_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Major Joint Replacement (Yes/No)? (Page#) ,,JOINT_REPLACE_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Major Joint Replacement, describe schedule name",,JOINT_REPLACE_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Major Joint Replacement, describe schedule reference year or version",,JOINT_REPLACE_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Major Joint Replacement, describe reimbursement rate",,JOINT_REPLACE_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Transplant (Yes/No)? (Page#) ,,TRANSPLANT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transplant, describe schedule name",,TRANSPLANT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transplant, describe schedule reference year or version",,TRANSPLANT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transplant, describe reimbursement rate",,TRANSPLANT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for OB/GYN Services (Yes/No)? (Page#) ,,OBGYN_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, describe schedule name",,OBGYN_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, describe schedule reference year or version",,OBGYN_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, describe reimbursement rate",,OBGYN_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, is there a lesser of billed charges clause? (Yes/No)",,OBGYN_CARVEOUT_LESSER_OF_BILLED_IND,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for OB/GYN Services, describe billed charges reimbursement rate",,OBGYN_BILLED_CHARGE_REIMBURSEMENT_RATE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for OB/GYN, describe exceptions",,OBGYN_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Neonatal Services (Yes/No)? (Page#) ,,NEONATAL_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Neonatal Services, describe schedule name",,NEONATAL_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Neonatal Services, describe schedule reference year or version",,NEONATAL_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Neonatal Services, describe reimbursement rate",,NEONATAL_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Behavioral Health & Substance Abuse Services (Yes/No)? (Page#) ,,BEH_HEALTH_SUB_ABUSE_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe schedule name",,BEH_HEALTH_SUB_ABUSE_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe schedule reference year or version",,BEH_HEALTH_SUB_ABUSE_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe reimbursement rate",,BEH_HEALTH_SUB_ABUSE_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Ophthalmology & Vision Services (Yes/No)? (Page#) ,,OPHTHAMOLOGY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Ophthalmology & Vision Services, describe schedule name",,OPHTHAMOLOGY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Ophthalmology & Vision Services, describe schedule reference year or version",,OPHTHAMOLOGY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Ophthalmology & Vision Services, describe reimbursement rate",,OPHTHAMOLOGY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for never events (Yes/No)? (Page#) ,,NEVER_EVENT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for never events, describe schedule name",,NEVER_EVENT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for never events, describe schedule reference year or version",,NEVER_EVENT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for never events, describe reimbursement rate",,NEVER_EVENT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for procedures that are not medically necessary (Yes/No)? (Page#) ,,NOT_MED_NECESSARY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for procedures that are not medically necessary, describe schedule name",,NOT_MED_NECESSARY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for procedures that are not medically necessary, describe schedule reference year or version",,NOT_MED_NECESSARY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for procedures that are not medically necessary, describe reimbursement rate",,NOT_MED_NECESSARY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for experimental procedures (Yes/No)? (Page#) ,,EXPERIMENTAL_PROCEDURES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for experimental procedures, describe schedule name",,EXPERIMENTAL_PROCEDURES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for experimental procedures, describe schedule reference year or version",,EXPERIMENTAL_PROCEDURES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for experimental procedures, describe reimbursement rate",,EXPERIMENTAL_PROCEDURES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for investigational procedures (Yes/No)? (Page#) ,,INVESTIGATIONAL_PROCEDURES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for investigational procedures, describe schedule name",,INVESTIGATIONAL_PROCEDURES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for investigational procedures, describe schedule reference year or version",,INVESTIGATIONAL_PROCEDURES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for investigational procedures, describe reimbursement rate",,INVESTIGATIONAL_PROCEDURES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Unlisted codes (Yes/No)? (Page#) ,,UNLISTED_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Unlisted codes, describe schedule name",,UNLISTED_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Unlisted codes, describe schedule reference year or version",,UNLISTED_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Unlisted codes, describe reimbursement rate",,UNLISTED_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Unlisted Codes, describe exceptions",,UNLISTED_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for invalid codes (Yes/No)? (Page#) ,,INVALID_CODES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for invalid codes, describe schedule name",,INVALID_CODES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for invalid codes, describe schedule reference year or version",,INVALID_CODES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for invalid codes, describe reimbursement rate",,INVALID_CODES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Durable Medical Equipment (Yes/No)? (Page#) ,,DME_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Durable Medical Equipment, describe schedule name",,DME_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Durable Medical Equipment, describe schedule reference year or version",,DME_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Durable Medical Equipment, describe reimbursement rate",,DME_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Durable Medical Equipment, describe exceptions",,DME_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for prosthetics (Yes/No)? (Page#) ,,PROSTHETICS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for prosthetics, describe schedule name",,PROSTHETICS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for prosthetics, describe schedule reference year or version",,PROSTHETICS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for prosthetics, describe reimbursement rate",,PROSTHETICS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for implants (Yes/No)? (Page#) ,,IMPLANTS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for implants, describe schedule name",,IMPLANTS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for implants, describe schedule reference year or version",,IMPLANTS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for implants, describe reimbursement rate",,IMPLANTS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for implants, describe exceptions",,IMPLANTS_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Hearing Aids & Hearing Services (Yes/No)? (Page#) ,,HEARING_AID_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hearing Aids & Hearing Services, describe schedule name",,HEARING_AID_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hearing Aids & Hearing Services, describe schedule reference year or version",,HEARING_AID_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hearing Aids & Hearing Services, describe reimbursement rate",,HEARING_AID_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for anesthesia (Yes/No)? (Page#) ,,ANESTHESIA_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for anesthesia, describe schedule name",,ANESTHESIA_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for anesthesia, describe schedule reference year or version",,ANESTHESIA_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for anesthesia, describe reimbursement rate",,ANESTHESIA_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for anesthesia, is there a lesser of billed charges clause? (Yes/No)",,ANESTHESIA_CARVEOUT_LESSER_OF_BILLED_IND,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for anesthesia, describe billed charges reimbursement rate",,ANESTHESIA_BILLED_CHARGE_REIMBURSEMENT_RATE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for medical pharmacy and/or physician administered drugs (Yes/No)? (Page#) ,,ADMINISTERED_DRUGS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe schedule name",,ADMINISTERED_DRUGS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe schedule reference year or version",,ADMINISTERED_DRUGS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe reimbursement rate",,ADMINISTERED_DRUGS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe exceptions",,ADMINISTERED_DRUGS_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, is there a lesser of billed charges clause? (Yes/No)",,ADMINISTERED_DRUGS_CARVEOUT_LESSER_OF_BILLED_IND,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe billed charges reimbursement rate",,ADMINISTERED_DRUGS_BILLED_CHARGE_REIMBURSEMENT_RATE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for global services (Yes/No)? (Page#) ,,GLOBAL_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for global services, describe schedule name",,GLOBAL_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for global services, describe schedule reference year or version",,GLOBAL_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for global services, describe reimbursement rate",,GLOBAL_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include a carve out for bundled or unbundled codes (e.g., bundling, unbundling) (Yes/No)? (Page#) ",,BUNDLED_UNBUNDLED_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for bundling or unbundling, describe schedule name",,BUNDLED_UNBUNDLED_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for bundling or unbundling, describe schedule reference year or version",,BUNDLED_UNBUNDLED_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for bundling or unbundling, describe reimbursement rate",,BUNDLED_UNBUNDLED_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include a carve out for Multiple Procedure Reductions (i.e., discounted procedures) (Yes/No)? (Page#) ",,MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Multiple Procedure Reductions, describe schedule name",,MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract address Multiple Procedure Reductions, describe schedule reference year or version",,MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Multiple Procedure Reductions, describe reimbursement rate",,MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for second surgeries and/or procedures (Yes/No)? (Page#) ,,SECOND_SURGERIES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for second surgeries and/or procedures, describe schedule name",,SECOND_SURGERIES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for second surgeries and/or procedures, describe schedule reference year or version",,SECOND_SURGERIES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for second surgeries and/or procedures, describe reimbursement rate",,SECOND_SURGERIES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for subsequent surgeries and/or procedures (Yes/No)? (Page#) ,,SUBSEQUENT_SURGERIES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for subsequent surgeries and/or procedures, describe schedule name",,SUBSEQUENT_SURGERIES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for subsequent surgeries and/or procedures, describe schedule reference year or version",,SUBSEQUENT_SURGERIES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for subsequent surgeries and/or procedures, describe reimbursement rate",,SUBSEQUENT_SURGERIES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Mid-Level Professionals (Yes/No)? (Page#) ,,MID_LEVEL_PROFESSIONAL_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Mid-Level Professionals, describe schedule name",,MID_LEVEL_PROFESSIONAL_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Mid-Level Professionals, describe schedule reference year or version",,MID_LEVEL_PROFESSIONAL_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Mid-Level Professionals, describe reimbursement rate",,MID_LEVEL_PROFESSIONAL_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Technical Component (Yes/No)? (Page#) ,,TECHNICAL_COMPONENT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Technical Component, describe schedule name",,TECHNICAL_COMPONENT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Technical Component, describe schedule reference year or version",,TECHNICAL_COMPONENT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Technical Component, describe reimbursement rate",,TECHNICAL_COMPONENT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Professional Component (Yes/No)? (Page#) ,,PROFESSIONAL_COMPONENT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Professional Component, describe schedule name",,PROFESSIONAL_COMPONENT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Professional Component, describe schedule reference year or version",,PROFESSIONAL_COMPONENT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Professional Component, describe reimbursement rate",,PROFESSIONAL_COMPONENT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Laboratory / Pathology (Yes/No)? (Page#) ,,LAB_PATHOLOGY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , describe schedule name",,LAB_PATHOLOGY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , describe schedule reference year or version",,LAB_PATHOLOGY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , describe reimbursement rate",,LAB_PATHOLOGY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , is there a lesser of billed charges clause? (Yes/No)",,LAB_PATHOLOGY_CARVEOUT_LESSER_OF_BILLED_IND,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , describe billed charges reimbursement rate",,LAB_PATHOLOGY_BILLED_CHARGE_REIMBURSEMENT_RATE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Laboratory / Pathology , describe exceptions",,LAB_PATHOLOGY_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Radiology/Imaging Services (Yes/No)? (Page#) ,,RADIOLOGY_IMAGING_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Radiology/Imaging Services, describe schedule name",,RADIOLOGY_IMAGING_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Radiology/Imaging Services, describe schedule reference year or version",,RADIOLOGY_IMAGING_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Radiology/Imaging Services, describe reimbursement rate",,RADIOLOGY_IMAGING_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Radiology / Imaging , describe exceptions",,RADIOLOGY_IMAGING_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for diagnostic services (Yes/No)? (Page#) ,,DIAGNOSTIC_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for diagnostic services, describe schedule name",,DIAGNOSTIC_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for diagnostic services, describe schedule reference year or version",,DIAGNOSTIC_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for diagnostic services, describe reimbursement rate",,DIAGNOSTIC_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for pre-admission procedures (Yes/No)? (Page#) ,,PREADMISSION_PROC_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for pre-admission procedures, describe schedule name",,PREADMISSION_PROC_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for pre-admissions procedures, describe schedule reference year or