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doczyai-pipelines/archive/streamlit/contract_fields.csv
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Katon Minhas afb6d5185d Merged in feature/lesser-table-caching-refactor-hybrid (pull request #847)
Feature/lesser table caching refactor hybrid

* chore: Remove unused duplicate main.py from shared pipeline

* fix: Correct crosswalk paths in aarete_derived.py

* chore: Remove unused documentation files from fieldExtraction

* docs: Add documentation files to documentation folder

* docs: Update README with uv setup, expanded project structure, and branching conventions

* docs: Add uv installation steps with Ubuntu/WSL emphasis

* Enable prompt caching for all remaining LLM calls

- Add _INSTRUCTION() functions for: EXHIBIT_HEADER, EXHIBIT_LINKAGE,
  EXHIBIT_TITLE_MATCH, DATE_FIX, DERIVED_TERM_DATE, CHECK_PROVIDER_NAME_MATCH,
  SPECIAL_CASE_ASSIGNMENT
- Update all invoke_claude() calls in saas and clover pipelines to use
  cache=True with corresponding _INSTRUCTION() functions
- Add new instructions to get_cacheable_instructions() for cache warming
- Update tests for new instruction functions

Functions now using caching:
- prompt_exhibit_level
- prompt_exhibit_lesser (EXHIBIT_LEVEL_LESSER_OF)
- prompt_fee_schedule_breakout
- prompt_grouper_breakout
- prompt_special_case_assignment
- prompt_exhibit_linkage
- prompt_exhibit_header
- prompt_smart_chunked (ONE_TO_ONE templates)
- prompt_date_fix
- prompt_derived_term_date
- prompt_exhibit_title_match
- provider_name_match_check

🤖 Generated with [Claude Code](https://claude.com/claude-code)

Co-Authored-By: Claude Opus 4.5 <noreply@anthropic.com>

* Reorder

* feat: Add bcbs_promise client pipeline with OFFSET_TERM extraction

- Add new bcbs_promise client with HSC-based OFFSET_TERM field extraction
- Extract full paragraph text of offset/recoupment provisions from contracts
- Derive OFFSET_INDICATOR (Y/N) from OFFSET_TERM presence
- Fix reorder_columns to preserve extra columns not in COLUMN_ORDER
- Update QC/QA output path to outputs/qc_qa/

* fix: Update dev deps and test assertions for QC/QA output path

- Add pytest/pytest-mock to dev dependencies for mypy type checking
- Update test assertions to expect outputs/qc_qa instead of qa_qc_output

* style: Apply black formatting to prompt_templates.py

* Merge main, move scripts

* Archive some scripts

* update py version

* remove .py version file

* Remove ASCII characters

* Restore testbed code

* restore tracking

* Update testbed metrics

* Enable prompt caching for CODE_LAST_CHECK, FILL_BILL_TYPE, DUAL_LOB_CHECK, and GROUPER_BREAKOUT

- Add CODE_LAST_CHECK_INSTRUCTION() for service specificity classification
- Add FILL_BILL_TYPE_INSTRUCTION() for bill type code determination
- Add DUAL_LOB_CHECK_INSTRUCTION() for Medicare/Medicaid classification
- Update code_funcs.py to use caching for CODE_LAST_CHECK, FILL_BILL_TYPE, GROUPER_BREAKOUT
- Update postprocessing_funcs.py to use caching for DUAL_LOB_CHECK
- Add new instructions to get_cacheable_instructions() for cache warming
- Add unit tests for new instruction functions

🤖 Generated with [Claude Code](https://claude.com/claude-code)

