Objectives and Assumptions

Summary

Summary

Objectives

  • Keep the display simple.
  • Show the full list of providers who perform a service regardless of payment arrangement type.
  • Add user friendly definitions or detailed payer descriptions to explain the new terms.
  • Emphasize the difference between standard (Fee for service) in Search Results cards.
  • Provide payers with configuration options to avoid displaying bad data.
  • Provide payers with configuration options to turn on the UI display for bundled/capitation payments. 

Assumptions

    • Payment arrangements can change when a user selects a different place of service.
    • Bundles and capitation are not relevant to out of network costs
    • Capitation and Bundled may not have additional billing codes. Billing code list is optional in the data specification.
    • Capitation and bundled information display the same in the UI.
    • Capitation and bundled are less likely to appear together in search results. 
    • Assume Fee for Service and only call attention to bundled and capitation cost differences.
  • Solve for long lists of services/billing codes for bundled and capitation. (Ex: 50+)
  • Billing codes for bundled/capitation may be missing required data. Use cost data domain document to determine if billing code is supported. Note: Bundled/Capitation with unsupported billing codes will not display. (Ex: If 10 billing codes in a bundle, if one billing code is not supported, the bundle will not display)