Specialties

The entity specifies the domain of available specialties. Specialties can be attached to claims, in order to reflect the specialty under which a service was performed, and providers, in order to reflect that a provider is capable of performing services that fall under that particular specialty.

A specialty has the following attributes:

Field	Description
Code	The unique code for this specialty.
Description	The description for this specialty.

The following scenarios clarify how specialties can be applied.

Scenario 1: Doctor Thomson has two specialties: general practitioner and gynecologist. Doctor Thomson can do a blood test in both capacities. The payer HealthSecure has two different benefit regimes for blood tests: a $5 copay if the test is rendered by a general practitioner and a $10 copay if rendered by a gynecologist.

Now suppose that doctor Thomson sends in a claim with a blood test. If the claim specifies only the procedure (blood test) and the servicing provider (doctor Thomson) the payer has no way of knowing which copay to apply. For this reason, before the claim is processed by OHI Claims, the specialty "Gynecology" is attached to the claim, so that OHI Claims knows to apply a $10 copay.

Note that this scenario requires a dynamic condition on the claim specialty, specified under a coverage specification.

Scenario 2: Payer HealthSecure wants to check that, every time when it processes a claim that has a specialty attached to it, the servicing provider actually has that particular specialty. Within OHI Claims, doctor Thomson is stored as a provider with two specialties: 001 (general practitioner) and 020 (gynecologist). Doctor Thomson sends in a claim on which he himself is the servicing provider, with specialty 001 attached.

Payer HealthSecure sets up a dynamic check tries to match the specialty on a claim to the specialties of the servicing provider. Once the claim is processed, it passes the check because specialty 001 is attached to both the servicing provider and the claim.

Note that this scenario requires a dynamic check on the claim specialty, which is configurable for the claims flow.