Co-Authored-By: Claude Opus 4.5 <noreply@anthropic.com>

* Fix postprocessing_funcs to remove invalid columns

* Merge branch 'main' into feature/lesser-table-caching-refactor-hybrid

* Revert prompt caching changes from aed1b73c

* update formatting

* Update imports


Approved-by: Sha Brown
Approved-by: Praneel Panchigar
2026-01-26 16:52:55 +00:00

248 KiB

1Interrogation Question?Field NameSF_DB_COL_NAMEDATA_TYPEPRIORITYFLAGRelated Generic Data Pipeline Field Name?Source of DataThemeRequired Field?Use of Field Beyond Contract Config?
2Does the contract include a carve out for Ambulatory Surgery (Yes/No)?Ambulatory Surgery Carve Out (Y/N)?AMBULATORY_SURGERY_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
3If 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_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
4If the contract includes a carve out for Ambulatory Surgery, describe how these codes are reimbursedAmbulatory Surgery Reimbursement MethodologyAMBULATORY_SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
5Does the contract include a carve out for anesthesia (Yes/No)?Anesthesia Carve Out (Y/N)?ANESTHESIA_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
6If the contract includes a carve out for anesthesia, list the applicable codes or code ranges Anesthesia Codes or Code RangeANESTHESIA_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
7If the contract includes a carve out for anesthesia, describe how these codes are reimbursedAnesthesia Reimbursement Methodology ANESTHESIA_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
8If the Primary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code rangesApplicable Admit Type Codes - PrimaryPRIMARY_REIMBURSEMENT_ADMITTYPE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
9If the Secondary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code rangesApplicable Admit Type Codes - SecondarySECONDARY_REIMBURSEMENT_ADMITTYPE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
10If the Tertiary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code rangesApplicable Admit Type Codes - TertiaryTERTIARY_REIMBURSEMENT_ADMITTYPE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
11If the Primary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code rangesApplicable Diagnosis Codes - PrimaryPRIMARY_REIMBURSEMENT_DIAG_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
12If the Secondary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code rangesApplicable Diagnosis Codes - SecondarySECONDARY_REIMBURSEMENT_DIAG_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
13If the Tertiary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code rangesApplicable Diagnosis Codes - TertiaryTERTIARY_REIMBURSEMENT_DIAG_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
14If the Primary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code rangesApplicable Grouper Codes - PrimaryPRIMARY_REIMBURSEMENT_GROUPER_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
15If the Secondary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code rangesApplicable Grouper Codes - SecondarySECONDARY_REIMBURSEMENT_GROUPER_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
16If the Tertiary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code rangesApplicable Grouper Codes - TertiaryTERTIARY_REIMBURSEMENT_GROUPER_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
17If the Primary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code rangesApplicable Place of Service Codes - PrimaryPRIMARY_REIMBURSEMENT_PLACEOFSERVICE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
18If the Secondary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code rangesApplicable Place of Service Codes - SecondarySECONDARY_REIMBURSEMENT_PLACEOFSERVICE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
19If the Tertiary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code rangesApplicable Place of Service Codes - TertiaryTERTIARY_REIMBURSEMENT_PLACEOFSERVICE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
20If the Primary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code rangesApplicable Procedure Codes - PrimaryPRIMARY_REIMBURSEMENT_PROC_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
21If the Secondary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code rangesApplicable Procedure Codes - SecondarySECONDARY_REIMBURSEMENT_PROC_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
22If the Tertiary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code rangesApplicable Procedure Codes - TertiaryTERTIARY_REIMBURSEMENT_PROC_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
23If the Primary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinationsApplicable Revenue /Procedure Code Combinations - PrimaryPRIMARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBOVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
24If the Secondary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinationsApplicable Revenue /Procedure Code Combinations - SecondarySECONDARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBOVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
25If the Tertiary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinationsApplicable Revenue /Procedure Code Combinations - TertiaryTERTIARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBOVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
26If the Primary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code rangesApplicable Revenue Codes - PrimaryPRIMARY_REIMBURSEMENT_REVENUE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
27If the Secondary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code rangesApplicable Revenue Codes - SecondarySECONDARY_REIMBURSEMENT_REVENUE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
28If the Tertiary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code rangesApplicable Revenue Codes - TertiaryTERTIARY_REIMBURSEMENT_REVENUE_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
29If the Primary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code rangesApplicable Status Indicator Codes - PrimaryPRIMARY_REIMBURSEMENT_STATUS_INDICATOR_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
30If the Secondary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code rangesApplicable Status Indicator Codes - SecondarySECONDARY_REIMBURSEMENT_STATUS_INDICATOR_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
31If the Tertiary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code rangesApplicable Status Indicator Codes - TertiaryTERTIARY_REIMBURSEMENT_STATUS_INDICATOR_CODESVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
32If 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 DateCONTRACT_BASE_EFFECTIVE_DTDATECACTIVENoPreamble Contract Required Only If Agreement Is NOT the Base Contract
33If 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 TitleCONTRACT_BASE_TITLEVARCHARCACTIVENoPreamble Contract Required Only If Agreement Is NOT the Base Contract
34What 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 NamesPROV_DOING_BUSINESS_ASVARCHARAACTIVEYesPreamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
35What 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 IdentifiersPROV_NPI_OTHERVARIANTAACTIVENo (but please use GDP NPI format throughout)Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
36What 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 NumbersPROV_TIN_OTHERVARIANTAACTIVENo (but please use GDP TIN format throughout)Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
37Does 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_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
38If 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_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
39If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe how these codes are reimbursedBehavioral Health & Substance Abuse Reimbursement MethodologyBEH_HEALTH_SUB_ABUSE_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
40Does 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_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
41If the contract includes a carve out for bundling or unbundling, list the applicable codes or code ranges Bundled Services Codes or Code RangeBUNDLED_UNBUNDLED_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
42If the contract includes a carve out for bundling or unbundling, describe how these codes are reimbursedBundled Services Reimbursement Methodology BUNDLED_UNBUNDLED_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
43Does the contract include a carve out for Cancer (Yes/No)?Cancer Carve Out (Y/N)?CANCER_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
44If the contract includes a carve out for Cancer, list the applicable codes or code ranges Cancer Codes or Code Range CANCER_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
45If the contract includes a carve out for Cancer, describe how these codes are reimbursedCancer Reimbursement MethodologyCANCER_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
46Does contract include terms for discounts applied to total claim (Yes/No)?Claim Discount (Y/N)CLAIM_DISCOUNT_INDVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
47What is claim discount rate?Claim Discount RateCLM_DISC_RATEVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
48What is claim discount start date?Claim Discount Start DateCLAIM_DISCOUNT_START_DTDBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
49What is claim discount termination date?Claim Discount Termination DateCLAIM_DISCOUNT_TERMINATION_DTDBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
50Does contract include terms for premiums applied to total claim (Yes/No)?Claim Premium (Y/N)CLAIM_PREMIUM_INDVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
51What is claim premium rate?Claim Premium RateCLAIM_PREMIUM_RATEVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
52What is claim premium start date?Claim Premium Start DateCLAIM_PREMIUM_START_DTDBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
53What is claim premium termination date?Claim Premium Termination DateCLAIM_PREMIUM_TERMINATION_DTDBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
54Does contract include terms for sequestration amounts applied to total claim (Yes/No)?Claim Sequestration (Y/N)CLAIM_SEQUESTRATION_INDVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
55What is claim sequestration rate?Claim Sequestration RateCLAIM_SEQUESTRATION_RATEVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
56What is claim sequestration start date?Claim Sequestration Start DateCLAIM_SEQUESTRATION_START_DTDBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
57What is claim sequestration termination date?Claim Sequestration Termination DateCLAIM_SEQUESTRATION_TERMINATION_DTDBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
58If the contract includes Vaccine for Children carve outs, list the applicable codes or code ranges Client-Specific Carve Out #1 Codes or Code RangeVACCINE_CHILDREN_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
59If the contract includes Vaccine for Children client-specific carve outs, describe how these codes are reimbursedClient-Specific Carve Out #1 Reimbursement MethodologyVACCINE_CHILDREN_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
60Does the contract include other Vaccine for Children carve outs (Yes/No)?Client-Specific Carve Out #1 (Y/N)VACCINE_CHILDREN_CAREVEOUT_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
61Does the contract include Surgical Assist/Assistant carve outs (Yes/No)?Client-Specific Carve Out #2 (Y/N)SURGICAL_ASSIST_CAREVEOUT_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
62If the contract includes Surgical Assist/Assistant carve outs, list the applicable codes or code ranges Client-Specific Carve Out #2 Codes or Code RangeSURGICAL_ASSIST_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
63If the contract includes other client-specific carve outs, describe how these codes are reimbursedClient-Specific Carve Out #2 Reimbursement MethodologyVARCHARINACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
64Does 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_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
65If 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 RangePHY_CLINICAL_PSYCHOLOGIST_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
66If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe how these codes are reimbursedClient-Specific Carve Out #3 Reimbursement MethodologyPHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
67Does 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_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
68Does the contract include Board Certified Behavioral Analyst (BCBA) carve outs (Yes/No)?Client-Specific Carve Out #4-25 (Y/N)CERT_BH_ANALYST_CAREVEOUT_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
69Does the contract include Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs (Yes/No)?Client-Specific Carve Out #4-25 (Y/N)INDEPENDENT_LICENSURES_CAREVEOUT_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
70Does 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_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
71Does 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_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
72Does the contract include Transportation Services carve outs (Yes/No)?Client-Specific Carve Out #4-25 (Y/N)TRANSPORTATION_SVCS_CAREVEOUT_INDVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
73If 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 RangeAUDIO_CHIRO_DIETICIAN_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
74If 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 RangeCERT_BH_ANALYST_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
75If 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 RangeINDEPENDENT_LICENSURES_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
76If 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 RangeBH_OP_CLINICS_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
77If 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 RangePOS_THERAPISTS_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
78If the contract includes Transportation Services carve outs, list the applicable codes or code ranges Client-Specific Carve Out #4-25 Codes or Code RangeTRANSPORTATION_SVCS_CAREVOUT_CODESVARCHARFACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
79If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe how these codes are reimbursedClient-Specific Carve Out #4-25 Reimbursement MethodologyAUDIO_CHIRO_DIETICIAN_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
80If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe how these codes are reimbursedClient-Specific Carve Out #4-25 Reimbursement MethodologyCERT_BH_ANALYST_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
81If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe how these codes are reimbursedClient-Specific Carve Out #4-25 Reimbursement MethodologyINDEPENDENT_LICENSURES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
82If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe how these codes are reimbursedClient-Specific Carve Out #4-25 Reimbursement MethodologyBH_OP_CLINICS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
83If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe how these codes are reimbursedClient-Specific Carve Out #4-25 Reimbursement MethodologyPOS_THERAPISTS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
84If the contract includes Transportation Services carve outs, describe how these codes are reimbursedClient-Specific Carve Out #4-25 Reimbursement MethodologyTRANSPORTATION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVETBDFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
85If contract automatically renews, then then what is the adjusted contract termination date?Contract Adjusted Termination Date Resulting from Auto RenewalAA_CONTRACT_ADJUSTED_TERMINATION_DT_FROM_AUTO_RENEWALDATEACTIVENoAArete Derived from Contract Termination Date As Adjusted for Renewals Key DatesAlways RequiredGREEN LIGHT - IF DATE IS LESS THAN TODAY'S DATE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNLESS THERE IS AN EFFECTIVE AMENDMENT
86Does 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_INDBOOLEANAACTIVENoTerm & Termination Section of Contract Key DatesRequired Only If Available PAYMENT ACCURACY UNIQUE KEY
87If 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_LENGTHVARCHARAACTIVENoTerm & Termination Section of Contract Key DatesRequired Only If Available PAYMENT ACCURACY UNIQUE KEY
88Are the contract effective dates in the Preamble and the final signatory section consistent?Contract Effective Date Consistency (Y/N)?AAR_IS_EFFECTIVE_DT_CONSISTENT_INDBOOLEANACTIVENoAArete Derived (Does Column D = Column E)?Key DatesAlways Required PAYMENT ACCURACY
89What 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 PreambleCONTRACT_EFFECTIVE_DTDATEAACTIVENo (but please use GDP date format throughout)Preamble Key DatesAlways Required PAYMENT ACCURACY UNIQUE KEY
90What 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 SignatoryCONTRACT_EFFECTIVE_DT_SIGNATORYDATEAACTIVENo (but please use GDP date format throughout)Signature PageKey DatesAlways Required PAYMENT ACCURACY UNIQUE KEY
91A 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_INDBOOLEANAACTIVENoSignature PageContract 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
92What 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 DateCONTRACT_TERMINATION_DTDATEAACTIVENo (but please use GDP date format throughout)Term & Termination Section of Contract Key DatesAlways Required PAYMENT ACCURACY UNIQUE KEY
93What 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 TitleCONTRACT_TITLEVARCHARCACTIVENoTitleContract Always Required
94What 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 TypeCONTRACT_HEADERVARCHARAACTIVENoTitle or PreambleContract Always Required UNIQUE KEY
95Does the contract include a carve out for diagnostic services (Yes/No)?Diagnostic Services Carve Out (Y/N)?DIAGNOSTIC_SVCS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
96If the contract includes a carve out for diagnostic services, list the applicable codes or code ranges Diagnostic Services Codes or Code RangeDIAGNOSTIC_SVCS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
97If the contract includes a carve out for diagnostic services, describe how these codes are reimbursedDiagnostic Services Reimbursement Methodology DIAGNOSTIC_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
98Does the contract include a carve out for Durable Medical Equipment (Yes/No)?Durable Medical Equipment Carve Out (Y/N)?DME_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
99If the contract includes a carve out for Durable Medical Equipment, list the applicable codes or code ranges Durable Medical Equipment Codes or Code RangeDME_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
100If the contract includes a carve out for Durable Medical Equipment, describe how these codes are reimbursedDurable Medical Equipment Reimbursement Methodology DME_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
101What 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 TermsLOB_PRICING_TERMS_EFFECTIVE_DTDAACTIVENo (but please use GDP date format throughout)From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificAlways Required PAYMENT ACCURACY UNIQUE KEY
102Does the contract include a carve out for Emergency Department (Yes/No)?Emergency Carve Out (Y/N)?EMERGENCY_DEPARTMENT_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
103If the contract includes a carve out for Emergency Department, list the applicable codes or code ranges Emergency Codes or Code Range EMERGENCY_DEPARTMENT_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
104If the contract includes a carve out for Emergency Department, describe how these codes are reimbursedEmergency Reimbursement MethodologyEMERGENCY_DEPARTMENT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
105If the contract includes a carve out for experimental procedures, list the applicable codes or code ranges Experimental Codes or Code RangeEXPERIMENTAL_PROCEDURES_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
106Does the contract include a carve out for experimental procedures (Yes/No)?Experimental Procedures Carve Out (Y/N)?EXPERIMENTAL_PROCEDURES_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
107If the contract includes a carve out for experimental procedures, describe how these codes are reimbursedExperimental Reimbursement Methodology EXPERIMENTAL_PROCEDURES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
108If 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 - PrimaryPRIMARY_REIMBURSEMENT_FEE_SCHEDULEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
109If 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 - SecondarySECONDARY_REIMBURSEMENT_FEE_SCHEDULEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
110If 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 - TertiaryTERTIARY_REIMBURSEMENT_FEE_SCHEDULEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
111If the primary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?Fee Schedule Version - PrimaryPRIMARY_REIMBURSEMENT_FEE_SCHEDULE_VERSIONVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
112If the secondary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?Fee Schedule Version - SecondarySECONDARY_REIMBURSEMENT_FEE_SCHEDULE_VERSIONVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
113If the tertiary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?Fee Schedule Version - TertiaryTERTIARY_REIMBURSEMENT_FEE_SCHEDULE_VERSIONVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
114Does the contract include a carve out for global services (Yes/No)?Global Services Carve Out (Y/N)?GLOBAL_SVCS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
115If the contract includes a carve out for global services, list the applicable codes or code ranges Global Services Codes or Code RangeGLOBAL_SVCS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
116If the contract includes a carve out for global services, describe how these codes are reimbursedGlobal Services Reimbursement Methodology GLOBAL_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
117Does the Reimbursement methodology include greater of language (Yes/No)?Greater Of Language (Y/N)?GREATER_OF_LANGUAGEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyAlways Required PAYMENT ACCURACY NETWORK
118What is the contact information of the Group provider named in this contract?Group Provider Address Line 1PROV_GROUP_ADDRESS_LINE1VARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
119Group Provider Address Line 2PROV_GROUP_ADDRESS_LINE2VARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
120What are the group providers identification numbers other than TIN and NPI?Group Provider CAQH Number PROV_GROUP_CAQH_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
121Group Provider CityPROV_GROUP_CITYVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
122Group Provider Fax NumberPROV_GROUP_FAX_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
123Group Provider Marketplace NumberPROV_GROUP_MARKETPLACE_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
124Group Provider Medicaid NumberPROV_GROUP_MEDICAID_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
125Group Provider Medicare NumberPROV_GROUP_MEDICARE_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
126What 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 PreamblePROV_GROUP_NAMEVARCHARAACTIVEYesPreamble Provider Always Required UNIQUE KEY
127What 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 SignatoryPROV_GROUP_NAME_SIGNATORYVARCHARAACTIVEYesSignature PageProvider Always Required UNIQUE KEY PDM
128What 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 IdentifierPROV_GROUP_NPIVARCHARAACTIVEYesSignature Page, Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
129Group Provider Phone NumberPROV_GROUP_PHONE_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
130Group Provider StatePROV_GROUP_STATE_CDVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM UNIQUE KEY
131What is the Group provider's taxpayer identification number stated in the Preamble?Group Provider Taxpayer Identification Number per PreamblePROV_GROUP_TINVARCHARAACTIVEYesPreamble Provider Required Only If Available UNIQUE KEY
132What is the group provider's taxpayer identification number stated in the Signatory Section?Group Provider Taxpayer Identification Number per Signatory PROV_GROUP_TIN_SIGNATORYVARCHARAACTIVEYesSignature PageProvider Always Required UNIQUE KEY PDM
133Group Provider ZIPPROV_GROUP_POSTAL_CDNUMERICDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
134Does 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_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
135If 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 RangeHEARING_AID_SVCS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
136If the contract includes a carve out for Hearing Aids & Hearing Services, describe how these codes are reimbursedHearing Aids & Hearing Services Reimbursement Methodology HEARING_AID_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
137Does the contract include a carve out for HIV (Yes/No)?HIV Carve Out (Y/N)?HIV_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
138If the contract includes a carve out for HIV, list the applicable codes or code ranges HIV Codes or Code Range HIV_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
139If the contract includes a carve out for HIV, describe how these codes are reimbursedHIV Reimbursement MethodologyHIV_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
