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TiC (All Services) Office Hours - Session 2
61 min
Course Overview
Session 2
Agenda and CLNR Updates
7 min
Validation Error Report Updates
2 min
Filters, OON Allowed Amounts, & Testing Best Practice Reminder
7 min
Member Enablement Planning
3 min
Questions & Next Steps
42 min
Additional Resources
Slide Presentation
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Filters, OON Allowed Amounts, & Testing Best Practice Reminder
Summary
Summary
Filters - 400 Limit
FAQ for 400 filter logic
Change location to the location of the provider
If NPI only, then increases data size and can hit limit sooner
New call out
: Setting up providers to avoid appearance of duplication:
Options:
Instead unique Provider Key in the provider data then multiple Location Key » This is set up as recommended
NPI and TINS need to match across rather than by only NPI
Filters - POS
(see top of page 28 - Cost Implementation Guide)
Three types of Place of Service need to match - negotiated rate data, service code, provider specialty POS. Options to address:
Override the Service POS to include
This may also require the data for the rate or the specialty POS to be updated
Override the Specialty
This may also require the data for the rate or the specialty POS to be updated
Remove the HealthSparq POS filtering
Additional testing needed to ensure mapping is better without the filtering
Request for a change in the Cost Data Domain
This may also require the data for the rate or the specialty POS to be updated
OON Allowed Amounts:
The OON Allowed amount will come from data
If there are multiple rates, the lowest rate will be shown in the application
OON is the amount insurance will pay for the service vs INN is the amount the member will pay
Testing best practice reminder:
Use documented test cases vs comparing production to UAT