OO CR-807 - Limited Coverage Policy

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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.

The problem definition and proposal can be found in the attached document.

2014-08-26 eDOS WG reviewed with a few minor edits in the proposal (typos); updated version at: File:File:807.doc

Recommendation

The eDOS Work Group might be interested in moving this into v2.8.2.

Rationale

Discussion

Recommended Action Items

Resolution