140Does the contract include a carve out for implants (Yes/No)?Implants Carve Out (Y/N)?IMPLANTS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
141If the contract includes a carve out for implants, list the applicable codes or code ranges Implants Codes or Code RangeIMPLANTS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
142If the contract includes a carve out for implants, describe how these codes are reimbursedImplants Reimbursement Methodology IMPLANTS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
143What is the contact information for each of the other providers associated with this agreement?Individual Provider Address Line 1PROV_OTHER_ADDRESS_LINE1VARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
144Individual Provider Address Line 2PROV_OTHER_ADDRESS_LINE2VARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
145What are the individual providers identification numbers other than TIN and NPI?Individual Provider CAQH Number PROV_OTHER_CAQH_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
146Individual Provider CityPROV_OTHER_CITYVARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
147Individual Provider Fax NumberPROV_OTHER_FAX_NUMVARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
148If 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 NamePROV_FIRST_NAME_OTHERVARCHARAINACTIVEYesPreamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
149If 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 NamePROV_LAST_NAME_OTHERVARCHARAINACTIVEYesPreamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
150Individual Provider Marketplace NumberPROV_OTHER_MARKETPLACE_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
151Individual Provider Medicaid NumberPROV_OTHER_MEDICAID_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
152Individual Provider Medicare NumberPROV_OTHER_MEDICARE_NUMVARCHARDACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
153If 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 InitialPROV_MIDDLE_NAME_OTHERVARCHARAINACTIVEYesPreamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contractProvider Required Only If Available UNIQUE KEY PDM
154Individual Provider Phone NumberPROV_OTHER_PHONE_NUMVARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
155What is individual provider specialty as mapped by AArete?Individual Provider Specialty as MappedAAR_PROV_SPECIALTY_AARETE_MAPPEDVARCHARACTIVEYesAArete DerivedProvider Always Required PAYMENT ACCURACY INTELLIGENT EDITS PDM PRICING
156What is individual provider specialty per contract?Individual Provider Specialty per ContractPROV_SPECIALTYVARIANTBACTIVEYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available PAYMENT ACCURACY INTELLIGENT EDITS PDM PRICING
157Individual Provider StatePROV_OTHER_STATE_CDVARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
158Individual Provider ZIPPROV_OTHER_POSTAL_CDVARCHARDTRANSFORMEDYesExhibit, Attachment, or Schedule to contractProvider Required Only If Available LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
159Does the contract include a carve out for Intensive Care Unit (Yes/No)?Intensive Care Carve Out (Y/N)?INTENSIVE_CARE_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
160If 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_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
161If the contract includes a carve out for Intensive Care Unit, describe how these codes are reimbursedIntensive Care Reimbursement MethodologyINTENSIVE_CARE_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
162If the contract includes a carve out for invalid codes, describe how these codes are reimbursedInvalid Code Reimbursement Methodology INVALID_CODES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
163Does the contract include a carve out for invalid codes (Yes/No)?Invalid Codes Carve Out (Y/N)?INVALID_CODES_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
164If the contract includes a carve out for invalid codes, list the applicable codes or code ranges Invalid Codes or Code RangeINVALID_CODES_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
165If the contract includes a carve out for investigational procedures, list the applicable codes or code ranges Investigational Codes or Code RangeINVESTIGATIONAL_PROCEDURES_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
166Does the contract include a carve out for investigational procedures (Yes/No)?Investigational Procedures Carve Out (Y/N)?INVESTIGATIONAL_PROCEDURES_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
167If the contract includes a carve out for investigational procedures, describe how these codes are reimbursedInvestigational Reimbursement Methodology INVESTIGATIONAL_PROCEDURES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
168Does the contract include a carve out for Major Joint Replacement (Yes/No)?Joint Replacement Carve Out (Y/N)?JOINT_REPLACE_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
169If 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_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
170If the contract includes a carve out for Major Joint Replacement, describe how these codes are reimbursedJoint Replacement Reimbursement MethodologyJOINT_REPLACE_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
171Does the contract include a carve out for Laboratory / Pathology (Yes/No)?Laboratory / Pathology Carve Out (Y/N)?LAB_PATHOLOGY_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
172If the contract includes a carve out for Laboratory / Pathology , list the applicable codes or code ranges Laboratory / Pathology Codes or Code RangeLAB_PATHOLOGY_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
173If the contract includes a carve out for Laboratory / Pathology , describe how these codes are reimbursedLaboratory / Pathology Reimbursement Methodology LAB_PATHOLOGY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
174Does the Reimbursement methodology include lesser of language (Yes/No)?Lesser Of Language (Y/N)?LESSER_OF_LANGUAGE_INDVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyAlways Required PAYMENT ACCURACY NETWORK
175If 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 BusinessCONTRACT_LOBVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificAlways Required UNIQUE KEY
176If 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 - PrimaryPRIMARY_REIMBURSEMENT_MEDICAID_RATEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
177If 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 - SecondarySECONDARY_REIMBURSEMENT_MEDICAID_RATEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
178If 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 - TertiaryTERTIARY_REIMBURSEMENT_MEDICAID_RATEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
179Does Medicaid agreement allow offshore (Yes/No)?Medicaid Offshore (Y/N)? MEDICAID_ALLOW_OFFSHOREVARCHARINACTIVENoMedicaid Agreement Required Only If Available
180Does 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_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
181If 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 RangeADMINISTERED_DRUGS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
182If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe how these codes are reimbursedMedical Reimbursement Methodology ADMINISTERED_DRUGS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
183If the Primary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?Medicare $ Rate - PrimaryPRIMARY_REIMBURSEMENT_CMS_MEDICARE_RATEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
184If the Secondary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?Medicare $ Rate - SecondarySECONDARY_REIMBURSEMENT_CMS_MEDICARE_RATEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
185If the Tertiary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?Medicare $ Rate - TertiaryTERTIARY_REIMBURSEMENT_CMS_MEDICARE_RATEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
186Does Medicare agreement allow offshore (Yes/No)?Medicare Offshore (Y/N)? MEDICARE_ALLOW_OFSHOREVARCHAREACTIVENoMedicare Agreement Required Only If Available
187Does the contract include a carve out for Mid-Level Professionals (Yes/No)? Mid-Level Carve Out (Y/N)?MID_LEVEL_PROFESSIONAL_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
188If the contract includes a carve out for Mid-Level Professionals, list the applicable codes or code ranges Mid-Level Codes or Code RangeMID_LEVEL_PROFESSIONAL_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
189If the contract includes a carve out for Mid-Level Professionals, describe how these codes are reimbursedMid-Level Reimbursement Methodology MID_LEVEL_PROFESSIONAL_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
190Does the contract include a carve out for Neonatal Services (Yes/No)?Neonatal Carve Out (Y/N)?NEONATAL_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
191If the contract includes a carve out for Neonatal Services, list the applicable codes or code ranges Neonatal Codes or Code Range NEONATAL_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
192If the contract includes a carve out for Neonatal Services, describe how these codes are reimbursedNeonatal Reimbursement MethodologyNEONATAL_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
193If the contract is based on network type, list each payer network relevant to each line of business as outlined in the contract.NetworkCONTRACT_NETWORKVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificRequired Only If Available UNIQUE KEY
194Does the contract include a carve out for never events (Yes/No)?Never Event Carve Out (Y/N)?NEVER_EVENT_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
195If the contract includes a carve out for never events, list the applicable codes or code ranges Never Event Codes or Code RangeNEVER_EVENT_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
196If the contract includes a carve out for never events, describe how these codes are reimbursedNever Event Reimbursement Methodology NEVER_EVENT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
197If the contract includes a carve out for procedures that are not medically necessary, describe how these codes are reimbursedNot Medically Necessary Reimbursement Methodology NOT_MED_NECESSARY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
198If 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 RangeNOT_MED_NECESSARY_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
199Does 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_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
200If 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, ScheduleCONTRACT_NUMVARCHARAACTIVENoTitle or PreambleContract Required Only If Agreement NOT the Base ContractGREEN 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
201Does the contract include a carve out for OB/GYN Services (Yes/No)?OB/GYN Carve Out (Y/N)?OBGYN_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
202If 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_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
203If the contract includes a carve out for OB/GYN Services, describe how these codes are reimbursedOB/GYN Reimbursement MethodologyOBGYN_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
204If the contract includes a carve out for Observation, list the applicable codes or code ranges Observation Codes or Code Range OBSERVATION_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
205If the contract includes a carve out for Observation, describe how these codes are reimbursedObservation Reimbursement MethodologyOBSERVATION_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
206Does the contract include a carve out for Ophthalmology & Vision Services (Yes/No)?Ophthalmology & Vision Services Carve Out (Y/N)?OPHTHAMOLOGY_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
207If 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_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
208If the contract includes a carve out for Ophthalmology & Vision Services, describe how these codes are reimbursedOphthalmology & Vision Services Reimbursement MethodologyOPHTHAMOLOGY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
209Other Group Provider IdentifiersPROV_GROUP_OTHER_NUMVARCHARDACTIVENoExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
210Other Individual Provider IdentifiersPROV_OTHER_NUMVARCHARDACTIVENoExhibit, Attachment, or Schedule to contractProvider Required Only If Available PDM
211If the contract includes a carve out for outlier provisions, what is the reimbursement method?Outlier Allowed AmountOUTLIER_PROVISIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
212Does the contract include a carve out for outlier provisions (Yes/No)?Outlier Provisions (Y/N)?OUTLIER_PROVISIONS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
213If the contract includes a carve out for outlier provisions, what is the outlier threshold?Outlier ThresholdOUTLIER_PROVISIONS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
214Is the provider contracted to participate in the line of business, network, plan, program for the given provider type?Participation StatusPROV_PARTICIPATION_STATUSVARCHARAACTIVEYesDerived From Combination of LOB, Network, Metal Level, Service Area, Program and/or Type of Provider Fields LOB/Provider Type SpecificAlways Required UNIQUE KEY
215What is the name of the payer that is a party to the contract as stated in the Preamble?Payer Name per PreamblePAYER_NAMEVARCHARAACTIVEYesPreamble PayerAlways Required GREEN LIGHT - IF PAYER NAME DOES NOT EQUAL "CLIENT NAME" THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION; UNIQUE KEY
216Does the contract include terms for penalties and interest (Yes/No)?Penalties & Interest (Y/N)?PENALTIES_INTEREST_INDVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
217What is rate charged for penalties and interest?Penalties & Interest RatePENALTIES_INTEREST_RATEVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
218What triggers computation of penalties and interest?Penalties & Interest TriggerPENALTIES_INTEREST_TRIGGERVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
219If the contract is for Marketplace line of business, then list all metal levels , such as platinum, bronze, silver, and gold.Plan - Metal LevelCONTRACT_MARKETPLACE_METAL_LEVELVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificRequired Only If Available UNIQUE KEY
220If 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 AreaCONTRACT_SERVICE_AREAVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificRequired Only If Available UNIQUE KEY
221Does the contract include a carve out for post-discharge procedures (Yes/No)?Post-Discharge Procedures Carve Out (Y/N)?POSTDISCHARGE_PROC_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
222If the contract includes a carve out for post-discharge procedures, list the applicable codes or code rangesPost-Discharge Services Codes or Code RangePOSTDISCHARGE_PROC_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
223If the contract includes a carve out for post-discharge procedures, describe how these codes are reimbursedPost-Discharge Services Reimbursement Methodology POSTDISCHARGE_PROC_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
224If the contract includes a carve out for post-discharge procedures, how long is the post-discharge window?Post-Discharge WindowPOSTDISCHARGE_PROC_CARVEOUT_WINDOWVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
225Does the contract include a carve out for pre-admission procedures (Yes/No)? Pre-Admission Procedures Carve Out (Y/N)?PREADMISSION_PROC_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
226If the contract includes a carve out for pre-admission procedures, list the applicable codes or code ranges Pre-Admission Services Codes or Code RangePREADMISSION_PROC_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
227If the contract includes a carve out for pre-admission procedures, describe how these codes are reimbursedPre-Admission Services Reimbursement Methodology PREADMISSION_PROC_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
228If the contract includes a carve out for pre-admissions procedures, how long is the pre-admission window?Pre-Admission WindowPREADMISSION_PROC_CAREVEOUT_WINDOWVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
229Does the contract include a carve out for Professional Component (Yes/No)? Professional Component Carve Out (Y/N)?PROFESSIONAL_COMPONENT_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
230If the contract includes a carve out for Professional Component, list the applicable codes or code ranges Professional Component Codes or Code RangePROFESSIONAL_COMPONENT_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
231If the contract includes a carve out for Professional Component, describe how these codes are reimbursedProfessional Component Reimbursement Methodology PROFESSIONAL_COMPONENT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
232If the contract is for Medicare or Medicaid line of business, then list the programs for each line of business.ProgramCONTRACT_PROGRAMVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificRequired Only If Available UNIQUE KEY
233Does the contract include a carve out for prosthetics (Yes/No)?Prosthetics Carve Out (Y/N)?PROSTHETICS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
234If the contract includes a carve out for prosthetics, list the applicable codes or code ranges Prosthetics Codes or Code RangePROSTHETICS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
235If the contract includes a carve out for prosthetics, describe how these codes are reimbursedProsthetics Reimbursement Methodology PROSTHETICS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
236If the contract is limited to certain Professional specialties, then list each specialty and the line of business it applies to.Provider SpecialtyPROV_SPECIALTYTYVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificRequired Only If Available UNIQUE KEY
237Does the contract include a carve out for Radiology/Imaging Services (Yes/No)?Radiology/Imaging Carve Out (Y/N)?RADIOLOGY_IMAGING_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
238If the contract includes a carve out for Radiology/Imaging Services, list the applicable codes or code ranges Radiology/Imaging Codes or Code RangeRADIOLOGY_IMAGING_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
239If the contract includes a carve out for Radiology/Imaging Services, describe how these codes are reimbursedRadiology/Imaging Reimbursement Methodology RADIOLOGY_IMAGING_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
240If contract includes annual rate escalators based on % rate increase, then what is the yearly percentage increase? Rate Escalator %RATE_ESCALATOR_YEARLY_PERCENT_INCREASEVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK
241If contract includes annual rate escalators, on what are they based?Rate Escalator BasisRATE_ESCALATOR_BASISVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK PRICING
242If 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_INDVARCHARBACTIVENoFrom Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderDiscounts, Premiums, Sequestration, Penalties, InterestRequired Only If Available PAYMENT ACCURACY NETWORK PRICING
243Does the contract include a carve out for readmissions (Yes/No)?Readmissions Carve Out (Y/N)?READMISSIONS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
244If the contract includes a carve out for readmissions, list the applicable codes or code ranges Readmissions Codes or Code RangeREADMISSIONS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
245If the contract includes a carve out for readmissions, describe how these codes are reimbursedReadmissions Reimbursement Methodology READMISSIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
246If the contract includes a carve out for readmissions, how long is the readmission window?Readmissions WindowREADMISSIONS_CAREVEOUT_WINDOWVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
247If the contract includes a carve out for Multiple Procedure Reductions, which types of reductions apply?Reduced Services Codes or Code RangeMULTIPLE_PROCEDURE_REDUCTIONS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
248If the contract address Multiple Procedure Reductions, for each type of reduction, what reimbursement methodology applies?Reduced Services Reimbursement Methodology MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
249Does 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_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
250If 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 - PrimaryPRIMARY_REIMBURSEMENT_FLAT_FEEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
251If 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 - SecondarySECONDARY_REIMBURSEMENT_FLAT_FEEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
252If 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 - TertiaryTERTIARY_REIMBURSEMENT_FLAT_FEEVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
253If 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 - PrimaryPRIMARY_REIMBURSEMENT_RATEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
254If 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 - SecondarySECONDARY_REIMBURSEMENT_RATEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
255If 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 - TertiaryTERTIARY_REIMBURSEMENT_RATEVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
256Deprecated - See columns PD, PE, PF Are there any carve outs or exceptions to the primary reimbursement methodology?Reimbursement Exceptions - Primary PRIMARY_REIMBURSEMENT_EXCEPTION_INDVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
257Are there any exceptions to the Secondary reimbursement methodology?Reimbursement Exceptions - Secondary SECONDARY_REIMBURSEMENT_EXCEPTION_INDVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
258Are there any exceptions to the Tertiary reimbursement methodology?Reimbursement Exceptions - Tertiary TERTIARY_REIMBURSEMENT_EXCEPTION_INDVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
259If the primary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?Reimbursement Grouper - Primary PRIMARY_REIMBURSEMENT_GROUPERVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
260If the Secondary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?Reimbursement Grouper - SecondarySECONDARY_REIMBURSEMENT_GROUPERVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
261If the Tertiary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?Reimbursement Grouper - TertiaryTERTIARY_REIMBURSEMENT_GROUPERVARCHARBACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
262What is the primary Reimbursement methodology?Reimbursement Methodology - PrimaryPRIMARY_REIMBURSEMENT_METHODOLOGYVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyAlways Required PAYMENT ACCURACY NETWORK
263If the contract includes lesser of or greater of language, what is the tertiary Reimbursement methodology (if any)?Reimbursement Methodology - TertiaryTERTIARY_REIMBURSEMENT_METHODOLOGYVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
264If the contract includes lesser of or greater of language, what is the secondary Reimbursement methodology?Reimbursement Methodology -SecondarySECONDARY_REIMBURSEMENT_METHODOLOGYVARCHARBACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderReimbursement MethodologyRequired Only If Available PAYMENT ACCURACY NETWORK
265Does the contract include a carve out for second surgeries and/or procedures (Yes/No)?Second Surgery/Procedure Carve Out (Y/N)?SECOND_SURGERIES_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
266If 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 RangeSECOND_SURGERIES_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
267If the contract includes a carve out for second surgeries and/or procedures, describe how these codes are reimbursedSecond Surgery/Procedure Reimbursement Methodology SECOND_SURGERIES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
268Does State Marketplace agreement allow offshore (Yes/No)?State Marketplace Offshore (Y/N)? MARKETPLACE_ALLOW_OFFSHOREVARCHARINACTIVENoState Marketplace Agreement Required Only If Available
269Does the contract include a carve out for certain Status Indicators (Yes/No)?Status Indicator Carve Out (Y/N)?STATUS_INDICATORS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
270If the contract includes a carve out for certain Status Indicators, list the applicable codes or code ranges Status Indicator Codes or Code RangeSTATUS_INDICATORS_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
271If the contract includes a carve out for certain Status Indicators, describe how these codes are reimbursedStatus Indicator Reimbursement Methodology STATUS_INDICATORS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
272Does the contact include a carve out for stop loss (Yes/No)?Stop Loss (Y/N)?STOP_LOSS_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
273If the contract includes a carve out for stop loss, what is the percent allowed above the stop loss threshold?Stop Loss Allowed AmountSTOP_LOSS_CARVEOUT_PERCENT_ALLOWEDVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
274If the contract includes a carve out for stop loss, what is the stop loss threshold?Stop Loss ThresholdSTOP_LOSS_CAREVOUT_THRESHOLDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
275Does the contract include a carve out for subsequent surgeries and/or procedures (Yes/No)?Subsequent Surgery/Procedure Carve Out (Y/N)?SUBSEQUENT_SURGERIES_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
276If 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 RangeSUBSEQUENT_SURGERIES_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
