Pricing Constructs
This feature allows access to pricing related entities.Access can be restricted on:
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Bundled Amount
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Charged Amount
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Diminishing Rate
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Fee Schedule
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Payment Function
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Pricing Rule
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Adjustment Rule
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Dynamic Field Rule
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Encounter Rule
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Inclusion Rule
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Lower of Rule
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Message Rule
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Pricing External Intervention Rule
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Provider Limit Rule
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Replacement Rule
-
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Pricing Option
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Pricing Template
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Pricing Worksheet
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Provider Pricing Clause
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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
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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.
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
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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:
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Bundled Amount Category
When access to a charged amount is restricted, the following details are also restricted:
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Charged Amount Classification
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Charged Amount Modifier
When access to a diminishing rate is restricted, the following details are also restricted:
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Diminishing Rate Block
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Diminishing Rate Block Amount
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Diminishing Rate Block Size
When access to a fee schedule is restricted, the following details are also restricted:
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Fee Schedule Line
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Fee Schedule Line Classification
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Fee Schedule Line Modifier
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Fee Schedule Modifier
When access to a pricing external intervention rule is restricted, the following details are also restricted:
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Pricing External Intervention Rule Claim Form
When access to a pricing rule is restricted, the following details are also restricted:
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Pricing Rule Classification
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Pricing Rule Modifier
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Pricing Rule Reimbursement Method Type
When access to a pricing worksheet is restricted, the following details are also restricted:
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Draft Provider Pricing Clause
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Draft Provider Pricing Clause Dynamic Logic
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Draft Provider Pricing Clause Diminishing Rate
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Draft Provider Pricing Clause Claim Classification
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Draft Provider Pricing Clause Claim Line Classification
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Draft Provider Pricing Clause Classification Scheme
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Draft Provider Pricing Clause Restrict Reimbursement Method
When access to a pricing template is restricted, the following details are also restricted:
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Pricing Section
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Pricing Section Option
When access to a pricing option is restricted, the following details are also restricted:
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Partial Provider Pricing Clause
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Partial Provider Pricing Clause Claim Classification
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Partial Provider Pricing Clause Claim Line Classification
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Partial Provider Pricing Clause Dynamic Logic
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Partial Provider Pricing Clause Restrict Reimbursement Method
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Partial Provider Pricing Clause Classification Scheme
When access to a provider pricing clause is restricted, the following details are also restricted:
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Provider Pricing Clause Claim Classification
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Provider Pricing Clause Claim Line Classification
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Provider Pricing Clause Classification Scheme
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Provider Pricing Clause Dynamic Logic
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Provider Pricing Clause Restrict Reimbursement Method
When access to a provider limit rule is restricted, the following details are also restricted:
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Provider Limit Height
When access to a reference sheet is restricted, the following details are also restricted:
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Reference Sheet Line
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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 |