Charge Amounts
A charged amount reimbursement method specifies which procedures need to paid at the charged amount.
Charged Amounts Fields
| Field | Description |
|---|---|
Code |
The code of the charged amount. |
Description |
The description of the charged amount. |
Type |
The charged amount type to which the charged amount belongs. |
Procedure group usage |
How should the procedure group be evaluated? In: When one or more of the procedures in the group are present on the claim line. Not In: When none of the procedures in the group are present on the claim line. |
Procedure group |
The group with the procedures to which the charged amount applies. |
Procedure condition usage |
How should the procedure condition be evaluated? In: When one or more of the procedures on the claim line meet the condition. Not In: When none of the procedures on the claim line meet the condition. |
Procedure condition |
The procedure condition that defines the procedures to which the charged amount applies. |
Procedure group 2 usage |
How should the second procedure group be evaluated? In: When one or more of the procedures in the group are present on the claim line. Not In: When none of the procedures in the group are present on the claim line. |
Procedure group 2 |
The second group with the procedures to which the charged amount applies. |
Procedure condition 2 usage |
How should the second procedure condition be evaluated? In: When one or more of the procedures on the claim line meet the condition. Not In: When none of the procedures on the claim line meet the condition. |
Procedure condition 2 |
The second procedure condition that defines the procedures to which the charged amount applies. |
Procedure group 3 usage |
How should the third procedure group be evaluated? In: When one or more of the procedures in the group are present on the claim line. Not In: When none of the procedures in the group are present on the claim line. |
Procedure group 3 |
The third group with the procedures to which the charged amount applies. |
Procedure condition 3 usage |
How should the third procedure condition be evaluated? In: When one or more of the procedures on the claim line meet the condition. Not In: When none of the procedures on the claim line meet the condition. |
Procedure condition 3 |
The third procedure condition that defines the procedures to which the charged amount applies. |
Classification usage |
How should the classification list be evaluated? In: When one of the classifications in the list is present on the claim line. Not In: When none of the classifications in the list are present on the claim line. |
Modifier usage |
How should the modifier list be evaluated? In: When one or more of the modifiers in the list is present on the claim line Not In: When none of the modifiers in the list are present on the claim line. |
Message |
The message that is attached to the claim line if the reimbursement method applies. |
Access Restriction |
Determines whether or not the access to the charged amount is restricted |
Constraints:
-
The modifier usage must be specified when a modifier list is used and may not be specified when a modifier list is not used.
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The classification usage must be specified when a classification list is used and may not be specified when a classification list is not used.
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The procedure group usage must be specified when a procedure group is used and may not be specified when a procedure group is not used (this applies to all three procedure groups).
-
The procedure condition usage must be specified when a procedure condition is used and may not be specified when a procedure condition is not used (this applies to all three procedure conditions).
The following list specifies the placeholder values for the message that is attached to the claim line upon applying a charged amount:
-
The code of the charged amount
-
The description of the charged amount
-
The provider pricing clause quantifier
-
The descriptions of the procedure groups/conditions (comma separated)
-
Modifier list
-
The description of the charged amount type
A charged amount can be linked to one or more modifiers:
Charged Amount Modifiers
| Field | Description |
|---|---|
Charged amount |
The charged amount reimbursement method to which the charged amount modifier refers. |
Modifier |
The modifier to which the charged amount modifier applies. |
A charged amount can be linked to one or more classifications:
Charged Amount Classifications
| Field | Description |
|---|---|
Charged amount |
The charged amount reimbursement method to which the charged amount classification refers. |
Classification |
The classification to which the charged amount classification applies. |
Charged amount types can be referred to by charged amounts for administrative purposes. Pricing rules can also refer to charged amount types. If a charged amount type is specified on a pricing rule then the rule is only applied if a charged amount of that type has been applied (in combination with an 'In' usage) or has not been applied (in combination with a 'Not In' usage) to calculate the price on the claim line.