277If the contract includes a carve out for subsequent surgeries and/or procedures, describe how these codes are reimbursedSubsequent Surgery/Procedure Reimbursement Methodology SUBSEQUENT_SURGERIES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
278Does the contract include a carve out for Technical Component (Yes/No)? Technical Component Carve Out (Y/N)?TECHNICAL_COMPONENT_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
279If the contract includes a carve out for Technical Component, list the applicable codes or code ranges Technical Component Codes or Code RangeTECHNICAL_COMPONENT_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
280If the contract includes a carve out for Technical Component, describe how these codes are reimbursedTechnical Component Reimbursement Methodology TECHNICAL_COMPONENT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
281For 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 TermsLOB_PRICING_TERMS_TERMINATION_DTDAACTIVENo (but please use GDP date format throughout)From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificAlways 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
282What is timeline for payer to audit claims per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Payer Claim Audit R156INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
283What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Payer Overpayment IdentificationR164INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
284What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Payer Policy Change Notice R146INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PAYMENT ACCURACY COST AVOIDANCE
285What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Payer Prompt Payment Electronic R154INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PREPAY
286What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Payer Prompt Payment Paper R152INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PREPAY
287What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Provider Claim Timely Filing R148INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
288What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Provider Corrected Claim Filing R150INACTIVENoMedicaid Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
289What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Provider Overpayment AppealR166INACTIVENoMedicaid Agreement Key DatesRequired Only If Available APPEALS INVOICING
290What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Provider Payment AppealR158INACTIVENoMedicaid Agreement Key DatesRequired Only If Available APPEALS INVOICING
291What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Provider Payment DisputeR160INACTIVENoMedicaid Agreement Key DatesRequired Only If Available APPEALS INVOICING
292What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT NUMBER)?Timeline Medicaid Provider Payment ReconsiderationR162INACTIVENoMedicaid Agreement Key DatesRequired Only If Available APPEALS INVOICING
293What is timeline for payer to audit claims per Medicare agreement (INSERT NUMBER)?Timeline Medicare Payer Claim Audit R134INACTIVENoMedicare Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
294What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT NUMBER)?Timeline Medicare Payer Overpayment IdentificationR142INACTIVENoMedicare Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
295What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT NUMBER)?Timeline Medicare Payer Policy Change Notice R124INACTIVENoMedicare Agreement Key DatesRequired Only If Available PAYMENT ACCURACY COST AVOIDANCE
296What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT NUMBER)?Timeline Medicare Payer Prompt Payment Electronic R132INACTIVENoMedicare Agreement Key DatesRequired Only If Available PREPAY
297What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT NUMBER)?Timeline Medicare Payer Prompt Payment Paper R130INACTIVENoMedicare Agreement Key DatesRequired Only If Available PREPAY
298What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT NUMBER)?Timeline Medicare Provider Claim Timely Filing R126INACTIVENoMedicare Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
299What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT NUMBER)?Timeline Medicare Provider Corrected Claim Filing R128INACTIVENoMedicare Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
300What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT NUMBER)?Timeline Medicare Provider Overpayment AppealR144INACTIVENoMedicare Agreement Key DatesRequired Only If Available APPEALS INVOICING
301What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)?Timeline Medicare Provider Payment AppealR136INACTIVENoMedicare Agreement Key DatesRequired Only If Available APPEALS INVOICING
302What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT NUMBER) ?Timeline Medicare Provider Payment DisputeR138INACTIVENoMedicare Agreement Key DatesRequired Only If Available APPEALS INVOICING
303What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT NUMBER)?Timeline Medicare Provider Payment ReconsiderationR140INACTIVENoMedicare Agreement Key DatesRequired Only If Available APPEALS INVOICING
304What is timeline for payer to audit claims per base agreement (INSERT NUMBER)?Timeline Payer Claim Audit R112INACTIVENoBase Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
305What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT NUMBER)?Timeline Payer Overpayment IdentificationR120INACTIVENoBase Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
306What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT NUMBER)Timeline Payer Policy Change Notice R102INACTIVENoBase Agreement Key DatesRequired Only If Available PAYMENT ACCURACY COST AVOIDANCE
307What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT NUMBER)?Timeline Payer Prompt Payment Electronic R110INACTIVENoBase Agreement Key DatesRequired Only If Available PREPAY
308What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT NUMBER)?Timeline Payer Prompt Payment Paper R108INACTIVENoBase Agreement Key DatesRequired Only If Available PREPAY
309What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT NUMEBER)?Timeline Provider Claim Timely Filing R104INACTIVENoBase Agreement Key DatesRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
310What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT NUMBER)?Timeline Provider Corrected Claim Filing R106INACTIVENoBase Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
311What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT NUMBER)?Timeline Provider Overpayment AppealR122INACTIVENoBase Agreement Key DatesRequired Only If Available APPEALS INVOICING
312What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT NUMBER)?Timeline Provider Payment AppealR114INACTIVENoBase Agreement Key DatesRequired Only If Available APPEALS INVOICING
313What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT NUMBER)?Timeline Provider Payment DisputeR116INACTIVENoBase Agreement Key DatesRequired Only If Available APPEALS INVOICING
314What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT NUMBER)?Timeline Provider Payment ReconsiderationR118INACTIVENoBase Agreement Key DatesRequired Only If Available APPEALS INVOICING
315What is timeline for payer to audit claims per State Marketplace agreement (INSERT NUMBER)?Timeline State Marketplace Payer Claim Audit R178INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
316What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT NUMBER)?Timeline State Marketplace Payer Overpayment IdentificationR186INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
317What 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 R168INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PAYMENT ACCURACY COST AVOIDANCE
318Does 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_CHANGEVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderKey DatesRequired Only If Available PAYMENT ACCURACY COST AVOIDANCE
319What 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 R176INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PREPAY
320What 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 R174INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PREPAY
321What 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 R170INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
322What 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 R172INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available PAYMENT ACCURACY
323What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?Timeline State Marketplace Provider Overpayment AppealR188INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available APPEALS INVOICING
324What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?Timeline State Marketplace Provider Payment AppealR180INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available APPEALS INVOICING
325What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT NUMBER) ?Timeline State Marketplace Provider Payment DisputeR182INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available APPEALS INVOICING
326What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT NUMBER)?Timeline State Marketplace Provider Payment ReconsiderationR184INACTIVENoState Marketplace Agreement Key DatesRequired Only If Available APPEALS INVOICING
327Does the contract include a carve out for Transplant (Yes/No)?Transplant Carve Out (Y/N)?TRANSPLANT_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
328If the contract includes a carve out for Transplant, list the applicable codes or code ranges Transplant Codes or Code Range TRANSPLANT_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
329If the contract includes a carve out for Transplant, describe how these codes are reimbursedTransplant Reimbursement MethodologyTRANSPLANT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
330Does the contract include a carve out for Trauma (Yes/No)?Trauma Carve Out (Y/N)?TRAUMA_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
331If the contract includes a carve out for Trauma, list the applicable codes or code ranges Trauma Codes or Code Range TRAUMA_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
332If the contract includes a carve out for Trauma, describe how these codes are reimbursedTrauma Reimbursement MethodologyTRAUMA_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
333Is the contract related to a Professional, Institutional or Ancillary provider? Only respond with "Professional," "Institutional,", or "Ancillary."Type of ContractCONTRACT_TYPEVARCHARAACTIVEYesAArete Derived from Title or Preamble LOB/Provider Type SpecificAlways Required UNIQUE KEY
334If 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 ProviderPROV_TYPEVARCHARAACTIVEYesFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderLOB/Provider Type SpecificAlways Required UNIQUE KEY
335If the contract includes a carve out for Unlisted codes, describe how these codes are reimbursedUnlisted Code Reimbursement Methodology UNLISTED_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
336Does the contract include a carve out for Unlisted codes (Yes/No)?Unlisted Codes Carve Out (Y/N)?UNLISTED_CAREVEOUT_INDVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
337If the contract includes a carve out for Unlisted codes, list the applicable codes or code ranges Unlisted Codes or Code RangeUNLISTED_CAREVOUT_CODESVARCHARFACTIVENoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY INTELLIGENT EDITS
338What is the title of the contract? (Page #)CONTRACT_TITLE_PGNUMERICCACTIVE
339What type of contract or agreement is the document? (Page #)CONTRACT_HEADER_PGNUMERICAACTIVE
340If the contract is numbered, which number is it (e.g., if contract is titled Amendment #1, then enter "1")? (Page #)CONTRACT_NUM_PGNUMERICAACTIVE
341If this agreement is not the base contract, then what is the title of the associated base contract? (Page#) CONTRACT_BASE_TITLE_PGNUMERICCACTIVE
342If this agreement is not the base contract, then what is the effective date of the associated base contract? (Page#) CONTRACT_BASE_EFFECTIVE_DT_PGNUMERICCACTIVE
343Is 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_PGNUMERICAACTIVE
344What is the name of the payer that is a party to the contract as stated in the Preamble? (Page#) PAYER_NAME_PGNUMERICAACTIVE
345What is the name of the Group provider that is a party to the contract as stated in the Preamble? (Page#) PROV_GROUP_NAME_PGNUMERICAACTIVE
346What is the Group provider's taxpayer identification number stated in the Preamble? (Page#) PROV_GROUP_TIN_PGNUMERICAACTIVE
347What 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_PGNUMERICAACTIVE
348What is the group provider's taxpayer identification number stated in the Signatory Section? (Page#) PROV_GROUP_TIN_SIGNATORY_PGNUMERICAACTIVE
349What is the group provider's national provider identifier number? (Page#) PROV_GROUP_NPI_PGNUMERICAACTIVE
350What is the contact information of the Group provider named in this contract? (Page#) PROV_GROUP_PGNUMERICDACTIVE
351What are the group providers identification numbers other than TIN and NPI? (Page#) PROV_GROUP_NUM_PGNUMERICDACTIVE
352What 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_PGNUMERICAACTIVE
353What are the provider taxpayer identification numbers for each of the other providers associated with this agreement? (Page#) PROV_TIN_OTHER_PGNUMERICAACTIVE
354What are the provider national provider identifier numbers for each of the other providers associated with this agreement? (Page#) PROV_NPI_OTHER_PGNUMERICAACTIVE
355What is the contact information for each of the other providers associated with this agreement? (Page#) PROV_OTHER_PGNUMERICDTRANSFORMED
356What are the individual providers identification numbers other than TIN and NPI? (Page#) PROV_OTHER_NUM_PGNUMERICDACTIVE
357What is individual provider specialty per contract? (Page#) PROV_SPECIALTY_PGNUMERICBACTIVE
358What is individual provider specialty as mapped by AArete? (Page#) INACTIVE
359What is the contract effective date as stated in Preamble of the agreement? (Page#) CONTRACT_EFFECTIVE_DT_PGNUMERICAACTIVE
360What is the contract effective date as stated in the signatory section of the agreement? (Page#) CONTRACT_EFFECTIVE_DT_SIGNATORY_PGNUMERICAACTIVE
361Are the contract effective dates in the Preamble and the final signatory section consistent? (Page#) R100INACTIVE
362What is the contract termination date? (Page#) CONTRACT_TERMINATION_DT_PGNUMERICACTIVE
363Does the contract automatically renew (Yes/No)? (Page#) CONTRACT_AUTO_RENEWAL_IND_PGNUMERICACTIVE
364If contract automatically renews, then what is the length of the renewal term? (Page#) CONTRACT_AUTO_RENEWAL_TERM_LENGTH_PGNUMERICAACTIVE
365If contract automatically renews, then then what is the adjusted contract termination date? (Page#) R101INACTIVE
366What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT UNIT OF MEASURE)R103INACTIVE
367Concat - What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT NUMBER)PAYER_POLICY_CHANGE_NOTICE_TIMELINEVARCHAREACTIVE
368What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT TRIGGER "FROM" or "BEFORE")PAYER_POLICY_CHANGE_NOTICE_INFOVARCHAREACTIVE
369What is timeline for payer to give notice of policy changes to provider per base agreement? (Page#)PAYER_POLICY_CHANGE_NOTICE_INFO_PGNUMERICEACTIVE
370What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT UNIT OF MEASURE)?R105INACTIVE
371Concat - What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT NUMEBER)?PROV_CLAIM_TIMELY_FILING_TIMELINEVARCHAREACTIVE
372What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_CLAIM_TIMELY_FILING_INFOVARCHAREACTIVE
373What is timeline for provider timely filing of claims submitted to the payer per base agreement (Page#)?PROV_CLAIM_TIMELY_FILING_PGNUMERICEACTIVE
374What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT UNIT OF MEASURE)?R107INACTIVE
375Concat - What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT NUMBER)?PROV_CORRECTED_CLAIM_FILING_TIMELINEVARCHAREACTIVE
376What 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_INFOVARCHAREACTIVE
377What is timeline for provider to file a corrected claim with the payer per the base agreement (Page#)?PROV_CORRECTED_CLAIM_FILING_PGNUMERICEACTIVE
378What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT UNIT OF MEASURE)?R109INACTIVE
379Concat - What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT NUMBER)?PAYER_PROMPT_PAY_PAPER_CLAIM_TIMELINEVARCHAREACTIVE
380What 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_INFOVARCHAREACTIVE
381What is timeline for payer to prompt pay paper claims to the provider per base agreement (Page#)?PAYER_PROMPT_PAY_PAPER_CLAIM_PGNUMERICEACTIVE
382What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT UNIT OF MEASURE)?R111INACTIVE
383Concat - What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT NUMBER)?PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_TIMELINEVARCHAREACTIVE
384What 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_INFOVARCHAREACTIVE
385What is timeline for payer to prompt pay electronic claims to the provider per base agreement (Page#)?PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_PGNUMERICEACTIVE
386What is timeline for payer to audit claims per base agreement (INSERT UNIT OF MEASURE)?R113INACTIVE
387Concat - What is timeline for payer to audit claims per base agreement (INSERT NUMBER)?PAYER_AUDIT_CLAIM_TIMELINEVARCHAREACTIVE
388What is timeline for payer to audit claims per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PAYER_AUDIT_CLAIM_INFOVARCHAREACTIVE
389What is timeline for payer to audit claims per base agreement (Page#)?PAYER_AUDIT_CLAIM_PGNUMERICEACTIVE
390What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT UNIT OF MEASURE)?R115INACTIVE
391Concat - What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT NUMBER)?PROV_SUBMIT_PAYMENT_APPEAL_TIMELINEVARCHAREACTIVE
392What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_SUBMIT_PAYMENT_APPEAL_INFOVARCHAREACTIVE
393What is timeline for provider to submit a payment appeal to the payer per base agreement (Page#)?PROV_SUBMIT_PAYMENT_APPEAL_PGNUMERICEACTIVE
394What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT UNIT OF MEASURE)?R117INACTIVE
395Concat - What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT NUMBER)?PROV_SUBMIT_PAYMENT_DISPUTE_TIMELINEVARCHAREACTIVE
396What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_SUBMIT_PAYMENT_DISPUTE_INFOVARCHAREACTIVE
397What is timeline for provider to submit a payment dispute to the payer per base agreement (Page#)?PROV_SUBMIT_PAYMENT_DISPUTE_PGNUMERICEACTIVE
398What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT UNIT OF MEASURE)?R119INACTIVE
399Concat - What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT NUMBER)?PROV_SUBMIT_PAYMENT_RECONSIDERATION_TIMELINEVARCHARACTIVE
400What 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_INFOVARCHAREACTIVE
401What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (Page#)?PROV_SUBMIT_PAYMENT_RECONSIDERATION_PGNUMERICEACTIVE
402What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT UNIT OF MEASURE)?R121INACTIVE
403Concat - What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT NUMBER)?PAYER_IDENTIFY_OVERPAYMENT_TIMELINEVARCHAREACTIVE
404What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PAYER_IDENTIFY_OVERPAYMENT_INFOVARCHAREACTIVE
405What is timeline for payer to identify overpayments in paid claims per base agreement (Page#)?PAYER_IDENTIFY_OVERPAYMENT_PGNUMERICEACTIVE
406What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT UNIT OF MEASURE)?R123INACTIVE
407Concat - What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT NUMBER)?PROV_SUBMIT_OVERPAYMENT_APPEAL_TIMELINEVARCHAREACTIVE
408What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_SUBMIT_OVERPAYMENT_APPEAL_INFOVARCHAREACTIVE
409What is timeline for provider to submit an overpayment appeal to the payer per base agreement (Page#)?PROV_SUBMIT_OVERPAYMENT_APPEAL_PGNUMERICEACTIVE
410What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT UNIT OF MEASURE)?R125INACTIVE
411Concat - What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT NUMBER)?PAYER_NOTICE_POLICY_CHANGE_MEDICARE_TIMELINEVARCHARINACTIVE
412What 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_INFOVARCHARINACTIVE
413What is timeline for payer to give notice of policy changes to provider per Medicare agreement (Page#)?PAYER_NOTICE_POLICY_CHANGE_MEDICARE_PGNUMERICINACTIVE
414What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?R127INACTIVE
415Concat - What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT NUMBER)?PROV_CLAIM_TIMELY_FILING_MEDICARE_TIMELINEVARCHARINACTIVE
416What 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_INFOVARCHARINACTIVE
417What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (Page#)?PROV_CLAIM_TIMELY_FILING_MEDICARE_PGNUMERICINACTIVE
418What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT UNIT OF MEASURE)?R129INACTIVE
419Concat - What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT NUMBER)?PROV_CORRECTED_CLAIM_FILING_MEDICARE_TIMELINEVARCHARINACTIVE
420What 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_INFOVARCHARINACTIVE
421What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (Page#)?PROV_CORRECTED_CLAIM_FILING_MEDICARE_PGNUMERICINACTIVE
422What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT UNIT OF MEASURE)?R131INACTIVE
423Concat - What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT NUMBER)?PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_TIMELINEVARCHARINACTIVE
424What 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_INFOVARCHARINACTIVE
425What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (Page#?PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_PGNUMERICINACTIVE
426What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT UNIT OF MEASURE)?R133INACTIVE
427Concat - What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT NUMBER)?PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_TIMELINEVARCHARINACTIVE
428What 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_INFOVARCHARINACTIVE
429What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (Page#)?PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_PGNUMERICINACTIVE
430What is timeline for payer to audit claims per Medicare agreement (INSERT UNIT OF MEASURE)?R135INACTIVE
431Concat - What is timeline for payer to audit claims per Medicare agreement (INSERT NUMBER)?PAYER_CLAIM_AUDIT_MEDICARE_TIMELINEVARCHARINACTIVE
432What is timeline for payer to audit claims per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PAYER_CLAIM_AUDIT_MEDICARE_INFOVARCHARINACTIVE
433What is timeline for payer to audit claims per Medicare agreement? (Page#) PAYER_CLAIM_AUDIT_MEDICARE_PGNUMERICINACTIVE
434What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?R137INACTIVE
435Concat - What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)?PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_TIMELINEVARCHARINACTIVE
436What 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_INFOVARCHARINACTIVE
437What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)? (Page#) PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_PGNUMERICINACTIVE
438What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT UNIT OF MEASURE) ?R139INACTIVE
439Concat - What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT NUMBER) ?PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_TIMELINEVARCHARINACTIVE
440What 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_INFOVARCHARINACTIVE
441What is timeline for provider to submit a payment dispute to the payer per Medicare agreement ? (Page#) PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_PNUMERICINACTIVE
442What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?R141INACTIVE
443Concat - What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT NUMBER)?PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_TIMELINEVARCHARINACTIVE
444What 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_INFOVARCHARINACTIVE
445What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement? (Page#) PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_PGNUMERICINACTIVE
446What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT UNIT OF MEASURE)?R143INACTIVE
447Concat - What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT NUMBER)?PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_TIMELINEVARCHARINACTIVE
448What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_INFOVARCHARINACTIVE
449What is timeline for payer to identify overpayments in paid claims per Medicare agreement? (Page#) PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_PGNUMERICINACTIVE
450What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?R145INACTIVE
451Concat - What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT NUMBER)?PROV_OVERPAYMENT_APPEAL_MEDICARE_TIMELINEVARCHARINACTIVE
452What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_OVERPAYMENT_APPEAL_MEDICARE_INFOVARCHARINACTIVE
453What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement? (Page#) PROV_OVERPAYMENT_APPEAL_MEDICARE_PGNUMERICINACTIVE
454Does Medicare agreement allow offshore (Yes/No)? (Page#) MEDICARE_ALLOW_OFFSHORE_PGNUMERICEACTIVE
455What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT UNIT OF MEASURE)?R147INACTIVE
456Concat - What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT NUMBER)?PAYER_NOTICE_POLICY_CHANGE_MEDICAID_TIMELINEVARCHARINACTIVE
457What 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_INFOVARCHARINACTIVE
458What is timeline for payer to give notice of policy changes to provider per Medicaid agreement? (Page#) PAYER_NOTICE_POLICY_CHANGE_MEDICAID_PGNUMERICINACTIVE
459What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?R149INACTIVE
