Tara Yebba joins to review what we are seeing with planning action submissions.
Block List: What is it and how is it used?
- Used to exclude a service or code set from the list of services a member can search for
- Two options for exclusion
- By key - exclude a specific service such as APC|2021|0020
- By code type - example exclude all APR-DRGs from the search: APC|2021|*
Block List: Template
- File needs to be tab delimited (.tsv or .txt)
- File needs to include header (template will be provided)
- Valid entries include - refer to Cost Data Domain-Regional-Clients or Cost Data Domain-Blue-Clients
- Service Key
- Code Type|Version|*
EQ Types: What is it and how is it used?
- Also known as Service Type code
- Are used to identify the classification of service or benefits
- Will be included in the call (API or 270) that is made to you for benefits
- Does not directly show in the UI
Places of Service (POS): What is it and how is it used?
- Indicates the setting in which a service is provided
- Presented in UI in three areas
- POS available for a clinical service are shown in the More Details section
- Healthsparq will call your benefits service for each relevant POS to obtain correct benefit for that setting
EQ Types and POS: Template
- File needs to be tab delimited (.tsv or .txt)
- File needs to include header (template will be provided)
- For default EQ Types and POS - refer to Cost Data Domain-Regional-Clients or Cost Data Domain-Blue-Clients
- Includes 4 fields
- Service Key - required
- Places of Service - can be left blank and will use default
- List should be separated by commas with no spaces
- 22,19,11,49,24,20,23,21
- EQ Type - can be left blank and will use default
- Should contain ONE entry
- 2
- Apply - required
- TRUE or FALSE - Can have entries that you have reviewed but don’t yet want applied set to FALSE
- TRUE
Service to Specialty Mapping: What is it and how is it used?
- Aligns relevant provider specialties with supported services
- Helps to remove providers from cost search results where none of their specialties make sense for the service.
- For example - a Knee Surgery rate may be correlated to a Provider having a specialty of Physician Assistant from a data perspective but they would never actually perform such a service.
Service to Specialty Mapping Overrides: Template
- File needs to be tab delimited (.tsv or .txt)
- File needs to include header (template will be provided)
- Valid entries include - refer to Cost Data Domain-Regional-Clients or Cost Data Domain-Blue-Clients for valid service keys and Search Data Domain for valid specialties
- Includes 3 fields
- Service Key - required
- Specialties (Array of Values)
- The array of values must be a comma separated list with no spaces between the ‘,’ and quotes.
- Each Specialty MUST be wrapped in quotes because some may contain a comma and spaces.
- "Hospital Medicine",”Hospitalist",”Inpatient Hospital”,"Inpatient Physician”,”Allopathic & Osteopathic Physicians/Family Medicine”,“Geriatric Medicine”
- Apply - required
- TRUE or FALSE - Can have entries that you have reviewed but don’t yet want applied set to FALSE
- TRUE
