Allowed Amount - Claim Modifier - Schema location for 0.10.1 seems incorrect #361
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Shouldn't the billing_code_modifier be part of the out of network payments object instead of allowed amount object? It was added to the negotiated rate object in the In-Network schema, so wouldn't the alignment for the Allowed Amount be in the payments object? Here's an example---where if the allowed amounts vary based on modifier, then it can be noted for the given item/service. Seems if it remains in the allowed amount object, then you would have to repeat some of the same data for a given procedure that may have base allowed amounts different than those with modifiers for the same procedure. Can someone clarify why the claim modifier is defined in allowed amount object rather than the payments object for the Allowed Amount File? @shaselton-usds Here's what I thought would be more in alignment with how the data schema aligned with pricing in the In-Network schema---where the modifier would be part of the payment data. Thoughts?? |
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@tdfow This definitely makes sense. I'm not sure how the PR ended up where it did because this was the original intend. Thank you for the watchful eye! |
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@tdfow This definitely makes sense. I'm not sure how the PR ended up where it did because this was the original intend. Thank you for the watchful eye!