460Concat - What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT NUMBER)?PROV_CLAIM_TIMELY_FILING_MEDICAID_TIMELINEVARCHARINACTIVE
461What 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_INFOVARCHARINACTIVE
462What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement? (Page#) PROV_CLAIM_TIMELY_FILING_MEDICAID_PGNUMERICINACTIVE
463What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT UNIT OF MEASURE)?R151INACTIVE
464Concat - What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT NUMBER)?PROV_CORRECTED_CLAIM_FILING_MEDICAID_TIMELINEVARCHARINACTIVE
465What 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_INFOVARCHARINACTIVE
466What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement? (Page#) PROV_CORRECTED_CLAIM_FILING_MEDICAID_PGNUMERICINACTIVE
467What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT UNIT OF MEASURE)?R153INACTIVE
468Concat - What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT NUMBER)?PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_TIMELINEVARCHARINACTIVE
469What 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_INFOVARCHARINACTIVE
470What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement? (Page#) PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_PGNUMERICINACTIVE
471What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT UNIT OF MEASURE)?R155INACTIVE
472Concat - What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT NUMBER)?PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_TIMELINEVARCHARINACTIVE
473What 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_INFOVARCHARINACTIVE
474What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement? (Page#) PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_PGNUMERICINACTIVE
475What is timeline for payer to audit claims per Medicaid agreement (INSERT UNIT OF MEASURE)?R157INACTIVE
476Concat - What is timeline for payer to audit claims per Medicaid agreement (INSERT NUMBER)?PROV_CLAIM_AUDIT_MEDICAID_TIMELINEVARCHARINACTIVE
477What is timeline for payer to audit claims per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_CLAIM_AUDIT_MEDICAID_INFOVARCHARINACTIVE
478What is timeline for payer to audit claims per Medicaid agreement? (Page#) PROV_CLAIM_AUDIT_MEDICAID_PGNUMERICINACTIVE
479What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?R159INACTIVE
480Concat - What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT NUMBER)?PROV_PAYMENT_APPEAL_MEDICAID_TIMELINEVARCHARINACTIVE
481What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_PAYMENT_APPEAL_MEDICAID_INFOVARCHARINACTIVE
482What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement? (Page#) PROV_PAYMENT_APPEAL_MEDICAID_PGNUMERICINACTIVE
483What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?R161INACTIVE
484Concat - What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT NUMBER)?PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_TIMELINEVARCHARINACTIVE
485What 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_INFOVARCHARINACTIVE
486What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement ? (Page#) PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_PGNUMERICINACTIVE
487What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?R163INACTIVE
488Concat - What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT NUMBER)?PROV_PAYMENT_RECONSIDERATION_MEDICAID_TIMELINEVARCHARINACTIVE
489What 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_INFOVARCHARINACTIVE
490What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement? (Page#) PROV_PAYMENT_RECONSIDERATION_MEDICAID_PGNUMERICINACTIVE
491What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT UNIT OF MEASURE)?R165INACTIVE
492Concat - What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT NUMBER)?PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_TIMELINEVARCHARINACTIVE
493What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_INFOVARCHARINACTIVE
494What is timeline for payer to identify overpayments in paid claims per Medicaid agreement? (Page#) PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_PGNUMERICINACTIVE
495What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?R167INACTIVE
496Concat - What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT NUMBER)?PROV_OVERPAYMENT_APPEAL_MEDICAID_TIMELINEVARCHARINACTIVE
497What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_OVERPAYMENT_APPEAL_MEDICAID_INFOVARCHARINACTIVE
498What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement? (Page#) PROV_OVERPAYMENT_APPEAL_MEDICAID_PGNUMERICINACTIVE
499Does Medicaid agreement allow offshore (Yes/No)? (Page#) MEDICAID_ALLOW_OFFSHORE_PGNUMERICINACTIVE
500What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT UNIT OF MEASURE)?R169INACTIVE
501Concat - What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT NUMBER)?PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_TIMELINEVARCHARINACTIVE
502What 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_INFOVARCHARINACTIVE
503What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement? (Page#) PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_PGNUMERICINACTIVE
504What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?R171INACTIVE
505Concat - What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT NUMBER)?PROV_CLAIM_TIMELY_FILING_MARKETPLACE_TIMELINEVARCHARINACTIVE
506What 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_INFOVARCHARINACTIVE
507What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement? (Page#) PROV_CLAIM_TIMELY_FILING_MARKETPLACE_PGNUMERICINACTIVE
508What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT UNIT OF MEASURE)?R173INACTIVE
509Concat - 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_TIMELINEVARCHARINACTIVE
510What 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_INFOVARCHARINACTIVE
511What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement? (Page#) PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_PGNUMERICINACTIVE
512What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT UNIT OF MEASURE) ?R175INACTIVE
513Concat - 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_TIMELINEVARCHARINACTIVE
514What 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_INFOVARCHARINACTIVE
515What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement? (Page#) PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_PGNUMERICINACTIVE
516What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT UNIT OF MEASURE) ?R177INACTIVE
517Concat - 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_TIMELINEVARCHARINACTIVE
518What 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_INFOVARCHARINACTIVE
519What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement? (Page#) PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_PGNUMERICINACTIVE
520What is timeline for payer to audit claims per State Marketplace agreement (INSERT UNIT OF MEASURE)?R179INACTIVE
521Concat - What is timeline for payer to audit claims per State Marketplace agreement (INSERT NUMBER)?PROV_CLAIM_AUDIT_MARKETPLACE_TIMELINEVARCHARINACTIVE
522What is timeline for payer to audit claims per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_CLAIM_AUDIT_MARKETPLACE_INFOVARCHARINACTIVE
523What is timeline for payer to audit claims per State Marketplace agreement? (Page#) PROV_CLAIM_AUDIT_MARKETPLACE_PGNUMERICINACTIVE
524What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?R181INACTIVE
525Concat - What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?PROV_PAYMENT_APPEAL_MARKETPLACE_TIMELINEVARCHARINACTIVE
526What 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_INFOVARCHARINACTIVE
527What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement? (Page#) PROV_PAYMENT_APPEAL_MARKETPLACE_PGNUMERICINACTIVE
528What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE) ?R183INACTIVE
529Concat - What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT NUMBER) ?PROV_PAYMENT_DISPUTE_MARKETPLACE_TIMELINEVARCHARINACTIVE
530What 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_INFOVARCHARINACTIVE
531What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement ? (Page#) PROV_PAYMENT_DISPUTE_MARKETPLACE_PGNUMERICINACTIVE
532What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?R185INACTIVE
533Concat - What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT NUMBER)?PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_TIMELINEVARCHARINACTIVE
534What 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_INFOVARCHARINACTIVE
535What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement? (Page#) PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_PGNUMERICINACTIVE
536What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT UNIT OF MEASURE)?R187INACTIVE
537Concat - What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT NUMBER)?PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_TIMELINEVARCHARINACTIVE
538What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_INFOVARCHARINACTIVE
539What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement? (Page#) PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_PGNUMERICINACTIVE
540What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE )?R189INACTIVE
541Concat - What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?PROV_OVERPAYMENT_APPEAL_MARKETPLACE_TIMELINEVARCHARINACTIVE
542What 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_INFOVARCHARINACTIVE
543What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement? (Page#) PROV_OVERPAYMENT_APPEAL_MARKETPLACE_PGNUMERICINACTIVE
544Does State Marketplace agreement allow offshore (Yes/No)? (Page#) MARKETPLACE_ALLOW_OFSHORE_PGNUMERICINACTIVE
545What is start date of line of business specific compensation exhibit? (Page#) LOB_PRICING_TERMS_EFFECTIVE_DT_PGNUMERICAACTIVE
546What is termination date of line of business specific compensation exhibit? (Page#) LOB_PRICING_TERMS_TERMINATION_DT_PGNUMERICAACTIVE
547Is the contract related to a Professional, Institutional or Ancillary provider? (Page#) CONTRACT_TYPE_PGNUMERICAACTIVE
548If the contract is based on line of business, then create one row for each line of business (Page#) CONTRACT_LOB_PGNUMERICAACTIVE
549If 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_PGNUMERICAACTIVE
550If 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_PGNUMERICAACTIVE
551If 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_PGVARCHARAACTIVE
552If 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_PGNUMERICAACTIVE
553If 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_PGNUMERICAACTIVE
554If 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_PGNUMERICAACTIVE
555Is the provider contracted to participate in the line of business, network, plan, program for the given provider type? (Page#) PROV_PARTICIPATION_STATUS_PGNUMERICAACTIVE
556If contract automatically renews, then does the contract include annual rate escalators for year-over-year rate increases (Yes/No)? (Page#) RATE_ESCALATOR_IND_PGNUMERICBACTIVE
557If contract includes annual rate escalators, on what are they based? (Page#) RATE_ESCALATOR_BASIS_PGNUMERICBACTIVE
558If contract includes annual rate escalators based on % rate increase, then what is the yearly percentage increase? (Page#) RATE_ESCALATOR_YEARLY_PERCENT_INCREASE_PGNUMERICBACTIVE
559Does contract include terms for discounts applied to total claim (Yes/No)? (Page#) CLAIM_DISCOUNT_IND_PGNUMERICBACTIVE
560What is claim discount rate? (Page#) CLAIM_DISCOUNT_RATE_PGNUMERICBACTIVE
561What is claim discount start date? (Page#) CLAIM_DISCOUNT_START_DT_PGNUMERICBACTIVE
562What is claim discount termination date? (Page#) CLAIM_DISCOUNT_TERMINATION_DT_PGNUMERICBACTIVE
563Does contract include terms for premiums applied to total claim (Yes/No)? (Page#) CLAIM_PREMIUM_IND_PGNUMERICBACTIVE
564What is claim premium rate? (Page#) CLAIM_PREMIUM_RATE_PGNUMERICBACTIVE
565What is claim premium start date? (Page#) CLAIM_PREMIUM_START_DT_PGNUMERICBACTIVE
566What is claim premium termination date? (Page#) CLAIM_PREMIUM_TERMINATION_DT_PGNUMERICBACTIVE
567Does contract include terms for sequestration amounts applied to total claim (Yes/No)? (Page#) CLAIM_SEQUESTRATION_IND_PGNUMERICBACTIVE
568What is claim sequestration rate? (Page#) CLAIM_SEQUESTRATION_RATE_PGNUMERICBACTIVE
569What is claim sequestration start date? (Page#) CLAIM_SEQUESTRATION_START_DT_PGNUMERICBACTIVE
570What is claim sequestration termination date? (Page#) CLAIM_SEQUESTRATION_TERMINATION_DT_PGNUMERICBACTIVE
571Does the contract include terms for penalties and interest (Yes/No)? (Page#) PENALTIES_INTEREST_IND_PGNUMERICBACTIVE
572What triggers computation of penalties and interest? (Page#) PENALTIES_INTEREST_TRIGGER_PGNUMERICBACTIVE
573What is rate charged for penalties and interest? (Page#) PENALTIES_INTEREST_RATE_PGNUMERICBACTIVE
574What is contract's Chargemaster protection language?CONTRACT_CHARGEMASTER_PROTECTION_LANGUAGEVARCHARBACTIVE
575What is contract's Chargemaster protection language? (Page#) CONTRACT_CHARGEMASTER_PROTECTION_LANGUAGE_PGNUMERICBACTIVE
576Does the Reimbursement methodology include lesser of language (Yes/No)? (Page#) LESSER_OF_LANGUAGE_IND_PGNUMERICBACTIVE
577Does the Reimbursement methodology include greater of language (Yes/No)? (Page#) GREATER_OF_LANGUAGE_PGNUMERICBACTIVE
578What is the primary Reimbursement methodology? (Page#) PRIMARY_REIMBURSEMENT_METHODOLOGY_PGNUMERICBACTIVE
579If the Primary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_PROC_CODES_PGNUMERICBACTIVE
580If the Primary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_REVENUE_CODES_PGNUMERICBACTIVE
581If the Primary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#) PRIMARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PGNUMERICBACTIVE
582If the Primary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_DIAG_CODES_PGNUMERICBACTIVE
583If the Primary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_GROUPER_CODES_PGNUMERICBACTIVE
584If the Primary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PGNUMERICBACTIVE
585If the Primary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_ADMITTYPE_CODES_PGNUMERICBACTIVE
586If the Primary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#) PRIMARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PGNUMERICBACTIVE
587If 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_PGNUMERICBACTIVE
588If the primary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#) PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PGNUMERICBACTIVE
589If 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_PGNUMERICBACTIVE
590If 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_PGNUMERICBACTIVE
591If 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_PGNUMERICBACTIVE
592If 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_PGNUMERICBACTIVE
593If the primary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#) PRIMARY_REIMBURSEMENT_GROUPER_PGNUMERICBACTIVE
594Deprecated - See columns PD, PE, PF Are there any carve outs or exceptions to the primary reimbursement methodology? (Page#) PRIMARY_REIMBURSEMENT_EXCEPTION_IND_PGNUMERICBACTIVE
595Are there any carve outs?PRIMARY_REIMBURSEMENT_CARVEOUT_INDVARCHARBACTIVE
596If there are any exceptions to Primary Reimbursement Methodology, describe exceptions?PRIMARY_REIMBURSEMENT_DESCRIBE_EXCEPTIONVARCHARBACTIVE
597If there are any exceptions to Primary Reimbursement Methodology, describe exceptions? ( Page #)PRIMARY_REIMBURSEMENT_DESCRIBE_EXCEPTION_PGNUMERICBACTIVE
598If the contract includes lesser of or greater of language, what is the secondary Reimbursement methodology? (Page#) SECONDARY_REIMBURSEMENT_METHODOLOGY_PGNUMERICBACTIVE
599If the Secondary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_PROC_CODES_PGNUMERICBACTIVE
600If the Secondary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_REVENUE_CODES_PGNUMERICBACTIVE
601If the Secondary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#) SECONDARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PGNUMERICBACTIVE
602If the Secondary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_DIAG_CODES_PGNUMERICBACTIVE
603If the Secondary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_GROUPER_CODES_PGNUMERICBACTIVE
604If the Secondary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PGNUMERICBACTIVE
605If the Secondary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_ADMITTYPE_CODES_PGNUMERICBACTIVE
606If the Secondary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#) SECONDARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PGNUMERICBACTIVE
607If 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_PGNUMERICBACTIVE
608If the secondary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#) SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PGNUMERICBACTIVE
609If 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_PGNUMERICBACTIVE
610If 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_PGNUMERICBACTIVE
611If 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_PGNUMERICBACTIVE
612If 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_PGNUMERICBACTIVE
613If the Secondary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#) SECONDARY_REIMBURSEMENT_GROUPER_PGNUMERICBACTIVE
614Are there any exceptions to the Secondary reimbursement methodology? (Page#) SECONDARY_REIMBURSEMENT_EXCEPTION_IND_PGNUMERICBACTIVE
615If the contract includes lesser of or greater of language, what is the tertiary Reimbursement methodology (if any)? (Page#) TERTIARY_REIMBURSEMENT_METHODOLOGY_PGNUMERICBACTIVE
616If the Tertiary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_PROC_CODES_PGNUMERICBACTIVE
617If the Tertiary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_REVENUE_CODES_PGNUMERICBACTIVE
618If the Tertiary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#) TERTIARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PGNUMERICBACTIVE
619If the Tertiary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_DIAG_CODES_PGNUMERICBACTIVE
620If the Tertiary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_GROUPER_CODES_PGNUMERICBACTIVE
621If the Tertiary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PGNUMERICBACTIVE
622If the Tertiary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_ADMITTYPE_CODES_PGNUMERICBACTIVE
623If the Tertiary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#) TERTIARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PGNUMERICBACTIVE
624If 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_PGNUMERICBACTIVE
625If the tertiary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#) TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PGNUMERICBACTIVE
626If 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_PGNUMERICBACTIVE
627If 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_PGNUMERICBACTIVE
628If 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_PGNUMERICBACTIVE
629If 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_PGNUMERICBACTIVE
630If the Tertiary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#) TERTIARY_REIMBURSEMENT_GROUPER_PGNUMERICBACTIVE
631Are there any exceptions to the Tertiary reimbursement methodology? (Page#) TERTIARY_REIMBURSEMENT_EXCEPTION_IND_PGNUMERICBACTIVE
632Does 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_PGNUMERICFACTIVE
633Does the contract include a carve out for Emergency Department (Yes/No)? (Page#) EMERGENCY_DEPARTMENT_CAREVEOUT_IND_PGNUMERICFACTIVE
634If the contract includes a carve out for Emergency Department, describe schedule nameEMERGENCY_DEPARTMENT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
635If the contract includes a carve out for Emergency Department, describe reference year or versionEMERGENCY_DEPARTMENT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
636If the contract includes a carve out for Emergency Department, describe describe reimbursement rateEMERGENCY_DEPARTMENT_CARVEOUT_DESCRIBEVARCHARGACTIVE
637Does the contract include a carve out for Observation Codes(Yes/No)?OBSERVATION_CAREVEOUT_INDVARCHARFACTIVE
638Does the contract include a carve out for Observation Codes(Yes/No)? (Page#) OBSERVATION_CAREVEOUT_IND_PGNUMERICFACTIVE
639If the contract includes a carve out for Observation, describe schedule nameOBSERVATION_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
640If the contract includes a carve out for Observation, describe schedule reference year or versionOBSERVATION_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
641If the contract includes a carve out for Observation, describe reimbursement rateOBSERVATION_CARVEOUT_DESCRIBEVARCHARGACTIVE
642Does the contract include a carve out for Ambulatory Surgery (Yes/No)? (Page#) AMBULATORY_SURGERY_CAREVEOUT_IND_PGNUMERICFACTIVE
643If the contract includes a carve out for Ambulatory Surgery, describe schedule nameAMBULATORY_SURGERY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
644If the contract includes a carve out for Ambulatory Surgery, describe schedule reference year or versionAMBULATORY_SURGERY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
645If the contract includes a carve out for Ambulatory Surgery, describe reimbursement rateAMBULATORY_SURGERY_CARVEOUT_DESCRIBEVARCHARGACTIVE
646Does the contract include a carve out for Intensive Care Unit (Yes/No)? (Page#) INTENSIVE_CARE_CAREVEOUT_IND_PGNUMERICFACTIVE
647If the contract includes a carve out for Intensive Care Unit, describe schedule nameINTENSIVE_CARE_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
648If the contract includes a carve out for Intensive Care Unit, describe schedule reference year or versionINTENSIVE_CARE_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
649If the contract includes a carve out for Intensive Care Unit, describe reimbursement rateINTENSIVE_CARE_CARVEOUT_DESCRIBEVARCHARGACTIVE
650Does the contract include a carve out for Trauma (Yes/No)? (Page#) TRAUMA_CAREVEOUT_IND_PGNUMERICFACTIVE
651If the contract includes a carve out for Trauma, describe schedule nameTRAUMA_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
652If the contract includes a carve out for Trauma, describe schedule reference year or versionTRAUMA_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
653If the contract includes a carve out for Trauma, describe reimbursement rateTRAUMA_CARVEOUT_DESCRIBEVARCHARGACTIVE
654Does the contract include a carve out for Cancer (Yes/No)? (Page#) CANCER_CAREVEOUT_IND_PGNUMERICFACTIVE
655If the contract includes a carve out for Cancer, describe schedule nameCANCER_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
656If the contract includes a carve out for Cancer, describe schedule reference year or versionCANCER_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
657If the contract includes a carve out for Cancer, describe reimbursement rateCANCER_CARVEOUT_DESCRIBEVARCHARGACTIVE
658Does the contract include a carve out for HIV (Yes/No)? (Page#) HIV_CAREVEOUT_IND_PGNUMERICFACTIVE
659If the contract includes a carve out for HIV, describe schedule nameHIV_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
660If the contract includes a carve out for HIV, describe schedule reference year or versionHIV_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
661If the contract includes a carve out for HIV, describe reimbursement rateHIV_CARVEOUT_DESCRIBEVARCHARGACTIVE
662Does the contract include a carve out for Major Joint Replacement (Yes/No)? (Page#) JOINT_REPLACE_CAREVEOUT_IND_PGNUMERICFACTIVE
663If the contract includes a carve out for Major Joint Replacement, describe schedule nameJOINT_REPLACE_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
664If the contract includes a carve out for Major Joint Replacement, describe schedule reference year or versionJOINT_REPLACE_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
665If the contract includes a carve out for Major Joint Replacement, describe reimbursement rateJOINT_REPLACE_CARVEOUT_DESCRIBEVARCHARGACTIVE
666Does the contract include a carve out for Transplant (Yes/No)? (Page#) TRANSPLANT_CAREVEOUT_IND_PGNUMERICFACTIVE
667If the contract includes a carve out for Transplant, describe schedule nameTRANSPLANT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
668If the contract includes a carve out for Transplant, describe schedule reference year or versionTRANSPLANT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
669If the contract includes a carve out for Transplant, describe reimbursement rateTRANSPLANT_CARVEOUT_DESCRIBEVARCHARGACTIVE
670Does the contract include a carve out for OB/GYN Services (Yes/No)? (Page#) OBGYN_CAREVEOUT_IND_PGNUMERICFACTIVE
671If the contract includes a carve out for OB/GYN Services, describe schedule nameOBGYN_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
672If the contract includes a carve out for OB/GYN Services, describe schedule reference year or versionOBGYN_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
673If the contract includes a carve out for OB/GYN Services, describe reimbursement rateOBGYN_CARVEOUT_DESCRIBEVARCHARGACTIVE
674If 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_INDVARCHARGACTIVE
675If the contract includes a carve out for OB/GYN Services, describe billed charges reimbursement rateOBGYN_BILLED_CHARGE_REIMBURSEMENT_RATEVARCHARGACTIVE
676If the contract includes a carve out for OB/GYN, describe exceptionsOBGYN_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
677Does the contract include a carve out for Neonatal Services (Yes/No)? (Page#) NEONATAL_CAREVEOUT_IND_PGNUMERICFACTIVE
678If the contract includes a carve out for Neonatal Services, describe schedule nameNEONATAL_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
679If the contract includes a carve out for Neonatal Services, describe schedule reference year or versionNEONATAL_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