version",,PREADMISSION_PROC_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for pre-admission procedures, describe reimbursement rate",,PREADMISSION_PROC_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for post-discharge procedures (Yes/No)? (Page#) ,,POSTDISCHARGE_PROC_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for post-discharge procedures, describe schedule name",,POSTDISCHARGE_PROC_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for post-discharge procedures, describe schedule reference year or version",,POSTDISCHARGE_PROC_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for post-discharge procedures, describe reimbursement rate",,POSTDISCHARGE_PROC_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for readmissions (Yes/No)? (Page#) ,,READMISSIONS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for readmissions, describe schedule name",,READMISSIONS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for readmissions, describe schedule reference year or version",,READMISSIONS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for readmissions, describe reimbursement rate",,READMISSIONS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for certain Status Indicators (Yes/No)? (Page#) ,,STATUS_INDICATORS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for certain Status Indicators, describe schedule name",,STATUS_INDICATORS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for certain Status Indicators, describe schedule reference year or version",,STATUS_INDICATORS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for certain Status Indicators, describe reimbursement rate",,STATUS_INDICATORS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for outlier provisions (Yes/No)? (Page#) ,,OUTLIER_PROVISIONS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for outlier provisions, describe schedule name",,OUTLIER_PROVISIONS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for outlier provisions, describe schedule reference year or version",,OUTLIER_PROVISIONS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for outlier provisions, describe reimbursement rate",,OUTLIER_PROVISIONS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If contract includes a carve out for outlier provisions, describe exceptions",,OUTLIER_PROVISIONS_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
OUTLIER FIELDS TO BE POPULATED ,,,VARCHAR,,,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
OUTLIER FIELDS TO BE POPULATED (Page#) ,,,VARCHAR,,,,,,,
|
||
|
|
Does the contact include a carve out for stop loss (Yes/No)? (Page#) ,,STOP_LOSS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for stop loss, what are the EMS Trauma codes?",,STOP_LOSS_CARVEOUT_EMS_TRAUMA_CODES,VARIANT,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for stop loss, what are the EMS Trauma rates?",,STOP_LOSS_CARVEOUT_EMS_TRAUMA_RATES,VARIANT,G,ACTIVE,,,,,
|
||
|
|
STOP LOSS FIELDS TO BE POPULATED ,,,VARCHAR,,,No,"From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider",Carve Outs,Required Only If Available ,"PAYMENT ACCURACY
|
||
|
|
NETWORK"
|
||
|
|
STOP LOSS FIELDS TO BE POPULATED (Page#) ,,,VARCHAR,,,,,,,
|
||
|
|
Does the contract include other Vaccine for Children carve outs (Yes/No)? (Page#) ,,VACCINE_CHILDREN_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Vaccine for Children carve outs, describe schedule name",,VACCINE_CHILDREN_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Vaccine for Children client-specific carve outs, describe schedule reference year or version",,VACCINE_CHILDREN_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Vaccine for Children carve outs, describe reimbursement rate",,VACCINE_CHILDREN_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Surgical Assist/Assistant carve outs (Yes/No)? (Page#) ,,SURGICAL_ASSIST_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Surgical Assist/Assistant carve outs, describe how these codes are reimbursed",,SURGICAL_ASSIST_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Surgical Assist/Assistant carve outs, describe schedule name",,SURGICAL_ASSIST_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Surgical Assist/Assistant carve outs, describe schedule reference year or version",,SURGICAL_ASSIST_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Surgical Assist/Assistant carve outs, describe reimbursement rate",,SURGICAL_ASSIST_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes other client-specific carve outs, describe how these codes are reimbursed (Page#) ",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"Does the contract include Physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs (Yes/No)? (Page#) ",,PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe schedule name",,PHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe schedule reference year or version",,PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe reimbursement rate",,PHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs)carve outs (Yes/No)? (Page#) ",,AUDIO_CHIRO_DIETICIAN_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe schedule name",,AUDIO_CHIRO_DIETICIAN_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe schedule reference year or version",,AUDIO_CHIRO_DIETICIAN_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe reimbursement rate",,AUDIO_CHIRO_DIETICIAN_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Board Certified Behavioral Analyst (BCBA) carve outs (Yes/No)? (Page#) ,,CERT_BH_ANALYST_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe schedule name",,CERT_BH_ANALYST_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe schedule reference year or version",,CERT_BH_ANALYST_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe reimbursement rate",,CERT_BH_ANALYST_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs (Yes/No)? (Page#) ",,INDEPENDENT_LICENSURES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe schedule name",,INDEPENDENT_LICENSURES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe schedule reference year or version",,INDEPENDENT_LICENSURES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe reimbursement rate",,INDEPENDENT_LICENSURES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Behavioral Health Outpatient Clinics/Integrated Clinics carve outs (Yes/No)? (Page#) ,,BH_OP_CLINICS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe schedule name",,BH_OP_CLINICS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe schedule reference year or version",,BH_OP_CLINICS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe reimbursement rate",,BH_OP_CLINICS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs (Yes/No)? (Page#) ",,POS_THERAPISTS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe schedule name",,POS_THERAPISTS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe schedule reference year or version",,POS_THERAPISTS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe reimbursement rate",,POS_THERAPISTS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Transportation Services carve outs (Yes/No)? (Page#) ,,TRANSPORTATION_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Transportation Services carve outs, describe schedule name",,TRANSPORTATION_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Transportation Services carve outs, describe schedule reference year or version",,TRANSPORTATION_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Transportation Services carve outs, describe reimbursement rate",,TRANSPORTATION_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include PCP - Medical carve outs (Yes/No)?,,PCP_MEDICAL_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include PCP - Medical carve outs (Yes/No)? (Page#) ,,PCP_MEDICAL_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - Medical carve outs, list the applicable codes or code ranges ",,PCP_MEDICAL_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - Medical carve outs, describe how these codes are reimbursed",,PCP_MEDICAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - Medical carve outs, describe schedule name",,PCP_MEDICAL_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - Medical carve outs, describe schedule