Data Requirements for Tiered Networks
- Providers not in a tiered network will have a NULL value in the tier number field
- Providers in a tiered network must have a valid tier number value in the tier number field
- The tier number must match the tier number as defined in the Tiered Networks Matrix
- The client needs to decide in which file to send the tier number value
- ProductNetwork - broader and applies to the provider at the network level (fields 16 & 17)
- ProvNetworks - more granular and applies to the provider at the network-location level (field 11)
- Kyruus Health's recommendation is to send the tier number in the ProvNetworks file
- The Tiered Networks Matrix defines products (by productCode) that are tiered. The productCode used in the Tiered Networks Matrix must match a valid productCode from the ProductNetworks file and must also match the product sent in the members SAML