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