reference year or version",,PCP_MEDICAL_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - Medical carve outs, describe reimbursement rate",,PCP_MEDICAL_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include PCP - BH carve outs (Yes/No)?,,PCP_BH_CAREVEOUT_IND,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include PCP - BH carve outs (Yes/No)? (Page#) ,,PCP_BH_CAREVEOUT_IND_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - BH carve outs, list the applicable codes or code ranges ",,PCP_BH_CAREVOUT_CODES,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - BH carve outs, describe how these codes are reimbursed",,PCP_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - BH carve outs, describe schedule name",,PCP_BH_CARVEOUT_SCHEDULE_NAME,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - BH carve outs, describe schedule reference year or version",,PCP_BH_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes PCP - BH carve outs, describe reimbursement rate",,PCP_BH_CARVEOUT_DESCRIBE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"Does the contract include BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs (Yes/No)?",,BH_MID_LEVEL_PRACTIONER_CAREVEOUT_IND,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, list the applicable codes or code ranges ",,BH_MID_LEVEL_PRACTIONER_CAREVOUT_CODES,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe how these codes are reimbursed",,BH_MID_LEVEL_PRACTIONER_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe schedule name",,BH_MID_LEVEL_PRACTIONER_CARVEOUT_SCHEDULE_NAME,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe schedule reference year or version",,BH_MID_LEVEL_PRACTIONER_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe reimbursement rate",,BH_MID_LEVEL_PRACTIONER_CARVEOUT_DESCRIBE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Mid-Level - BH carve outs (Yes/No)?,,BH_MID_LEVEL_PRACTIONER_CARVEOUT_DESCRIBE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Mid-Level - BH carve outs (Yes/No)? (Page#) ,,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Mid-Level - BH carve outs, list the applicable codes or code ranges ",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Mid-Level - BH carve outs, describe how these codes are reimbursed",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Mid-Level - BH carve outs, describe schedule name",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Mid-Level - BH carve outs, describe schedule reference year or version",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Mid-Level - BH carve outs, describe reimbursement rate",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include BCBA - BH carve outs (Yes/No)?,,BCBA_BH_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include BCBA - BH carve outs (Yes/No)? (Page#) ,,BCBA_BH_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes BCBA - BH carve outs, list the applicable codes or code ranges ",,BCBA_BH_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes BCBA - BH carve outs, describe how these codes are reimbursed",,BCBA_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes BCBA - BH carve outs, describe schedule name",,BCBA_BH_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes BCBA - BH carve outs, describe schedule reference year or version",,BCBA_BH_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes BCBA - BH carve outs, describe reimbursement rate",,BCBA_BH_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Independent Licensures - BH carve outs (Yes/No)?,,INDEPENDENT_LICENSURES_BH_CAREVEOUT_IND,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Independent Licensures - BH carve outs (Yes/No)? (Page#) ,,INDEPENDENT_LICENSURES_BH_CAREVEOUT_IND_PG,NUMERIC,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures - BH carve outs, list the applicable codes or code ranges ",,INDEPENDENT_LICENSURES_BH_CAREVOUT_CODES,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures - BH carve outs, describe how these codes are reimbursed",,INDEPENDENT_LICENSURES_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures - BH carve outs, describe schedule name",,INDEPENDENT_LICENSURES_BH_CARVEOUT_SCHEDULE_NAME,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures - BH carve outs, describe schedule reference year or version",,INDEPENDENT_LICENSURES_BH_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Independent Licensures - BH carve outs, describe reimbursement rate",,INDEPENDENT_LICENSURES_BH_CARVEOUT_DESCRIBE,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs (Yes/No)?,,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs (Yes/No)? (Page#) ,,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, list the applicable codes or code ranges ",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe how these codes are reimbursed",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe schedule name",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe schedule reference year or version",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe reimbursement rate",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Physicians/Clinical Psychologists - BH carve outs (Yes/No)?,,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Physicians/Clinical Psychologists - BH carve outs (Yes/No)? (Page#) ,,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Physicians/Clinical Psychologists - BH carve outs, list the applicable codes or code ranges ",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe how these codes are reimbursed",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe schedule name",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe schedule reference year or version",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
"If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe reimbursement rate",,,VARCHAR,,INACTIVE,,,,,
|
||
|
|
Does the contract include Dentist carve outs (Yes/No)?,,DENTIST_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Dentist carve outs (Yes/No)? (Page#) ,,DENTIST_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Dentist carve outs, list the applicable codes or code ranges ",,DENTIST_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Dentist carve outs, describe how these codes are reimbursed",,DENTIST_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Dentist carve outs, describe schedule name",,DENTIST_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Dentist carve outs, describe schedule reference year or version",,DENTIST_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Dentist carve outs, describe reimbursement rate",,DENTIST_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Supplies and Devices carve outs (Yes/No)?,,SUPPLIES_DEVICES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Supplies and Devices carve outs (Yes/No)? (Page#) ,,SUPPLIES_DEVICES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, list the applicable codes or code ranges ",,SUPPLIES_DEVICES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, describe how these codes are reimbursed",,SUPPLIES_DEVICES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, describe schedule name",,SUPPLIES_DEVICES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, describe schedule reference year or version",,SUPPLIES_DEVICES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, describe reimbursement rate",,SUPPLIES_DEVICES_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, is there a lesser of billed charges clause? (Yes/No)",,SUPPLIES_DEVICES_CARVEOUT_LESSER_OF_BILLED_IND,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Supplies and Devices carve outs, describe billed charges reimbursement rate",,SUPPLIES_DEVICES_BILLED_CHARGE_REIMBURSEMENT_RATE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Immunizations carve outs (Yes/No)?,,IMMUNIZATION_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Immunizations carve outs (Yes/No)? (Page#) ,,IMMUNIZATION_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, list the applicable codes or code ranges ",,IMMUNIZATION_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, describe how these codes are reimbursed",,IMMUNIZATION_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, describe