680If the contract includes a carve out for Neonatal Services, describe reimbursement rateNEONATAL_CARVEOUT_DESCRIBEVARCHARGACTIVE
681Does the contract include a carve out for Behavioral Health & Substance Abuse Services (Yes/No)? (Page#) BEH_HEALTH_SUB_ABUSE_CAREVEOUT_IND_PGNUMERICFACTIVE
682If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe schedule nameBEH_HEALTH_SUB_ABUSE_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
683If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe schedule reference year or versionBEH_HEALTH_SUB_ABUSE_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
684If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe reimbursement rateBEH_HEALTH_SUB_ABUSE_CARVEOUT_DESCRIBEVARCHARGACTIVE
685Does the contract include a carve out for Ophthalmology & Vision Services (Yes/No)? (Page#) OPHTHAMOLOGY_CAREVEOUT_IND_PGNUMERICFACTIVE
686If the contract includes a carve out for Ophthalmology & Vision Services, describe schedule nameOPHTHAMOLOGY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
687If the contract includes a carve out for Ophthalmology & Vision Services, describe schedule reference year or versionOPHTHAMOLOGY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
688If the contract includes a carve out for Ophthalmology & Vision Services, describe reimbursement rateOPHTHAMOLOGY_CARVEOUT_DESCRIBEVARCHARGACTIVE
689Does the contract include a carve out for never events (Yes/No)? (Page#) NEVER_EVENT_CAREVEOUT_IND_PGNUMERICFACTIVE
690If the contract includes a carve out for never events, describe schedule nameNEVER_EVENT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
691If the contract includes a carve out for never events, describe schedule reference year or versionNEVER_EVENT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
692If the contract includes a carve out for never events, describe reimbursement rateNEVER_EVENT_CARVEOUT_DESCRIBEVARCHARGACTIVE
693Does the contract include a carve out for procedures that are not medically necessary (Yes/No)? (Page#) NOT_MED_NECESSARY_CAREVEOUT_IND_PGNUMERICFACTIVE
694If the contract includes a carve out for procedures that are not medically necessary, describe schedule nameNOT_MED_NECESSARY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
695If the contract includes a carve out for procedures that are not medically necessary, describe schedule reference year or versionNOT_MED_NECESSARY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
696If the contract includes a carve out for procedures that are not medically necessary, describe reimbursement rateNOT_MED_NECESSARY_CARVEOUT_DESCRIBEVARCHARGACTIVE
697Does the contract include a carve out for experimental procedures (Yes/No)? (Page#) EXPERIMENTAL_PROCEDURES_CAREVEOUT_IND_PGNUMERICFACTIVE
698If the contract includes a carve out for experimental procedures, describe schedule nameEXPERIMENTAL_PROCEDURES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
699If the contract includes a carve out for experimental procedures, describe schedule reference year or versionEXPERIMENTAL_PROCEDURES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
700If the contract includes a carve out for experimental procedures, describe reimbursement rateEXPERIMENTAL_PROCEDURES_CARVEOUT_DESCRIBEVARCHARGACTIVE
701Does the contract include a carve out for investigational procedures (Yes/No)? (Page#) INVESTIGATIONAL_PROCEDURES_CAREVEOUT_IND_PGNUMERICFACTIVE
702If the contract includes a carve out for investigational procedures, describe schedule nameINVESTIGATIONAL_PROCEDURES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
703If the contract includes a carve out for investigational procedures, describe schedule reference year or versionINVESTIGATIONAL_PROCEDURES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
704If the contract includes a carve out for investigational procedures, describe reimbursement rateINVESTIGATIONAL_PROCEDURES_CARVEOUT_DESCRIBEVARCHARGACTIVE
705Does the contract include a carve out for Unlisted codes (Yes/No)? (Page#) UNLISTED_CAREVEOUT_IND_PGNUMERICFACTIVE
706If the contract includes a carve out for Unlisted codes, describe schedule nameUNLISTED_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
707If the contract includes a carve out for Unlisted codes, describe schedule reference year or versionUNLISTED_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
708If the contract includes a carve out for Unlisted codes, describe reimbursement rateUNLISTED_CARVEOUT_DESCRIBEVARCHARGACTIVE
709If the contract includes a carve out for Unlisted Codes, describe exceptionsUNLISTED_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
710Does the contract include a carve out for invalid codes (Yes/No)? (Page#) INVALID_CODES_CAREVEOUT_IND_PGNUMERICFACTIVE
711If the contract includes a carve out for invalid codes, describe schedule nameINVALID_CODES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
712If the contract includes a carve out for invalid codes, describe schedule reference year or versionINVALID_CODES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
713If the contract includes a carve out for invalid codes, describe reimbursement rateINVALID_CODES_CARVEOUT_DESCRIBEVARCHARGACTIVE
714Does the contract include a carve out for Durable Medical Equipment (Yes/No)? (Page#) DME_CAREVEOUT_IND_PGNUMERICFACTIVE
715If the contract includes a carve out for Durable Medical Equipment, describe schedule nameDME_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
716If the contract includes a carve out for Durable Medical Equipment, describe schedule reference year or versionDME_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
717If the contract includes a carve out for Durable Medical Equipment, describe reimbursement rateDME_CARVEOUT_DESCRIBEVARCHARGACTIVE
718If the contract includes a carve out for Durable Medical Equipment, describe exceptionsDME_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
719Does the contract include a carve out for prosthetics (Yes/No)? (Page#) PROSTHETICS_CAREVEOUT_IND_PGNUMERICFACTIVE
720If the contract includes a carve out for prosthetics, describe schedule namePROSTHETICS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
721If the contract includes a carve out for prosthetics, describe schedule reference year or versionPROSTHETICS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
722If the contract includes a carve out for prosthetics, describe reimbursement ratePROSTHETICS_CARVEOUT_DESCRIBEVARCHARGACTIVE
723Does the contract include a carve out for implants (Yes/No)? (Page#) IMPLANTS_CAREVEOUT_IND_PGNUMERICFACTIVE
724If the contract includes a carve out for implants, describe schedule nameIMPLANTS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
725If the contract includes a carve out for implants, describe schedule reference year or versionIMPLANTS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
726If the contract includes a carve out for implants, describe reimbursement rateIMPLANTS_CARVEOUT_DESCRIBEVARCHARGACTIVE
727If the contract includes a carve out for implants, describe exceptionsIMPLANTS_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
728Does the contract include a carve out for Hearing Aids & Hearing Services (Yes/No)? (Page#) HEARING_AID_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
729If the contract includes a carve out for Hearing Aids & Hearing Services, describe schedule nameHEARING_AID_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
730If the contract includes a carve out for Hearing Aids & Hearing Services, describe schedule reference year or versionHEARING_AID_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
731If the contract includes a carve out for Hearing Aids & Hearing Services, describe reimbursement rateHEARING_AID_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
732Does the contract include a carve out for anesthesia (Yes/No)? (Page#) ANESTHESIA_CAREVEOUT_IND_PGNUMERICFACTIVE
733If the contract includes a carve out for anesthesia, describe schedule nameANESTHESIA_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
734If the contract includes a carve out for anesthesia, describe schedule reference year or versionANESTHESIA_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
735If the contract includes a carve out for anesthesia, describe reimbursement rateANESTHESIA_CARVEOUT_DESCRIBEVARCHARGACTIVE
736If the contract includes a carve out for anesthesia, is there a lesser of billed charges clause? (Yes/No)ANESTHESIA_CARVEOUT_LESSER_OF_BILLED_INDVARCHARGACTIVE
737If the contract includes a carve out for anesthesia, describe billed charges reimbursement rateANESTHESIA_BILLED_CHARGE_REIMBURSEMENT_RATEVARCHARGACTIVE
738Does the contract include a carve out for medical pharmacy and/or physician administered drugs (Yes/No)? (Page#) ADMINISTERED_DRUGS_CAREVEOUT_IND_PGNUMERICFACTIVE
739If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe schedule nameADMINISTERED_DRUGS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
740If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe schedule reference year or versionADMINISTERED_DRUGS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
741If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe reimbursement rateADMINISTERED_DRUGS_CARVEOUT_DESCRIBEVARCHARGACTIVE
742If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe exceptionsADMINISTERED_DRUGS_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
743If 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_INDVARCHARGACTIVE
744If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe billed charges reimbursement rateADMINISTERED_DRUGS_BILLED_CHARGE_REIMBURSEMENT_RATEVARCHARGACTIVE
745Does the contract include a carve out for global services (Yes/No)? (Page#) GLOBAL_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
746If the contract includes a carve out for global services, describe schedule nameGLOBAL_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
747If the contract includes a carve out for global services, describe schedule reference year or versionGLOBAL_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
748If the contract includes a carve out for global services, describe reimbursement rateGLOBAL_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
749Does the contract include a carve out for bundled or unbundled codes (e.g., bundling, unbundling) (Yes/No)? (Page#) BUNDLED_UNBUNDLED_CAREVEOUT_IND_PGNUMERICFACTIVE
750If the contract includes a carve out for bundling or unbundling, describe schedule nameBUNDLED_UNBUNDLED_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
751If the contract includes a carve out for bundling or unbundling, describe schedule reference year or versionBUNDLED_UNBUNDLED_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
752If the contract includes a carve out for bundling or unbundling, describe reimbursement rateBUNDLED_UNBUNDLED_CARVEOUT_DESCRIBEVARCHARGACTIVE
753Does the contract include a carve out for Multiple Procedure Reductions (i.e., discounted procedures) (Yes/No)? (Page#) MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_IND_PGNUMERICFACTIVE
754If the contract includes a carve out for Multiple Procedure Reductions, describe schedule nameMULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
755If the contract address Multiple Procedure Reductions, describe schedule reference year or versionMULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
756If the contract includes a carve out for Multiple Procedure Reductions, describe reimbursement rateMULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_DESCRIBEVARCHARGACTIVE
757Does the contract include a carve out for second surgeries and/or procedures (Yes/No)? (Page#) SECOND_SURGERIES_CAREVEOUT_IND_PGNUMERICFACTIVE
758If the contract includes a carve out for second surgeries and/or procedures, describe schedule nameSECOND_SURGERIES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
759If the contract includes a carve out for second surgeries and/or procedures, describe schedule reference year or versionSECOND_SURGERIES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
760If the contract includes a carve out for second surgeries and/or procedures, describe reimbursement rateSECOND_SURGERIES_CARVEOUT_DESCRIBEVARCHARGACTIVE
761Does the contract include a carve out for subsequent surgeries and/or procedures (Yes/No)? (Page#) SUBSEQUENT_SURGERIES_CAREVEOUT_IND_PGNUMERICFACTIVE
762If the contract includes a carve out for subsequent surgeries and/or procedures, describe schedule nameSUBSEQUENT_SURGERIES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
763If the contract includes a carve out for subsequent surgeries and/or procedures, describe schedule reference year or versionSUBSEQUENT_SURGERIES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
764If the contract includes a carve out for subsequent surgeries and/or procedures, describe reimbursement rateSUBSEQUENT_SURGERIES_CARVEOUT_DESCRIBEVARCHARGACTIVE
765Does the contract include a carve out for Mid-Level Professionals (Yes/No)? (Page#) MID_LEVEL_PROFESSIONAL_CAREVEOUT_IND_PGNUMERICFACTIVE
766If the contract includes a carve out for Mid-Level Professionals, describe schedule nameMID_LEVEL_PROFESSIONAL_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
767If the contract includes a carve out for Mid-Level Professionals, describe schedule reference year or versionMID_LEVEL_PROFESSIONAL_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
768If the contract includes a carve out for Mid-Level Professionals, describe reimbursement rateMID_LEVEL_PROFESSIONAL_CARVEOUT_DESCRIBEVARCHARGACTIVE
769Does the contract include a carve out for Technical Component (Yes/No)? (Page#) TECHNICAL_COMPONENT_CAREVEOUT_IND_PGNUMERICFACTIVE
770If the contract includes a carve out for Technical Component, describe schedule nameTECHNICAL_COMPONENT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
771If the contract includes a carve out for Technical Component, describe schedule reference year or versionTECHNICAL_COMPONENT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
772If the contract includes a carve out for Technical Component, describe reimbursement rateTECHNICAL_COMPONENT_CARVEOUT_DESCRIBEVARCHARGACTIVE
773Does the contract include a carve out for Professional Component (Yes/No)? (Page#) PROFESSIONAL_COMPONENT_CAREVEOUT_IND_PGNUMERICFACTIVE
774If the contract includes a carve out for Professional Component, describe schedule namePROFESSIONAL_COMPONENT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
775If the contract includes a carve out for Professional Component, describe schedule reference year or versionPROFESSIONAL_COMPONENT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
776If the contract includes a carve out for Professional Component, describe reimbursement ratePROFESSIONAL_COMPONENT_CARVEOUT_DESCRIBEVARCHARGACTIVE
777Does the contract include a carve out for Laboratory / Pathology (Yes/No)? (Page#) LAB_PATHOLOGY_CAREVEOUT_IND_PGNUMERICFACTIVE
778If the contract includes a carve out for Laboratory / Pathology , describe schedule nameLAB_PATHOLOGY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
779If the contract includes a carve out for Laboratory / Pathology , describe schedule reference year or versionLAB_PATHOLOGY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
780If the contract includes a carve out for Laboratory / Pathology , describe reimbursement rateLAB_PATHOLOGY_CARVEOUT_DESCRIBEVARCHARGACTIVE
781If 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_INDVARCHARGACTIVE
782If the contract includes a carve out for Laboratory / Pathology , describe billed charges reimbursement rateLAB_PATHOLOGY_BILLED_CHARGE_REIMBURSEMENT_RATEVARCHARGACTIVE
783If the contract includes a carve out for Laboratory / Pathology , describe exceptionsLAB_PATHOLOGY_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
784Does the contract include a carve out for Radiology/Imaging Services (Yes/No)? (Page#) RADIOLOGY_IMAGING_CAREVEOUT_IND_PGNUMERICFACTIVE
785If the contract includes a carve out for Radiology/Imaging Services, describe schedule nameRADIOLOGY_IMAGING_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
786If the contract includes a carve out for Radiology/Imaging Services, describe schedule reference year or versionRADIOLOGY_IMAGING_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
787If the contract includes a carve out for Radiology/Imaging Services, describe reimbursement rateRADIOLOGY_IMAGING_CARVEOUT_DESCRIBEVARCHARGACTIVE
788If the contract includes a carve out for Radiology / Imaging , describe exceptionsRADIOLOGY_IMAGING_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
789Does the contract include a carve out for diagnostic services (Yes/No)? (Page#) DIAGNOSTIC_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
790If the contract includes a carve out for diagnostic services, describe schedule nameDIAGNOSTIC_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
791If the contract includes a carve out for diagnostic services, describe schedule reference year or versionDIAGNOSTIC_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
792If the contract includes a carve out for diagnostic services, describe reimbursement rateDIAGNOSTIC_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
793Does the contract include a carve out for pre-admission procedures (Yes/No)? (Page#) PREADMISSION_PROC_CAREVEOUT_IND_PGNUMERICFACTIVE
794If the contract includes a carve out for pre-admission procedures, describe schedule namePREADMISSION_PROC_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
795If the contract includes a carve out for pre-admissions procedures, describe schedule reference year or versionPREADMISSION_PROC_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
796If the contract includes a carve out for pre-admission procedures, describe reimbursement ratePREADMISSION_PROC_CARVEOUT_DESCRIBEVARCHARGACTIVE
797Does the contract include a carve out for post-discharge procedures (Yes/No)? (Page#) POSTDISCHARGE_PROC_CAREVEOUT_IND_PGNUMERICFACTIVE
798If the contract includes a carve out for post-discharge procedures, describe schedule namePOSTDISCHARGE_PROC_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
799If the contract includes a carve out for post-discharge procedures, describe schedule reference year or versionPOSTDISCHARGE_PROC_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
800If the contract includes a carve out for post-discharge procedures, describe reimbursement ratePOSTDISCHARGE_PROC_CARVEOUT_DESCRIBEVARCHARGACTIVE
801Does the contract include a carve out for readmissions (Yes/No)? (Page#) READMISSIONS_CAREVEOUT_IND_PGNUMERICFACTIVE
802If the contract includes a carve out for readmissions, describe schedule nameREADMISSIONS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
803If the contract includes a carve out for readmissions, describe schedule reference year or versionREADMISSIONS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
804If the contract includes a carve out for readmissions, describe reimbursement rateREADMISSIONS_CARVEOUT_DESCRIBEVARCHARGACTIVE
805Does the contract include a carve out for certain Status Indicators (Yes/No)? (Page#) STATUS_INDICATORS_CAREVEOUT_IND_PGNUMERICFACTIVE
806If the contract includes a carve out for certain Status Indicators, describe schedule nameSTATUS_INDICATORS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
807If the contract includes a carve out for certain Status Indicators, describe schedule reference year or versionSTATUS_INDICATORS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
808If the contract includes a carve out for certain Status Indicators, describe reimbursement rateSTATUS_INDICATORS_CARVEOUT_DESCRIBEVARCHARGACTIVE
809Does the contract include a carve out for outlier provisions (Yes/No)? (Page#) OUTLIER_PROVISIONS_CAREVEOUT_IND_PGNUMERICFACTIVE
810If the contract includes a carve out for outlier provisions, describe schedule nameOUTLIER_PROVISIONS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
811If the contract includes a carve out for outlier provisions, describe schedule reference year or versionOUTLIER_PROVISIONS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
812If the contract includes a carve out for outlier provisions, describe reimbursement rateOUTLIER_PROVISIONS_CARVEOUT_DESCRIBEVARCHARGACTIVE
813If contract includes a carve out for outlier provisions, describe exceptionsOUTLIER_PROVISIONS_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
814OUTLIER FIELDS TO BE POPULATED VARCHARNoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
815OUTLIER FIELDS TO BE POPULATED (Page#) VARCHAR
816Does the contact include a carve out for stop loss (Yes/No)? (Page#) STOP_LOSS_CAREVEOUT_IND_PGNUMERICFACTIVE
817If the contract includes a carve out for stop loss, what are the EMS Trauma codes?STOP_LOSS_CARVEOUT_EMS_TRAUMA_CODESVARIANTGACTIVE
818If the contract includes a carve out for stop loss, what are the EMS Trauma rates?STOP_LOSS_CARVEOUT_EMS_TRAUMA_RATESVARIANTGACTIVE
819STOP LOSS FIELDS TO BE POPULATED VARCHARNoFrom LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, RiderCarve OutsRequired Only If Available PAYMENT ACCURACY NETWORK
820STOP LOSS FIELDS TO BE POPULATED (Page#) VARCHAR
821Does the contract include other Vaccine for Children carve outs (Yes/No)? (Page#) VACCINE_CHILDREN_CAREVEOUT_IND_PGNUMERICFACTIVE
822If the contract includes Vaccine for Children carve outs, describe schedule nameVACCINE_CHILDREN_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
823If the contract includes Vaccine for Children client-specific carve outs, describe schedule reference year or versionVACCINE_CHILDREN_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
824If the contract includes Vaccine for Children carve outs, describe reimbursement rateVACCINE_CHILDREN_CARVEOUT_DESCRIBEVARCHARGACTIVE
825Does the contract include Surgical Assist/Assistant carve outs (Yes/No)? (Page#) SURGICAL_ASSIST_CAREVEOUT_IND_PGNUMERICFACTIVE
826If the contract includes Surgical Assist/Assistant carve outs, describe how these codes are reimbursedSURGICAL_ASSIST_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
827If the contract includes Surgical Assist/Assistant carve outs, describe schedule nameSURGICAL_ASSIST_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
828If the contract includes Surgical Assist/Assistant carve outs, describe schedule reference year or versionSURGICAL_ASSIST_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
829If the contract includes Surgical Assist/Assistant carve outs, describe reimbursement rateSURGICAL_ASSIST_CARVEOUT_DESCRIBEVARCHARGACTIVE
830If the contract includes other client-specific carve outs, describe how these codes are reimbursed (Page#) VARCHARINACTIVE
831Does the contract include Physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs (Yes/No)? (Page#) PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_IND_PGNUMERICFACTIVE
832If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe schedule namePHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
833If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe schedule reference year or versionPHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
834If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe reimbursement ratePHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_DESCRIBEVARCHARGACTIVE
835Does the contract include Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs)carve outs (Yes/No)? (Page#) AUDIO_CHIRO_DIETICIAN_CAREVEOUT_IND_PGNUMERICFACTIVE
836If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe schedule nameAUDIO_CHIRO_DIETICIAN_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
837If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe schedule reference year or versionAUDIO_CHIRO_DIETICIAN_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
838If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe reimbursement rateAUDIO_CHIRO_DIETICIAN_CARVEOUT_DESCRIBEVARCHARGACTIVE
839Does the contract include Board Certified Behavioral Analyst (BCBA) carve outs (Yes/No)? (Page#) CERT_BH_ANALYST_CAREVEOUT_IND_PGNUMERICFACTIVE
840If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe schedule nameCERT_BH_ANALYST_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
841If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe schedule reference year or versionCERT_BH_ANALYST_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
842If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe reimbursement rateCERT_BH_ANALYST_CARVEOUT_DESCRIBEVARCHARGACTIVE
843Does the contract include Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs (Yes/No)? (Page#) INDEPENDENT_LICENSURES_CAREVEOUT_IND_PGNUMERICFACTIVE
844If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe schedule nameINDEPENDENT_LICENSURES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
845If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe schedule reference year or versionINDEPENDENT_LICENSURES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
846If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe reimbursement rateINDEPENDENT_LICENSURES_CARVEOUT_DESCRIBEVARCHARGACTIVE
847Does the contract include Behavioral Health Outpatient Clinics/Integrated Clinics carve outs (Yes/No)? (Page#) BH_OP_CLINICS_CAREVEOUT_IND_PGNUMERICFACTIVE
848If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe schedule nameBH_OP_CLINICS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
849If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe schedule reference year or versionBH_OP_CLINICS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
850If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe reimbursement rateBH_OP_CLINICS_CARVEOUT_DESCRIBEVARCHARGACTIVE
