This wiki has undergone a migration to Confluence found Here
OO CR-807 - Limited Coverage Policy
Revision as of 16:40, 7 August 2014 by Kmccaslin (talk | contribs) (Created page with "{{OO Open V2.9 Change Requests}} Return to OO Change Requests page. {|width=100% cellspacing=0 cellpadding=2 border=1 || '''Submitted by:''' ...")
Return to OO Change Requests page.
| Submitted by: Ken McCaslin - on behalf of ACLA | Revision date: <<Revision Date>> |
| Submitted date: 7 August 2014 | Change request ID: OO CR807 |
| Standard/IG: Standard | Artifact ID, Name: <<Artifact ID, Name>> |
Issue
The proposal -
Based on a service providers catelog or Directory of Services payers may not reimburse for those services based on Diagnosis and CPT coding. This is to add a message and segments to define Limited Coverage and Permissible coverage policy requirements based on Payer. The message will be from the service provider based on their Universal Service Identifiers and will defined by Payer and the diagnosis and CPT codes, either what is permissible or what will not be reimbursed.