schedule name",,IMMUNIZATION_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, describe schedule reference year or version",,IMMUNIZATION_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, describe reimbursement rate",,IMMUNIZATION_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, is there a lesser of billed charges clause? (Yes/No)",,IMMUNIZATION_CARVEOUT_LESSER_OF_BILLED_IND,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Immunizations carve outs, describe billed charges reimbursement rate",,IMMUNIZATION_BILLED_CHARGE_REIMBURSEMENT_RATE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for immunizations, describe exceptions",,IMMUNIZATION_CARVEOUT_DESCRIBE_EXCEPTIONS,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include OB Epidural carve outs (Yes/No)?,,OB_EPIDURAL_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes OB Epidural carve outs, list the applicable codes or code ranges ",,OB_EPIDURAL_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes OB Epidural carve outs, describe how these codes are reimbursed",,OB_EPIDURAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes OB Epidural carve outs, describe schedule name",,OB_EPIDURAL_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes OB Epidural carve outs, describe schedule reference year or version",,OB_EPIDURAL_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes OB Epidural carve outs, describe reimbursement rate",,OB_EPIDURAL_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Pediatric Subspecialties carve outs (Yes/No)?,,PEDIATRIC_SUBSPECIALTY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Pediatric Subspecialties carve outs (Yes/No)? (Page#) ,,PEDIATRIC_SUBSPECIALTY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Subspecialties carve outs, list the applicable codes or code ranges ",,PEDIATRIC_SUBSPECIALTY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Subspecialties carve outs, describe how these codes are reimbursed",,PEDIATRIC_SUBSPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Subspecialties carve outs, describe schedule name",,PEDIATRIC_SUBSPECIALTY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Subspecialties carve outs, describe schedule reference year or version",,PEDIATRIC_SUBSPECIALTY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Subspecialties carve outs, describe reimbursement rate",,PEDIATRIC_SUBSPECIALTY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Neurosurgery Subspecialties carve outs (Yes/No)?,,NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Neurosurgery Subspecialties carve outs (Yes/No)? (Page#) ,,NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Neurosurgery Subspecialties carve outs, list the applicable codes or code ranges ",,NEUROSURGEY_SUBSPECIALTY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Neurosurgery Subspecialties carve outs, describe how these codes are reimbursed",,NEUROSURGEY_SUBSPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Neurosurgery Subspecialties carve outs, describe schedule name",,NEUROSURGEY_SUBSPECIALTY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Neurosurgery Subspecialties carve outs, describe schedule reference year or version",,NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Neurosurgery Subspecialties carve outs, describe reimbursement rate",,NEUROSURGEY_SUBSPECIALTY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Orthopedic Surgery subspecialties carve outs (Yes/No)?,,ORTHOPEDIC_SURGERY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Orthopedic Surgery subspecialties carve outs (Yes/No)? (Page#) ,,ORTHOPEDIC_SURGERY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Orthopedic Surgery subspecialties carve outs, list the applicable codes or code ranges ",,ORTHOPEDIC_SURGERY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Orthopedic Surgery subspecialties carve outs, describe how these codes are reimbursed",,ORTHOPEDIC_SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Orthopedic Surgery subspecialties carve outs, describe schedule name",,ORTHOPEDIC_SURGERY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Orthopedic Surgery subspecialties carve outs, describe schedule reference year or version",,ORTHOPEDIC_SURGERY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Orthopedic Surgery subspecialties carve outs, describe reimbursement rate",,ORTHOPEDIC_SURGERY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include All Other Specialists carve outs (Yes/No)?,,ALL_OTHER_SPECIALTY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include All Other Specialists carve outs (Yes/No)? (Page#) ,,ALL_OTHER_SPECIALTY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes All Other Specialists carve outs, list the applicable codes or code ranges ",,ALL_OTHER_SPECIALTY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes All Other Specialists carve outs, describe how these codes are reimbursed",,ALL_OTHER_SPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes All Other Specialists carve outs, describe schedule name",,ALL_OTHER_SPECIALTY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes All Other Specialists carve outs, describe schedule reference year or version",,ALL_OTHER_SPECIALTY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes All Other Specialists carve outs, describe reimbursement rate",,ALL_OTHER_SPECIALTY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Pediatric Primary Care Physicians carve outs (Yes/No)?,,PEDIATRIC_PCP_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Pediatric Primary Care Physicians carve outs (Yes/No)? (Page#) ,,PEDIATRIC_PCP_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Primary Care Physicians carve outs, list the applicable codes or code ranges ",,PEDIATRIC_PCP_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Primary Care Physicians carve outs, describe how these codes are reimbursed",,PEDIATRIC_PCP_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Primary Care Physicians carve outs, describe schedule name",,PEDIATRIC_PCP_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Primary Care Physicians carve outs, describe schedule reference year or version",,PEDIATRIC_PCP_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Pediatric Primary Care Physicians carve outs, describe reimbursement rate",,PEDIATRIC_PCP_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs (Yes/No)?,,ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs (Yes/No)? (Page#) ,,ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includesMedical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, list the applicable codes or code ranges ",,ANESTHESIOLOGY_RN_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe how these codes are reimbursed",,ANESTHESIOLOGY_RN_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includesMedical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe schedule name",,ANESTHESIOLOGY_RN_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe schedule reference year or version",,ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includesMedical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe reimbursement rate",,ANESTHESIOLOGY_RN_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include EPSDT carve outs (Yes/No)?,,EPSDT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include EPSDT carve outs (Yes/No)? (Page#) ,,EPSDT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes EPSDT carve outs, list the applicable codes or code ranges ",,EPSDT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes EPSDT carve outs, describe how these codes are reimbursed",,EPSDT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes EPSDT carve outs, describe schedule name",,EPSDT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes EPSDT carve outs, describe schedule reference year or version",,EPSDT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes EPSDT carve outs, describe reimbursement rate",,EPSDT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Ancillary carveout to professional contract (Yes/No)?,,ANCILLARY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Ancillary carveout to professional