851Does the contract include Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs (Yes/No)? (Page#) POS_THERAPISTS_CAREVEOUT_IND_PGNUMERICFACTIVE
852If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe schedule namePOS_THERAPISTS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
853If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe schedule reference year or versionPOS_THERAPISTS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
854If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe reimbursement ratePOS_THERAPISTS_CARVEOUT_DESCRIBEVARCHARGACTIVE
855Does the contract include Transportation Services carve outs (Yes/No)? (Page#) TRANSPORTATION_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
856If the contract includes Transportation Services carve outs, describe schedule nameTRANSPORTATION_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
857If the contract includes Transportation Services carve outs, describe schedule reference year or versionTRANSPORTATION_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
858If the contract includes Transportation Services carve outs, describe reimbursement rateTRANSPORTATION_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
859Does the contract include PCP - Medical carve outs (Yes/No)?PCP_MEDICAL_CAREVEOUT_INDVARCHARFACTIVE
860Does the contract include PCP - Medical carve outs (Yes/No)? (Page#) PCP_MEDICAL_CAREVEOUT_IND_PGNUMERICFACTIVE
861If the contract includes PCP - Medical carve outs, list the applicable codes or code ranges PCP_MEDICAL_CAREVOUT_CODESVARCHARFACTIVE
862If the contract includes PCP - Medical carve outs, describe how these codes are reimbursedPCP_MEDICAL_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
863If the contract includes PCP - Medical carve outs, describe schedule namePCP_MEDICAL_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
864If the contract includes PCP - Medical carve outs, describe schedule reference year or versionPCP_MEDICAL_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
865If the contract includes PCP - Medical carve outs, describe reimbursement ratePCP_MEDICAL_CARVEOUT_DESCRIBEVARCHARGACTIVE
866Does the contract include PCP - BH carve outs (Yes/No)?PCP_BH_CAREVEOUT_INDVARCHARINACTIVE
867Does the contract include PCP - BH carve outs (Yes/No)? (Page#) PCP_BH_CAREVEOUT_IND_PGNUMERICINACTIVE
868If the contract includes PCP - BH carve outs, list the applicable codes or code ranges PCP_BH_CAREVOUT_CODESVARCHARINACTIVE
869If the contract includes PCP - BH carve outs, describe how these codes are reimbursedPCP_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARINACTIVE
870If the contract includes PCP - BH carve outs, describe schedule namePCP_BH_CARVEOUT_SCHEDULE_NAMEVARCHARINACTIVE
871If the contract includes PCP - BH carve outs, describe schedule reference year or versionPCP_BH_CAREVEOUT_SCHEDULE_VERSIONVARCHARINACTIVE
872If the contract includes PCP - BH carve outs, describe reimbursement ratePCP_BH_CARVEOUT_DESCRIBEVARCHARINACTIVE
873Does 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_INDVARCHARINACTIVE
874If 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_CODESVARCHARINACTIVE
875If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe how these codes are reimbursedBH_MID_LEVEL_PRACTIONER_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARINACTIVE
876If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe schedule nameBH_MID_LEVEL_PRACTIONER_CARVEOUT_SCHEDULE_NAMEVARCHARINACTIVE
877If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe schedule reference year or versionBH_MID_LEVEL_PRACTIONER_CAREVEOUT_SCHEDULE_VERSIONVARCHARINACTIVE
878If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe reimbursement rateBH_MID_LEVEL_PRACTIONER_CARVEOUT_DESCRIBEVARCHARINACTIVE
879Does the contract include Mid-Level - BH carve outs (Yes/No)?BH_MID_LEVEL_PRACTIONER_CARVEOUT_DESCRIBEVARCHARINACTIVE
880Does the contract include Mid-Level - BH carve outs (Yes/No)? (Page#) VARCHARINACTIVE
881If the contract includes Mid-Level - BH carve outs, list the applicable codes or code ranges VARCHARINACTIVE
882If the contract includes Mid-Level - BH carve outs, describe how these codes are reimbursedVARCHARINACTIVE
883If the contract includes Mid-Level - BH carve outs, describe schedule nameVARCHARINACTIVE
884If the contract includes Mid-Level - BH carve outs, describe schedule reference year or versionVARCHARINACTIVE
885If the contract includes Mid-Level - BH carve outs, describe reimbursement rateVARCHARINACTIVE
886Does the contract include BCBA - BH carve outs (Yes/No)?BCBA_BH_CAREVEOUT_INDVARCHARFACTIVE
887Does the contract include BCBA - BH carve outs (Yes/No)? (Page#) BCBA_BH_CAREVEOUT_IND_PGNUMERICFACTIVE
888If the contract includes BCBA - BH carve outs, list the applicable codes or code ranges BCBA_BH_CAREVOUT_CODESVARCHARFACTIVE
889If the contract includes BCBA - BH carve outs, describe how these codes are reimbursedBCBA_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
890If the contract includes BCBA - BH carve outs, describe schedule nameBCBA_BH_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
891If the contract includes BCBA - BH carve outs, describe schedule reference year or versionBCBA_BH_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
892If the contract includes BCBA - BH carve outs, describe reimbursement rateBCBA_BH_CARVEOUT_DESCRIBEVARCHARGACTIVE
893Does the contract include Independent Licensures - BH carve outs (Yes/No)?INDEPENDENT_LICENSURES_BH_CAREVEOUT_INDVARCHARINACTIVE
894Does the contract include Independent Licensures - BH carve outs (Yes/No)? (Page#) INDEPENDENT_LICENSURES_BH_CAREVEOUT_IND_PGNUMERICINACTIVE
895If the contract includes Independent Licensures - BH carve outs, list the applicable codes or code ranges INDEPENDENT_LICENSURES_BH_CAREVOUT_CODESVARCHARINACTIVE
896If the contract includes Independent Licensures - BH carve outs, describe how these codes are reimbursedINDEPENDENT_LICENSURES_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARINACTIVE
897If the contract includes Independent Licensures - BH carve outs, describe schedule nameINDEPENDENT_LICENSURES_BH_CARVEOUT_SCHEDULE_NAMEVARCHARINACTIVE
898If the contract includes Independent Licensures - BH carve outs, describe schedule reference year or versionINDEPENDENT_LICENSURES_BH_CAREVEOUT_SCHEDULE_VERSIONVARCHARINACTIVE
899If the contract includes Independent Licensures - BH carve outs, describe reimbursement rateINDEPENDENT_LICENSURES_BH_CARVEOUT_DESCRIBEVARCHARINACTIVE
900Does the contract include Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs (Yes/No)?VARCHARINACTIVE
901Does the contract include Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs (Yes/No)? (Page#) VARCHARINACTIVE
902If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, list the applicable codes or code ranges VARCHARINACTIVE
903If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe how these codes are reimbursedVARCHARINACTIVE
904If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe schedule nameVARCHARINACTIVE
905If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe schedule reference year or versionVARCHARINACTIVE
906If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe reimbursement rateVARCHARINACTIVE
907Does the contract include Physicians/Clinical Psychologists - BH carve outs (Yes/No)?VARCHARINACTIVE
908Does the contract include Physicians/Clinical Psychologists - BH carve outs (Yes/No)? (Page#) VARCHARINACTIVE
909If the contract includes Physicians/Clinical Psychologists - BH carve outs, list the applicable codes or code ranges VARCHARINACTIVE
910If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe how these codes are reimbursedVARCHARINACTIVE
911If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe schedule nameVARCHARINACTIVE
912If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe schedule reference year or versionVARCHARINACTIVE
913If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe reimbursement rateVARCHARINACTIVE
914Does the contract include Dentist carve outs (Yes/No)?DENTIST_CAREVEOUT_INDVARCHARFACTIVE
915Does the contract include Dentist carve outs (Yes/No)? (Page#) DENTIST_CAREVEOUT_IND_PGNUMERICFACTIVE
916If the contract includes Dentist carve outs, list the applicable codes or code ranges DENTIST_CAREVOUT_CODESVARCHARFACTIVE
917If the contract includes Dentist carve outs, describe how these codes are reimbursedDENTIST_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
918If the contract includes Dentist carve outs, describe schedule nameDENTIST_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
919If the contract includes Dentist carve outs, describe schedule reference year or versionDENTIST_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
920If the contract includes Dentist carve outs, describe reimbursement rateDENTIST_CARVEOUT_DESCRIBEVARCHARGACTIVE
921Does the contract include Supplies and Devices carve outs (Yes/No)?SUPPLIES_DEVICES_CAREVEOUT_INDVARCHARFACTIVE
922Does the contract include Supplies and Devices carve outs (Yes/No)? (Page#) SUPPLIES_DEVICES_CAREVEOUT_IND_PGNUMERICFACTIVE
923If the contract includes Supplies and Devices carve outs, list the applicable codes or code ranges SUPPLIES_DEVICES_CAREVOUT_CODESVARCHARFACTIVE
924If the contract includes Supplies and Devices carve outs, describe how these codes are reimbursedSUPPLIES_DEVICES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
925If the contract includes Supplies and Devices carve outs, describe schedule nameSUPPLIES_DEVICES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
926If the contract includes Supplies and Devices carve outs, describe schedule reference year or versionSUPPLIES_DEVICES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
927If the contract includes Supplies and Devices carve outs, describe reimbursement rateSUPPLIES_DEVICES_CARVEOUT_DESCRIBEVARCHARGACTIVE
928If the contract includes Supplies and Devices carve outs, is there a lesser of billed charges clause? (Yes/No)SUPPLIES_DEVICES_CARVEOUT_LESSER_OF_BILLED_INDVARCHARGACTIVE
929If the contract includes Supplies and Devices carve outs, describe billed charges reimbursement rateSUPPLIES_DEVICES_BILLED_CHARGE_REIMBURSEMENT_RATEVARCHARGACTIVE
930Does the contract include Immunizations carve outs (Yes/No)?IMMUNIZATION_CAREVEOUT_INDVARCHARFACTIVE
931Does the contract include Immunizations carve outs (Yes/No)? (Page#) IMMUNIZATION_CAREVEOUT_IND_PGNUMERICFACTIVE
932If the contract includes Immunizations carve outs, list the applicable codes or code ranges IMMUNIZATION_CAREVOUT_CODESVARCHARFACTIVE
933If the contract includes Immunizations carve outs, describe how these codes are reimbursedIMMUNIZATION_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
934If the contract includes Immunizations carve outs, describe schedule nameIMMUNIZATION_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
935If the contract includes Immunizations carve outs, describe schedule reference year or versionIMMUNIZATION_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
936If the contract includes Immunizations carve outs, describe reimbursement rateIMMUNIZATION_CARVEOUT_DESCRIBEVARCHARGACTIVE
937If the contract includes Immunizations carve outs, is there a lesser of billed charges clause? (Yes/No)IMMUNIZATION_CARVEOUT_LESSER_OF_BILLED_INDVARCHARGACTIVE
938If the contract includes Immunizations carve outs, describe billed charges reimbursement rateIMMUNIZATION_BILLED_CHARGE_REIMBURSEMENT_RATEVARCHARGACTIVE
939If the contract includes a carve out for immunizations, describe exceptionsIMMUNIZATION_CARVEOUT_DESCRIBE_EXCEPTIONSVARCHARGACTIVE
940Does the contract include OB Epidural carve outs (Yes/No)?OB_EPIDURAL_CAREVEOUT_INDVARCHARFACTIVE
941If the contract includes OB Epidural carve outs, list the applicable codes or code ranges OB_EPIDURAL_CAREVOUT_CODESVARCHARFACTIVE
942If the contract includes OB Epidural carve outs, describe how these codes are reimbursedOB_EPIDURAL_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
943If the contract includes OB Epidural carve outs, describe schedule nameOB_EPIDURAL_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
944If the contract includes OB Epidural carve outs, describe schedule reference year or versionOB_EPIDURAL_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
945If the contract includes OB Epidural carve outs, describe reimbursement rateOB_EPIDURAL_CARVEOUT_DESCRIBEVARCHARGACTIVE
946Does the contract include Pediatric Subspecialties carve outs (Yes/No)?PEDIATRIC_SUBSPECIALTY_CAREVEOUT_INDVARCHARFACTIVE
947Does the contract include Pediatric Subspecialties carve outs (Yes/No)? (Page#) PEDIATRIC_SUBSPECIALTY_CAREVEOUT_IND_PGNUMERICFACTIVE
948If the contract includes Pediatric Subspecialties carve outs, list the applicable codes or code ranges PEDIATRIC_SUBSPECIALTY_CAREVOUT_CODESVARCHARFACTIVE
949If the contract includes Pediatric Subspecialties carve outs, describe how these codes are reimbursedPEDIATRIC_SUBSPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
950If the contract includes Pediatric Subspecialties carve outs, describe schedule namePEDIATRIC_SUBSPECIALTY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
951If the contract includes Pediatric Subspecialties carve outs, describe schedule reference year or versionPEDIATRIC_SUBSPECIALTY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
952If the contract includes Pediatric Subspecialties carve outs, describe reimbursement ratePEDIATRIC_SUBSPECIALTY_CARVEOUT_DESCRIBEVARCHARGACTIVE
953Does the contract include Neurosurgery Subspecialties carve outs (Yes/No)?NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_INDVARCHARFACTIVE
954Does the contract include Neurosurgery Subspecialties carve outs (Yes/No)? (Page#) NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_IND_PGNUMERICFACTIVE
955If the contract includes Neurosurgery Subspecialties carve outs, list the applicable codes or code ranges NEUROSURGEY_SUBSPECIALTY_CAREVOUT_CODESVARCHARFACTIVE
956If the contract includes Neurosurgery Subspecialties carve outs, describe how these codes are reimbursedNEUROSURGEY_SUBSPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
957If the contract includes Neurosurgery Subspecialties carve outs, describe schedule nameNEUROSURGEY_SUBSPECIALTY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
958If the contract includes Neurosurgery Subspecialties carve outs, describe schedule reference year or versionNEUROSURGEY_SUBSPECIALTY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
959If the contract includes Neurosurgery Subspecialties carve outs, describe reimbursement rateNEUROSURGEY_SUBSPECIALTY_CARVEOUT_DESCRIBEVARCHARGACTIVE
960Does the contract include Orthopedic Surgery subspecialties carve outs (Yes/No)?ORTHOPEDIC_SURGERY_CAREVEOUT_INDVARCHARFACTIVE
961Does the contract include Orthopedic Surgery subspecialties carve outs (Yes/No)? (Page#) ORTHOPEDIC_SURGERY_CAREVEOUT_IND_PGNUMERICFACTIVE
962If the contract includes Orthopedic Surgery subspecialties carve outs, list the applicable codes or code ranges ORTHOPEDIC_SURGERY_CAREVOUT_CODESVARCHARFACTIVE
963If the contract includes Orthopedic Surgery subspecialties carve outs, describe how these codes are reimbursedORTHOPEDIC_SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
964If the contract includes Orthopedic Surgery subspecialties carve outs, describe schedule nameORTHOPEDIC_SURGERY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
965If the contract includes Orthopedic Surgery subspecialties carve outs, describe schedule reference year or versionORTHOPEDIC_SURGERY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
966If the contract includes Orthopedic Surgery subspecialties carve outs, describe reimbursement rateORTHOPEDIC_SURGERY_CARVEOUT_DESCRIBEVARCHARGACTIVE
967Does the contract include All Other Specialists carve outs (Yes/No)?ALL_OTHER_SPECIALTY_CAREVEOUT_INDVARCHARFACTIVE
968Does the contract include All Other Specialists carve outs (Yes/No)? (Page#) ALL_OTHER_SPECIALTY_CAREVEOUT_IND_PGNUMERICFACTIVE
969If the contract includes All Other Specialists carve outs, list the applicable codes or code ranges ALL_OTHER_SPECIALTY_CAREVOUT_CODESVARCHARFACTIVE
970If the contract includes All Other Specialists carve outs, describe how these codes are reimbursedALL_OTHER_SPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
971If the contract includes All Other Specialists carve outs, describe schedule nameALL_OTHER_SPECIALTY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
972If the contract includes All Other Specialists carve outs, describe schedule reference year or versionALL_OTHER_SPECIALTY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
973If the contract includes All Other Specialists carve outs, describe reimbursement rateALL_OTHER_SPECIALTY_CARVEOUT_DESCRIBEVARCHARGACTIVE
974Does the contract include Pediatric Primary Care Physicians carve outs (Yes/No)?PEDIATRIC_PCP_CAREVEOUT_INDVARCHARFACTIVE
975Does the contract include Pediatric Primary Care Physicians carve outs (Yes/No)? (Page#) PEDIATRIC_PCP_CAREVEOUT_IND_PGNUMERICFACTIVE
976If the contract includes Pediatric Primary Care Physicians carve outs, list the applicable codes or code ranges PEDIATRIC_PCP_CAREVOUT_CODESVARCHARFACTIVE
977If the contract includes Pediatric Primary Care Physicians carve outs, describe how these codes are reimbursedPEDIATRIC_PCP_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
978If the contract includes Pediatric Primary Care Physicians carve outs, describe schedule namePEDIATRIC_PCP_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
979If the contract includes Pediatric Primary Care Physicians carve outs, describe schedule reference year or versionPEDIATRIC_PCP_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
980If the contract includes Pediatric Primary Care Physicians carve outs, describe reimbursement ratePEDIATRIC_PCP_CARVEOUT_DESCRIBEVARCHARGACTIVE
981Does the contract include Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs (Yes/No)?ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_INDVARCHARFACTIVE
982Does the contract include Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs (Yes/No)? (Page#) ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
983If the contract includesMedical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, list the applicable codes or code ranges ANESTHESIOLOGY_RN_SVCS_CAREVOUT_CODESVARCHARFACTIVE
984If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe how these codes are reimbursedANESTHESIOLOGY_RN_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
985If the contract includesMedical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe schedule nameANESTHESIOLOGY_RN_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
986If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe schedule reference year or versionANESTHESIOLOGY_RN_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
987If the contract includesMedical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe reimbursement rateANESTHESIOLOGY_RN_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
988Does the contract include EPSDT carve outs (Yes/No)?EPSDT_CAREVEOUT_INDVARCHARFACTIVE
989Does the contract include EPSDT carve outs (Yes/No)? (Page#) EPSDT_CAREVEOUT_IND_PGNUMERICFACTIVE
990If the contract includes EPSDT carve outs, list the applicable codes or code ranges EPSDT_CAREVOUT_CODESVARCHARFACTIVE
991If the contract includes EPSDT carve outs, describe how these codes are reimbursedEPSDT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
992If the contract includes EPSDT carve outs, describe schedule nameEPSDT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
993If the contract includes EPSDT carve outs, describe schedule reference year or versionEPSDT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
994If the contract includes EPSDT carve outs, describe reimbursement rateEPSDT_CARVEOUT_DESCRIBEVARCHARGACTIVE
995Does the contract include Ancillary carveout to professional contract (Yes/No)?ANCILLARY_CAREVEOUT_INDVARCHARFACTIVE
996Does the contract include Ancillary carveout to professional contract (Yes/No)? (Page#) ANCILLARY_CAREVEOUT_IND_PGNUMERICFACTIVE
997If the contract includes Ancillary carveout to professional contract, list the applicable codes or code ranges ANCILLARY_CAREVOUT_CODESVARCHARFACTIVE
998If the contract includes Ancillary carveout to professional contract, describe how these codes are reimbursedANCILLARY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
999If the contract includes Ancillary carveout to professional contract, describe schedule nameANCILLARY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1000If the contract includes Ancillary carveout to professional contract, describe schedule reference year or versionANCILLARY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1001If the contract includes Ancillary carveout to professional contract, describe reimbursement rateANCILLARY_CARVEOUT_DESCRIBEVARCHARGACTIVE
1002Does the contract include Physician Assistant and Nurse Practitioner carve outs (Yes/No)?PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_INDVARCHARFACTIVE
1003Does the contract include Physician Assistant and Nurse Practitioner carve outs (Yes/No)? (Page#) PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_IND_PGNUMERICFACTIVE
1004If the contract includes Physician Assistant and Nurse Practitioner carve outs, list the applicable codes or code ranges PHYASSISTANT_RNPRACTITIONER_CAREVOUT_CODESVARCHARFACTIVE
1005If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe how these codes are reimbursedPHYASSISTANT_RNPRACTITIONER_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1006If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe schedule namePHYASSISTANT_RNPRACTITIONER_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1007If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe schedule reference year or versionPHYASSISTANT_RNPRACTITIONER_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1008If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe reimbursement ratePHYASSISTANT_RNPRACTITIONER_CARVEOUT_DESCRIBEVARCHARGACTIVE
1009Does the contract include a carve out for Oncology Services (Yes/No)?ONCOLOGY_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1010Does the contract include a carve out for Oncology Services (Yes/No)? (Page#) ONCOLOGY_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1011If the contract includes a carve out for Oncology Services, list the applicable codes or code ranges ONCOLOGY_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1012If the contract includes a carve out for Oncology Services, describe how these codes are reimbursedONCOLOGY_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1013If the contract includes a carve out for Oncology Services, describe schedule nameONCOLOGY_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1014If the contract includes a carve out for Oncology Services, describe reference year or versionONCOLOGY_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1015If the contract includes a carve out for Oncology Services, describe reimbursement rateONCOLOGY_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1016Does the contract include a carve out for Rehabilitation Services (Yes/No)?REHABILITATION_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1017Does the contract include a carve out for Rehabilitation Services (Yes/No)? (Page#) REHABILITATION_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1018If the contract includes a carve out for Rehabilitation Services , list the applicable codes or code ranges REHABILITATION_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1019If the contract includes a carve out for Rehabilitation Services, describe how these codes are reimbursedREHABILITATION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1020If the contract includes a carve out for Rehabilitation Services , describe schedule nameREHABILITATION_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1021If the contract includes a carve out for Rehabilitation Services, describe reference year or versionREHABILITATION_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1022If the contract includes a carve out for Rehabilitation Services, describe describe reimbursement rateREHABILITATION_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1023Does the contract include a carve out for Surgery (Yes/No)?SURGERY_CAREVEOUT_INDVARCHARFACTIVE
1024Does the contract include a carve out for Surgery (Yes/No)? (Page#) SURGERY_CAREVEOUT_IND_PGNUMERICFACTIVE
1025If the contract includes a carve out for Surgery Services , list the applicable codes or code ranges SURGERY_CAREVOUT_CODESVARCHARFACTIVE
1026If the contract includes a carve out for Surgery Services, describe how these codes are reimbursedSURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1027If the contract includes a carve out for Surgery Services , describe schedule nameSURGERY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1028If the contract includes a carve out for Surgery Services, describe reference year or versionSURGERY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1029If the contract includes a carve out for Outpatient Surgery Services, describe reimbursement rateSURGERY_CARVEOUT_DESCRIBEVARCHARGACTIVE
1030Does the contract include a carve out for Lithotripsy Services (Yes/No)?LITHOTRIPSY_CAREVEOUT_INDVARCHARFACTIVE
1031Does the contract include a carve out for Lithotripsy Services (Yes/No)? (Page#) LITHOTRIPSY_CAREVEOUT_IND_PGNUMERICFACTIVE
1032If the contract includes a carve out for Lithotripsy Services , list the applicable codes or code ranges LITHOTRIPSY_CAREVOUT_CODESVARCHARFACTIVE
