Pricing Constructs

This feature allows access to pricing related entities.Access can be restricted on:

• Bundled Amount

• Charged Amount

• Diminishing Rate

• Fee Schedule

• Payment Function

• Pricing Rule

  • Adjustment Rule

  • Dynamic Field Rule

  • Encounter Rule

  • Inclusion Rule

  • Lower of Rule

  • Message Rule

  • Pricing External Intervention Rule

  • Provider Limit Rule

  • Replacement Rule

• Pricing Option

• Pricing Template

• Pricing Worksheet

• Provider Pricing Clause

• Reference Sheet

When a user searches for one of these pricing elements that they are not allowed to see will not be returned at all.

Example

User Bob is granted access restriction FS_WEST. No access restrictions have been granted to user Pete. The following table shows which fee schedules they can access.

Table 1. Example

Fee Schedule	Pricing Constructs Access Restriction	Accessible by Bob?	Accessible by Pete?
FS_West	FS_WEST	yes	no
FS_General	empty	yes	yes
FS_East	FS_EAST	no	no

Inference Prevention

Not applicable.

Related Entities

NOTE: Whenever a sub-entity is related to more than one parent entity, it is only restricted by the entity where it is listed as a restricted detail.

When access to a bundled amount is restricted, the following details are also restricted:

• Bundled Amount Category

When access to a charged amount is restricted, the following details are also restricted:

• Charged Amount Classification

• Charged Amount Modifier

When access to a diminishing rate is restricted, the following details are also restricted:

• Diminishing Rate Block

• Diminishing Rate Block Amount

• Diminishing Rate Block Size

When access to a fee schedule is restricted, the following details are also restricted:

• Fee Schedule Line

• Fee Schedule Line Classification

• Fee Schedule Line Modifier

• Fee Schedule Modifier

When access to a pricing external intervention rule is restricted, the following details are also restricted:

• Pricing External Intervention Rule Claim Form

When access to a pricing rule is restricted, the following details are also restricted:

• Pricing Rule Classification

• Pricing Rule Modifier

• Pricing Rule Reimbursement Method Type

When access to a pricing worksheet is restricted, the following details are also restricted:

• Draft Provider Pricing Clause

• Draft Provider Pricing Clause Dynamic Logic

• Draft Provider Pricing Clause Diminishing Rate

• Draft Provider Pricing Clause Claim Classification

• Draft Provider Pricing Clause Claim Line Classification

• Draft Provider Pricing Clause Classification Scheme

• Draft Provider Pricing Clause Restrict Reimbursement Method

When access to a pricing template is restricted, the following details are also restricted:

• Pricing Section

• Pricing Section Option

When access to a pricing option is restricted, the following details are also restricted:

• Partial Provider Pricing Clause

• Partial Provider Pricing Clause Claim Classification

• Partial Provider Pricing Clause Claim Line Classification

• Partial Provider Pricing Clause Dynamic Logic

• Partial Provider Pricing Clause Restrict Reimbursement Method

• Partial Provider Pricing Clause Classification Scheme

When access to a provider pricing clause is restricted, the following details are also restricted:

• Provider Pricing Clause Claim Classification

• Provider Pricing Clause Claim Line Classification

• Provider Pricing Clause Classification Scheme

• Provider Pricing Clause Dynamic Logic

• Provider Pricing Clause Restrict Reimbursement Method

When access to a provider limit rule is restricted, the following details are also restricted:

• Provider Limit Height

When access to a reference sheet is restricted, the following details are also restricted:

• Reference Sheet Line

• Dynamic Logic Reference Sheet

When searching with Generic API Top level and Sub-Resource Resource access restriction are applied. For details refer to HTTP API Data Access Restriction Concepts