contract (Yes/No)? (Page#) ,,ANCILLARY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Ancillary carveout to professional contract, list the applicable codes or code ranges ",,ANCILLARY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Ancillary carveout to professional contract, describe how these codes are reimbursed",,ANCILLARY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Ancillary carveout to professional contract, describe schedule name",,ANCILLARY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Ancillary carveout to professional contract, describe schedule reference year or version",,ANCILLARY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Ancillary carveout to professional contract, describe reimbursement rate",,ANCILLARY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include Physician Assistant and Nurse Practitioner carve outs (Yes/No)?,,PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include Physician Assistant and Nurse Practitioner carve outs (Yes/No)? (Page#) ,,PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physician Assistant and Nurse Practitioner carve outs, list the applicable codes or code ranges ",,PHYASSISTANT_RNPRACTITIONER_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe how these codes are reimbursed",,PHYASSISTANT_RNPRACTITIONER_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe schedule name",,PHYASSISTANT_RNPRACTITIONER_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe schedule reference year or version",,PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe reimbursement rate",,PHYASSISTANT_RNPRACTITIONER_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Oncology Services (Yes/No)?,,ONCOLOGY_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Oncology Services (Yes/No)? (Page#) ,,ONCOLOGY_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Oncology Services, list the applicable codes or code ranges ",,ONCOLOGY_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Oncology Services, describe how these codes are reimbursed",,ONCOLOGY_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Oncology Services, describe schedule name",,ONCOLOGY_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Oncology Services, describe reference year or version",,ONCOLOGY_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Oncology Services, describe reimbursement rate",,ONCOLOGY_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Rehabilitation Services (Yes/No)?,,REHABILITATION_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Rehabilitation Services (Yes/No)? (Page#) ,,REHABILITATION_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Rehabilitation Services , list the applicable codes or code ranges ",,REHABILITATION_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Rehabilitation Services, describe how these codes are reimbursed",,REHABILITATION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Rehabilitation Services , describe schedule name",,REHABILITATION_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Rehabilitation Services, describe reference year or version",,REHABILITATION_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Rehabilitation Services, describe describe reimbursement rate",,REHABILITATION_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Surgery (Yes/No)?,,SURGERY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Surgery (Yes/No)? (Page#) ,,SURGERY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Surgery Services , list the applicable codes or code ranges ",,SURGERY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Surgery Services, describe how these codes are reimbursed",,SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Surgery Services , describe schedule name",,SURGERY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Surgery Services, describe reference year or version",,SURGERY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Outpatient Surgery Services, describe reimbursement rate",,SURGERY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Lithotripsy Services (Yes/No)?,,LITHOTRIPSY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Lithotripsy Services (Yes/No)? (Page#) ,,LITHOTRIPSY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lithotripsy Services , list the applicable codes or code ranges ",,LITHOTRIPSY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lithotripsy Services, describe how these codes are reimbursed",,LITHOTRIPSY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lithotripsy Services , describe schedule name",,LITHOTRIPSY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lithotripsy Services, describe reference year or version",,LITHOTRIPSY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lithotripsy Services, describe reimbursement rate",,LITHOTRIPSY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Cardiac Services (Yes/No)?,,CARDIAC_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Cardiac Services (Yes/No)? (Page#) ,,CARDIAC_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services , list the applicable codes or code ranges ",,CARDIAC_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services, describe how these codes are reimbursed",,CARDIAC_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services , describe schedule name",,CARDIAC_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services, describe reference year or version",,CARDIAC_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services, describe reimbursement rate",,CARDIAC_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Special Care Unit Services (Yes/No)?,,SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Special Care Unit Services (Yes/No)? (Page#) ,,SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Special Care Unit Services , list the applicable codes or code ranges ",,SPECIAL_CARE_UNIT_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services, describe how these codes are reimbursed",,SPECIAL_CARE_UNIT_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Special Care Unit Services , describe schedule name",,SPECIAL_CARE_UNIT_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cardiac Services, describe reference year or version",,SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Special Unit Services, describe reimbursement rate",,SPECIAL_CARE_UNIT_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Skilled Nursing Services (Yes/No)?,,SKILLED_RN_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Skilled Nursing Services (Yes/No)? (Page#) ,,SKILLED_RN_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Skilled Nursing Services , list the applicable codes or code ranges ",,SKILLED_RN_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Skilled Nursing Service, describe how these codes are reimbursed",,SKILLED_RN_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Skilled Nursing Services Services , describe schedule name",,SKILLED_RN_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Skilled Nursing Services, describe reference year or version",,SKILLED_RN_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Skilled Nursing Services, describe reimbursement rate",,SKILLED_RN_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Infusion Services (Yes/No)?,,INFUSION_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Infusion Services (Yes/No)? (Page#) ,,INFUSION_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services , list the applicable codes or code ranges ",,INFUSION_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services, describe how these codes are reimbursed",,INFUSION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services , describe schedule name",,INFUSION_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services, describe reference year or version",,INFUSION_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services, describe reimbursement rate",,INFUSION_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Obesity Services (Yes/No)?,,OBESITY_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Obesity Services (Yes/No)? (Page#) ,,OBESITY_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Obesity Services , list the applicable