1033If the contract includes a carve out for Lithotripsy Services, describe how these codes are reimbursedLITHOTRIPSY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1034If the contract includes a carve out for Lithotripsy Services , describe schedule nameLITHOTRIPSY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1035If the contract includes a carve out for Lithotripsy Services, describe reference year or versionLITHOTRIPSY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1036If the contract includes a carve out for Lithotripsy Services, describe reimbursement rateLITHOTRIPSY_CARVEOUT_DESCRIBEVARCHARGACTIVE
1037Does the contract include a carve out for Cardiac Services (Yes/No)?CARDIAC_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1038Does the contract include a carve out for Cardiac Services (Yes/No)? (Page#) CARDIAC_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1039If the contract includes a carve out for Cardiac Services , list the applicable codes or code ranges CARDIAC_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1040If the contract includes a carve out for Cardiac Services, describe how these codes are reimbursedCARDIAC_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1041If the contract includes a carve out for Cardiac Services , describe schedule nameCARDIAC_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1042If the contract includes a carve out for Cardiac Services, describe reference year or versionCARDIAC_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1043If the contract includes a carve out for Cardiac Services, describe reimbursement rateCARDIAC_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1044Does the contract include a carve out for Special Care Unit Services (Yes/No)?SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1045Does the contract include a carve out for Special Care Unit Services (Yes/No)? (Page#) SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1046If the contract includes a carve out for Special Care Unit Services , list the applicable codes or code ranges SPECIAL_CARE_UNIT_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1047If the contract includes a carve out for Cardiac Services, describe how these codes are reimbursedSPECIAL_CARE_UNIT_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1048If the contract includes a carve out for Special Care Unit Services , describe schedule nameSPECIAL_CARE_UNIT_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1049If the contract includes a carve out for Cardiac Services, describe reference year or versionSPECIAL_CARE_UNIT_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1050If the contract includes a carve out for Special Unit Services, describe reimbursement rateSPECIAL_CARE_UNIT_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1051Does the contract include a carve out for Skilled Nursing Services (Yes/No)?SKILLED_RN_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1052Does the contract include a carve out for Skilled Nursing Services (Yes/No)? (Page#) SKILLED_RN_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1053If the contract includes a carve out for Skilled Nursing Services , list the applicable codes or code ranges SKILLED_RN_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1054If the contract includes a carve out for Skilled Nursing Service, describe how these codes are reimbursedSKILLED_RN_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1055If the contract includes a carve out for Skilled Nursing Services Services , describe schedule nameSKILLED_RN_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1056If the contract includes a carve out for Skilled Nursing Services, describe reference year or versionSKILLED_RN_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1057If the contract includes a carve out for Skilled Nursing Services, describe reimbursement rateSKILLED_RN_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1058Does the contract include a carve out for Infusion Services (Yes/No)?INFUSION_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1059Does the contract include a carve out for Infusion Services (Yes/No)? (Page#) INFUSION_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1060If the contract includes a carve out for Infusion Services , list the applicable codes or code ranges INFUSION_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1061If the contract includes a carve out for Infusion Services, describe how these codes are reimbursedINFUSION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1062If the contract includes a carve out for Infusion Services , describe schedule nameINFUSION_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1063If the contract includes a carve out for Infusion Services, describe reference year or versionINFUSION_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1064If the contract includes a carve out for Infusion Services, describe reimbursement rateINFUSION_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1065Does the contract include a carve out for Obesity Services (Yes/No)?OBESITY_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1066Does the contract include a carve out for Obesity Services (Yes/No)? (Page#) OBESITY_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1067If the contract includes a carve out for Obesity Services , list the applicable codes or code ranges OBESITY_SVCS_CAREVOUT_CODESVARCHARFACTIVE
1068If the contract includes a carve out for Infusion Services, describe how these codes are reimbursedOBESITY_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1069If the contract includes a carve out for Obesity Services , describe schedule nameOBESITY_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1070If the contract includes a carve out for Obesity Services, describe reference year or versionOBESITY_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1071If the contract includes a carve out for Infusion Services, describe reimbursement rateOBESITY_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1072Does the contract include a carve out for Specialty Care Physician Services (Yes/No)?SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_INDVARCHARFACTIVE
1073Does the contract include a carve out for Specialty Care Physician Services (Yes/No)? (Page#) SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_IND_PGNUMERICFACTIVE
1074If the contract includes a carve out for Specialty Care Physician Services , list the applicable codes or code ranges SPECIALTY_CARE_PHYSICIAN_CAREVOUT_CODESVARCHARFACTIVE
1075If the contract includes a carve out for Infusion Specialty Care Physician Services , describe how these codes are reimbursedSPECIALTY_CARE_PHYSICIAN_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1076If the contract includes a carve out for Specialty Care Physician Services , describe schedule nameSPECIALTY_CARE_PHYSICIAN_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1077If the contract includes a carve out for Specialty Care Physician Services, describe reference year or versionSPECIALTY_CARE_PHYSICIAN_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1078If the contract includes a carve out for Infusion Services, describe reimbursement rateSPECIALTY_CARE_PHYSICIAN_CARVEOUT_DESCRIBEVARCHARGACTIVE
1079Does the contract include a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient (Yes/No)?DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_INDVARCHARFACTIVE
1080Does the contract include a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient (Yes/No)? (Page#) DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_IND_PGNUMERICFACTIVE
1081If 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_CODESVARCHARFACTIVE
1082If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe how these codes are reimbursedDRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1083If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe schedule nameDRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1084If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient, describe reference year or versionDRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1085If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient, describe reimbursement rateDRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_DESCRIBEVARCHARGACTIVE
1086Does the contract include a carve out for High Cost Drugs, Implants Outpatient (Yes/No)?DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_INDVARCHARFACTIVE
1087Does the contract include a carve out for High Cost Drugs, Implants Outpatient (Yes/No)? (Page#) DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_IND_PGNUMERICFACTIVE
1088If the contract includes a carve out for High Cost Drugs, Implants Outpatient , list the applicable codes or code ranges DRUGS_ORGANS_IMPLANTS_OP_CAREVOUT_CODESVARCHARFACTIVE
1089If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe how these codes are reimbursedDRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1090If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe schedule nameDRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1091If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe reference year or versionDRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1092If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe reimbursement rateDRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_DESCRIBEVARCHARGACTIVE
1093Does the contract include a carve out for Blood Products - Outpatient/Inpatient (Yes/No)?BLOOD_PRODUCTS_CAREVEOUT_INDVARCHARFACTIVE
1094Does the contract include a carve out for Blood Products - Outpatient/Inpatient (Yes/No)? (Page#) BLOOD_PRODUCTS_CAREVEOUT_IND_PGNUMERICFACTIVE
1095If the contract includes a carve out for Blood Products - Outpatient/Inpatient , list the applicable codes or code ranges BLOOD_PRODUCTS_CAREVOUT_CODESVARCHARFACTIVE
1096If the contract includes a carve out forBlood Products - Outpatient/Inpatient , describe how these codes are reimbursedBLOOD_PRODUCTS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1097If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe schedule nameBLOOD_PRODUCTS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1098If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe reference year or versionBLOOD_PRODUCTS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1099If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe reimbursement rateBLOOD_PRODUCTS_CARVEOUT_DESCRIBEVARCHARGGGACTIVE
1100Does the contract include a carve out for High Cost Drugs (Yes/No)?HIGH_COST_DRUGS_CAREVEOUT_INDVARCHARFACTIVE
1101Does the contract include a carve out for High Cost Drugs (Yes/No)? (Page#) HIGH_COST_DRUGS_CAREVEOUT_IND_PGNUMERICFACTIVE
1102If the contract includes a carve out for High Cost Drugs, list the applicable codes or code ranges HIGH_COST_DRUGS_CAREVOUT_CODESVARCHARFACTIVE
1103If the contract includes a carve out for High Cost Drugs, describe how these codes are reimbursedHIGH_COST_DRUGS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1104If the contract includes a carve out for High Cost Drugs, describe schedule nameHIGH_COST_DRUGS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1105If the contract includes a carve out for High Cost Drugs, describe reference year or versionHIGH_COST_DRUGS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1106If the contract includes a carve out for High Cost Drugs, describe reimbursement rateHIGH_COST_DRUGS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1107Does the contract include a carve out for Physical Rehabilitation (Yes/No)?PHYSICAL_REHABILITATION_CAREVEOUT_INDVARCHARFACTIVE
1108Does the contract include a carve out for Physical Rehabilitation (Yes/No)? (Page#) PHYSICAL_REHABILITATION_CAREVEOUT_IND_PGNUMERICFACTIVE
1109If the contract includes a carve out for Inpatient Physical Rehabilitation , list the applicable codes or code ranges PHYSICAL_REHABILITATION_CAREVOUT_CODESVARCHARFACTIVE
1110If the contract includes a carve out for Inpatient Physical Rehabilitation , describe how these codes are reimbursedPHYSICAL_REHABILITATION_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1111If the contract includes a carve out for Inpatient Physical Rehabilitation , describe schedule namePHYSICAL_REHABILITATION_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1112If the contract includes a carve out forInpatient Physical Rehabilitation , describe reference year or versionPHYSICAL_REHABILITATION_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1113If the contract includes a carve out for Inpatient Physical Rehabilitation , describe reimbursement ratePHYSICAL_REHABILITATION_CARVEOUT_DESCRIBEVARCHARGACTIVE
1114Does the contract include a carve out for Sleep Studies (Yes/No)?SLEEP_STUDIES_CAREVEOUT_INDVARCHARFACTIVE
1115Does the contract include a carve out for Sleep Studies (Yes/No)? (Page#) SLEEP_STUDIES_CAREVEOUT_IND_PGNUMERICFACTIVE
1116If the contract includes a carve out for Sleep Studies, list the applicable codes or code ranges SLEEP_STUDIES_CAREVOUT_CODESVARCHARFACTIVE
1117If the contract includes a carve out for Sleep Studies, describe how these codes are reimbursedSLEEP_STUDIES_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1118If the contract includes a carve out for Sleep Studies, describe schedule nameSLEEP_STUDIES_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1119If the contract includes a carve out for Sleep Studies, describe reference year or versionSLEEP_STUDIES_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1120If the contract includes a carve out for Sleep Studies, describe reimbursement rateSLEEP_STUDIES_CARVEOUT_DESCRIBEVARCHARFACTIVE
1121Does the contract include a carve out for Lap Band Services (Yes/No)?LAP_BAND_SVCS_CAREVEOUT_INDVARCHARFACTIVE
1122Does the contract include a carve out for Lap Band Services (Yes/No)? (Page#) LAP_BAND_SVCS_CAREVEOUT_IND_PGNUMERICFACTIVE
1123If the contract includes a carve out for Lap Band Services , list the applicable codes or code ranges LAP_BAND_SVCS_CAREVOUT_CODESVARCHARGACTIVE
1124If the contract includes a carve out for Lap Band Services , describe how these codes are reimbursedLAP_BAND_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1125If the contract includes a carve out for Lap Band Services , describe schedule nameLAP_BAND_SVCS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1126If the contract includes a carve out for Lap Band Services, describe reference year or versionLAP_BAND_SVCS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1127If the contract includes a carve out for Lap Band Services , describe reimbursement rateLAP_BAND_SVCS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1128Does the contract include a carve out for Newborn/NICU (Yes/No)?NEWBORN_NICU_CAREVEOUT_INDVARCHARFACTIVE
1129Does the contract include a carve out for Newborn/NICU (Yes/No)? (Page#) NEWBORN_NICU_CAREVEOUT_IND_PGNUMERICFACTIVE
1130If the contract includes a carve out for Newborn/NICU, list the applicable codes or code ranges NEWBORN_NICU_CAREVOUT_CODESVARCHARFACTIVE
1131If the contract includes a carve out for Newborn/NICU, describe how these codes are reimbursedNEWBORN_NICU_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1132If the contract includes a carve out for Newborn/NICU, describe schedule nameNEWBORN_NICU_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1133If the contract includes a carve out for Newborn/NICU, describe reference year or versionNEWBORN_NICU_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1134If the contract includes a carve out for Newborn/NICU, describe reimbursement rateNEWBORN_NICU_CARVEOUT_DESCRIBEVARCHARGACTIVE
1135Does the contract include a carve out for Extracorporeal Membrane Oxygenation (ECMO) (Yes/No)?EMCO_CAREVEOUT_INDVARCHARFACTIVE
1136Does the contract include a carve out for Extracorporeal Membrane Oxygenation (ECMO) (Yes/No)? (Page#) EMCO_CAREVEOUT_IND_PGNUMERICFACTIVE
1137If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), list the applicable codes or code ranges EMCO_CAREVOUT_CODESVARCHARFACTIVE
1138If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe how these codes are reimbursedEMCO_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1139If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe schedule nameEMCO_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1140If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe reference year or versionEMCO_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1141If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe reimbursement rateEMCO_CARVEOUT_DESCRIBEVARCHARGACTIVE
1142Does the contract include a carve out for Burns (Yes/No)?BURNS_CAREVEOUT_INDVARCHARFACTIVE
1143Does the contract include a carve out for Burns (Yes/No)? (Page#) BURNS_CAREVEOUT_IND_PGNUMERICFACTIVE
1144If the contract includes a carve out for Burns, list the applicable codes or code ranges BURNS_CAREVOUT_CODESVARCHARFACTIVE
1145If the contract includes a carve out for Burns, describe how these codes are reimbursedBURNS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1146If the contract includes a carve out for Burns, describe schedule nameBURNS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1147If the contract includes a carve out for Burns, describe reference year or versionBURNS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1148If the contract includes a carve out forBurns, describe reimbursement rateBURNS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1149Does the contract include a carve out for Kyphoplasty (Yes/No)?KYPHOPLASTY_CAREVEOUT_INDVARCHARFACTIVE
1150Does the contract include a carve out for Kyphoplasty (Yes/No)? (Page#) KYPHOPLASTY_CAREVEOUT_IND_PGNUMERICFACTIVE
1151If the contract includes a carve out for Kyphoplasty, list the applicable codes or code ranges KYPHOPLASTY_CAREVOUT_CODESVARCHARFACTIVE
1152If the contract includes a carve out for Kyphoplasty, describe how these codes are reimbursedKYPHOPLASTY_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1153If the contract includes a carve out for Kyphoplasty, describe schedule nameKYPHOPLASTY_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1154If the contract includes a carve out for Kyphoplasty, describe reference year or versionKYPHOPLASTY_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1155If the contract includes a carve out for Kyphoplasty, describe reimbursement rateKYPHOPLASTY_CARVEOUT_DESCRIBEVARCHARGACTIVE
1156Does the contract include a carve out for Cryosurgical Ablation of the Prostate (Yes/No)?CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_INDVARCHARFACTIVE
1157Does the contract include a carve out for Cryosurgical Ablation of the Prostate (Yes/No)? (Page#) CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_IND_PGNUMERICFACTIVE
1158If the contract includes a carve out for Cryosurgical Ablation of the Prostate, list the applicable codes or code ranges CRYOSURGICAL_ABLATION_PROSTATE_CAREVOUT_CODESVARCHARFACTIVE
1159If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe how these codes are reimbursedCRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1160If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe schedule nameCRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1161If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe reference year or versionCRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1162If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe reimbursement rateCRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_DESCRIBEVARCHARGACTIVE
1163Does the contract include a carve out for Transurethral Thermal Ablation (TUMT) (Yes/No)?TUMT_CAREVEOUT_INDVARCHARFACTIVE
1164Does the contract include a carve out for Transurethral Thermal Ablation (TUMT) (Yes/No)? (Page#) TUMT_CAREVEOUT_IND_PGNUMERICFACTIVE
1165If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), list the applicable codes or code ranges TUMT_CAREVOUT_CODESVARCHARFACTIVE
1166If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe how these codes are reimbursedTUMT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1167If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe schedule nameTUMT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1168If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe reference year or versionTUMT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1169If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe reimbursement rateTUMT_CARVEOUT_DESCRIBEVARCHARGACTIVE
1170Does the contract include a carve out for Transurethral Needle Ablation (TUNA) (Yes/No)?TUNA_CAREVEOUT_INDVARCHARFACTIVE
1171Does the contract include a carve out for Transurethral Needle Ablation (TUNA) (Yes/No)? (Page#) TUNA_CAREVEOUT_IND_PGNUMERICFACTIVE
1172If the contract includes a carve out for Transurethral Needle Ablation (TUNA), list the applicable codes or code ranges TUNA_CAREVOUT_CODESVARCHARFACTIVE
1173If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe how these codes are reimbursedTUNA_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1174If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe schedule nameTUNA_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1175If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe reference year or versionTUNA_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1176If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe reimbursement rateTUNA_CARVEOUT_DESCRIBEVARCHARGACTIVE
1177Does the contract include a carve out for Hyperbaric Treatment (Yes/No)?HYPERBARIC_TREATMENT_CAREVEOUT_INDVARCHARFACTIVE
1178Does the contract include a carve out for Hyperbaric Treatment (Yes/No)? (Page#) HYPERBARIC_TREATMENT_CAREVEOUT_IND_PGNUMERICFACTIVE
1179If the contract includes a carve out for Hyperbaric Treatment, list the applicable codes or code ranges HYPERBARIC_TREATMENT_CAREVOUT_CODESVARCHARFACTIVE
1180If the contract includes a carve out for Hyperbaric Treatment, describe how these codes are reimbursedHYPERBARIC_TREATMENT_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1181If the contract includes a carve out for Hyperbaric Treatment, describe schedule nameHYPERBARIC_TREATMENT_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1182If the contract includes a carve out for Hyperbaric Treatment, describe reference year or versionHYPERBARIC_TREATMENT_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1183If the contract includes a carve out for Hyperbaric Treatment, describe reimbursement rateHYPERBARIC_TREATMENT_CARVEOUT_DESCRIBEVARCHARGACTIVE
1184Does the contract include a carve out for Clinic Visits (Yes/No)?CLINIC_VISITS_CAREVEOUT_INDVARCHARFACTIVE
1185Does the contract include a carve out for Clinic Visits (Yes/No)? (Page#) CLINIC_VISITS_CAREVEOUT_IND_PGNUMERICFACTIVE
1186If the contract includes a carve out for Clinic Visits, list the applicable codes or code ranges CLINIC_VISITS_CAREVOUT_CODESVARCHARFACTIVE
1187If the contract includes a carve out for Clinic Visits, describe how these codes are reimbursedCLINIC_VISITS_CARVEOUT_REIMBURSEMENT_METHODOLOGYVARCHARGACTIVE
1188If the contract includes a carve out for Clinic Visits, describe schedule nameCLINIC_VISITS_CARVEOUT_SCHEDULE_NAMEVARCHARGACTIVE
1189If the contract includes a carve out for Clinic Visits, describe reference year or versionCLINIC_VISITS_CAREVEOUT_SCHEDULE_VERSIONVARCHARGACTIVE
1190If the contract includes a carve out for Clinic Visits, describe reimbursement rateCLINIC_VISITS_CARVEOUT_DESCRIBEVARCHARGACTIVE
1191Does the contract include reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits?REIMBURSEMENT_EXHAUST_MEDI_BENEFITS_INDVARCHARBACTIVE
1192Does the contract include reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits? (Page#) REIMBURSEMENT_EXHAUST_MEDI_BENEFITS_IND_PGNUMERICBACTIVE
1193If 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_OFVARCHARBACTIVE
1194If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe primary reimbursementREIMBURSEMENT_EXHAUST_MEDI_PRIMARY_BENEFITSVARCHARBACTIVE
1195If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe secondary reimbursementREIMBURSEMENT_EXHAUST_MEDI_SECONDARY_BENEFITSVARCHARBACTIVE
1196If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe tertiary reimbursementREIMBURSEMENT_EXHAUST_MEDI_TERTIARY_BENEFITSVARCHARBACTIVE
1197If the contract includes reimbursement language for members who have exhausted Medicare benefits and Medicaid provides benefits, describe quaternary reimbursementREIMBURSEMENT_EXHAUST_MEDI_QUATERNARY_BENEFITSVARCHARBACTIVE
1198Does the contract include reimbursement language for members who have not selected Medicare coverage?REIMBURSEMENT_EXHAUST_MEDICARE_BENEFITS_INDVARCHARBACTIVE
1199Does the contract include reimbursement language for members who have not selected Medicare coverage? (Page#) REIMBURSEMENT_EXHAUST_NO_MEDICARE_BENEFITS_IND_PGNUMERICBACTIVE
1200If 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_OFVARCHARBACTIVE
1201If the contract includes reimbursement language for members who have not selected Medicare coverage, describe primary reimbursementREIMBURSEMENT_EXHAUST_NO_MEDICARE_PRIMARY_BENEFITSVARCHARBACTIVE
1202If the contract includes reimbursement language for members who have not selected Medicare coverage, describe secondary reimbursementREIMBURSEMENT_EXHAUST_NO_MEDICARE_SECONDARY_BENEFITSVARCHARBACTIVE
1203If the contract includes reimbursement language for members who have not selected Medicare coverage, describe tertiary reimbursementREIMBURSEMENT_EXHAUST_NO_MEDICARE_TERTIARY_BENEFITSVARCHARBACTIVE
1204If the contract includes reimbursement language for members who have not selected Medicare coverage, describe quaternary reimbursementREIMBURSEMENT_EXHAUST_NO_MEDICARE_QUATERNARY_BENEFITSVARCHARBACTIVE
1205Does the contract have default language?CONTRACT_HAS_DEFAULT_LANGVARCHARCACTIVE
1206Does the contract have default language? (Page#) CONTRACT_HAS_DEFAULT_LANG_PGNUMERICCACTIVE