codes or code ranges ",,OBESITY_SVCS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services, describe how these codes are reimbursed",,OBESITY_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Obesity Services , describe schedule name",,OBESITY_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Obesity Services, describe reference year or version",,OBESITY_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services, describe reimbursement rate",,OBESITY_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Specialty Care Physician Services (Yes/No)?,,SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Specialty Care Physician Services (Yes/No)? (Page#) ,,SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Specialty Care Physician Services , list the applicable codes or code ranges ",,SPECIALTY_CARE_PHYSICIAN_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Specialty Care Physician Services , describe how these codes are reimbursed",,SPECIALTY_CARE_PHYSICIAN_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Specialty Care Physician Services , describe schedule name",,SPECIALTY_CARE_PHYSICIAN_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Specialty Care Physician Services, describe reference year or version",,SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Infusion Services, describe reimbursement rate",,SPECIALTY_CARE_PHYSICIAN_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient (Yes/No)?",,DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"Does the contract include a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient (Yes/No)? (Page#) ",,DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , list the applicable codes or code ranges ",,DRUGS_ORGANS_IMPLANTS_IP_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe how these codes are reimbursed",,DRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe schedule name",,DRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient, describe reference year or version",,DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient, describe reimbursement rate",,DRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"Does the contract include a carve out for High Cost Drugs, Implants Outpatient (Yes/No)?",,DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"Does the contract include a carve out for High Cost Drugs, Implants Outpatient (Yes/No)? (Page#) ",,DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Implants Outpatient , list the applicable codes or code ranges ",,DRUGS_ORGANS_IMPLANTS_OP_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe how these codes are reimbursed",,DRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe schedule name",,DRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe reference year or version",,DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe reimbursement rate",,DRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Blood Products - Outpatient/Inpatient (Yes/No)?,,BLOOD_PRODUCTS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Blood Products - Outpatient/Inpatient (Yes/No)? (Page#) ,,BLOOD_PRODUCTS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Blood Products - Outpatient/Inpatient , list the applicable codes or code ranges ",,BLOOD_PRODUCTS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out forBlood Products - Outpatient/Inpatient , describe how these codes are reimbursed",,BLOOD_PRODUCTS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe schedule name",,BLOOD_PRODUCTS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe reference year or version",,BLOOD_PRODUCTS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe reimbursement rate",,BLOOD_PRODUCTS_CARVEOUT_DESCRIBE,VARCHAR,GGG,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for High Cost Drugs (Yes/No)?,,HIGH_COST_DRUGS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for High Cost Drugs (Yes/No)? (Page#) ,,HIGH_COST_DRUGS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, list the applicable codes or code ranges ",,HIGH_COST_DRUGS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, describe how these codes are reimbursed",,HIGH_COST_DRUGS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, describe schedule name",,HIGH_COST_DRUGS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, describe reference year or version",,HIGH_COST_DRUGS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for High Cost Drugs, describe reimbursement rate",,HIGH_COST_DRUGS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Physical Rehabilitation (Yes/No)?,,PHYSICAL_REHABILITATION_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Physical Rehabilitation (Yes/No)? (Page#) ,,PHYSICAL_REHABILITATION_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Inpatient Physical Rehabilitation , list the applicable codes or code ranges ",,PHYSICAL_REHABILITATION_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Inpatient Physical Rehabilitation , describe how these codes are reimbursed",,PHYSICAL_REHABILITATION_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Inpatient Physical Rehabilitation , describe schedule name",,PHYSICAL_REHABILITATION_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out forInpatient Physical Rehabilitation , describe reference year or version",,PHYSICAL_REHABILITATION_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Inpatient Physical Rehabilitation , describe reimbursement rate",,PHYSICAL_REHABILITATION_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Sleep Studies (Yes/No)?,,SLEEP_STUDIES_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Sleep Studies (Yes/No)? (Page#) ,,SLEEP_STUDIES_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Sleep Studies, list the applicable codes or code ranges ",,SLEEP_STUDIES_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Sleep Studies, describe how these codes are reimbursed",,SLEEP_STUDIES_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Sleep Studies, describe schedule name",,SLEEP_STUDIES_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Sleep Studies, describe reference year or version",,SLEEP_STUDIES_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Sleep Studies, describe reimbursement rate",,SLEEP_STUDIES_CARVEOUT_DESCRIBE,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Lap Band Services (Yes/No)?,,LAP_BAND_SVCS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Lap Band Services (Yes/No)? (Page#) ,,LAP_BAND_SVCS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lap Band Services , list the applicable codes or code ranges ",,LAP_BAND_SVCS_CAREVOUT_CODES,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lap Band Services , describe how these codes are reimbursed",,LAP_BAND_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lap Band Services , describe schedule name",,LAP_BAND_SVCS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lap Band Services, describe reference year or version",,LAP_BAND_SVCS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Lap Band Services , describe reimbursement rate",,LAP_BAND_SVCS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Newborn/NICU (Yes/No)?,,NEWBORN_NICU_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Newborn/NICU (Yes/No)? (Page#) ,,NEWBORN_NICU_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Newborn/NICU, list the applicable codes or code ranges ",,NEWBORN_NICU_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Newborn/NICU, describe how these codes are reimbursed",,NEWBORN_NICU_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Newborn/NICU, describe schedule name",,NEWBORN_NICU_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Newborn/NICU, describe reference year or version",,NEWBORN_NICU_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Newborn/NICU, describe reimbursement rate",,NEWBORN_NICU_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Extracorporeal Membrane Oxygenation (ECMO) (Yes/No)?,,EMCO_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Extracorporeal Membrane Oxygenation (ECMO) (Yes/No)? (Page#) ,,EMCO_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), list the applicable codes or code ranges ",,EMCO_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe how these codes are reimbursed",,EMCO_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe schedule name",,EMCO_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe reference year or version",,EMCO_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe reimbursement rate",,EMCO_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Burns (Yes/No)?,,BURNS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Burns (Yes/No)? (Page#) ,,BURNS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Burns, list the applicable codes or code ranges ",,BURNS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Burns, describe how these codes are reimbursed",,BURNS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Burns, describe schedule name",,BURNS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Burns, describe reference year or version",,BURNS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out forBurns, describe reimbursement rate",,BURNS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Kyphoplasty (Yes/No)?,,KYPHOPLASTY_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Kyphoplasty (Yes/No)? (Page#) ,,KYPHOPLASTY_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Kyphoplasty, list the applicable codes or code ranges ",,KYPHOPLASTY_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Kyphoplasty, describe how these codes are reimbursed",,KYPHOPLASTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Kyphoplasty, describe schedule name",,KYPHOPLASTY_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Kyphoplasty, describe reference year or version",,KYPHOPLASTY_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Kyphoplasty, describe reimbursement rate",,KYPHOPLASTY_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Cryosurgical Ablation of the Prostate (Yes/No)?,,CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Cryosurgical Ablation of the Prostate (Yes/No)? (Page#) ,,CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cryosurgical Ablation of the Prostate, list the applicable codes or code ranges ",,CRYOSURGICAL_ABLATION_PROSTATE_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe how these codes are reimbursed",,CRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe schedule name",,CRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe reference year or version",,CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe reimbursement rate",,CRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Transurethral Thermal Ablation (TUMT) (Yes/No)?,,TUMT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Transurethral Thermal Ablation (TUMT) (Yes/No)? (Page#) ,,TUMT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), list the applicable codes or code ranges ",,TUMT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe how these codes are reimbursed",,TUMT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe schedule name",,TUMT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe reference year or version",,TUMT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe reimbursement rate",,TUMT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Transurethral Needle Ablation (TUNA) (Yes/No)?,,TUNA_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Transurethral Needle Ablation (TUNA) (Yes/No)? (Page#) ,,TUNA_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Needle Ablation (TUNA), list the applicable codes or code ranges ",,TUNA_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe how these codes are reimbursed",,TUNA_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe schedule name",,TUNA_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe reference year or version",,TUNA_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe reimbursement rate",,TUNA_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Hyperbaric Treatment (Yes/No)?,,HYPERBARIC_TREATMENT_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Hyperbaric Treatment (Yes/No)? (Page#) ,,HYPERBARIC_TREATMENT_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hyperbaric Treatment, list the applicable codes or code ranges ",,HYPERBARIC_TREATMENT_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hyperbaric Treatment, describe how these codes are reimbursed",,HYPERBARIC_TREATMENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hyperbaric Treatment, describe schedule name",,HYPERBARIC_TREATMENT_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hyperbaric Treatment, describe reference year or version",,HYPERBARIC_TREATMENT_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Hyperbaric Treatment, describe reimbursement rate",,HYPERBARIC_TREATMENT_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Clinic Visits (Yes/No)?,,CLINIC_VISITS_CAREVEOUT_IND,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
Does the contract include a carve out for Clinic Visits (Yes/No)? (Page#) ,,CLINIC_VISITS_CAREVEOUT_IND_PG,NUMERIC,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Clinic Visits, list the applicable codes or code ranges ",,CLINIC_VISITS_CAREVOUT_CODES,VARCHAR,F,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Clinic Visits, describe how these codes are reimbursed",,CLINIC_VISITS_CARVEOUT_REIMBURSEMENT_METHODOLOGY,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Clinic Visits, describe schedule name",,CLINIC_VISITS_CARVEOUT_SCHEDULE_NAME,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Clinic Visits, describe reference year or version",,CLINIC_VISITS_CAREVEOUT_SCHEDULE_VERSION,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
"If the contract includes a carve out for Clinic Visits, describe reimbursement rate",,CLINIC_VISITS_CARVEOUT_DESCRIBE,VARCHAR,G,ACTIVE,,,,,
|
||
|
|
Does the contract include reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits?,,REIMBURSEMENT_EXHAUST_MEDI_BENEFITS_IND,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
Does the contract include reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits? (Page#) ,,REIMBURSEMENT_EXHAUST_MEDI_BENEFITS_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, is there lesser of language?",,REIMBURSEMENT_EXHAUST_MEDI_BENEFITS_IS_LESSER_OF,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe primary reimbursement",,REIMBURSEMENT_EXHAUST_MEDI_PRIMARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe secondary reimbursement",,REIMBURSEMENT_EXHAUST_MEDI_SECONDARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe tertiary reimbursement",,REIMBURSEMENT_EXHAUST_MEDI_TERTIARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe quaternary reimbursement",,REIMBURSEMENT_EXHAUST_MEDI_QUATERNARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
Does the contract include reimbursement language for members who have not selected Medicare coverage?,,REIMBURSEMENT_EXHAUST_MEDICARE_BENEFITS_IND,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
Does the contract include reimbursement language for members who have not selected Medicare coverage? (Page#) ,,REIMBURSEMENT_EXHAUST_NO_MEDICARE_BENEFITS_IND_PG,NUMERIC,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have not selected Medicare coverage, is there lesser of language?",,REIMBURSEMENT_EXHAUST_NO_MEDICARE_BENEFITS_IS_LESSER_OF,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have not selected Medicare coverage, describe primary reimbursement",,REIMBURSEMENT_EXHAUST_NO_MEDICARE_PRIMARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have not selected Medicare coverage, describe secondary reimbursement",,REIMBURSEMENT_EXHAUST_NO_MEDICARE_SECONDARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have not selected Medicare coverage, describe tertiary reimbursement",,REIMBURSEMENT_EXHAUST_NO_MEDICARE_TERTIARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
"If the contract includes reimbursement language for members who have not selected Medicare coverage, describe quaternary reimbursement",,REIMBURSEMENT_EXHAUST_NO_MEDICARE_QUATERNARY_BENEFITS,VARCHAR,B,ACTIVE,,,,,
|
||
|
|
Does the contract have default language?,,CONTRACT_HAS_DEFAULT_LANG,VARCHAR,C,ACTIVE,,,,,
|
||
|
|
Does the contract have default language? (Page#) ,,CONTRACT_HAS_DEFAULT_LANG_PG,NUMERIC,C,ACTIVE,,,,,
|