Provider reference at header level of In-Network file #371
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Can the provider-reference at the header level of the In-Network MRF be used in lieu of the provider-reference field within the Negotiated Rates Detail object? It states within the Negotiated rates detail object that either provider-group or provider-reference is required but this defeats the purpose of saving space by not having to repeat multiple provider data per rate. |
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Replies: 2 comments
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@SCShuler -- moved the "issue" to a "discussion". The This is to say, I think the way it is set up is the way that you're asking for it to be set up. An example would be the definition of a provider network at the "header level" (aka, the root node) that is used later in the file for a negotiated item/service. Please note that in the example, the ID being referenced is "1", but it could have easily been "2" that points back to an externally referenced provider network. |
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Thanks Scott! This is very helpful.
From: scott haselton ***@***.***>
Sent: Wednesday, February 2, 2022 3:34 PM
To: CMSgov/price-transparency-guide ***@***.***>
Cc: TOM SHULER ***@***.***>; Mention ***@***.***>
Subject: [EXTERNAL] Re: [CMSgov/price-transparency-guide] Provider reference at header level of In-Network file (Discussion #371)
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@SCShuler<https://github.com/SCShuler> -- moved the "issue" to a "discussion".
The provider_references in the Negotiated Rate Details Object<https://github.com/CMSgov/price-transparency-guide/tree/master/schemas/in-network-rates#negotiated-rate-details-object> is an array of IDs referencing the provider_group_id in the Provider Reference Object<https://github.com/CMSgov/price-transparency-guide/tree/master/schemas/in-network-rates#provider-reference-object> that is found in the "header level" of the in-network MRF.
This is to say, that I think the way it is set up is the way that you're asking for it to be set up.
An example would be the definition of a provider network<https://github.com/CMSgov/price-transparency-guide/blob/master/examples/in-network-rates/in-network-rates-fee-for-service-single-plan-sample.json#L25-L28> at the "header level" (aka, the root node) that is used later in the file for a negotiated item/service<https://github.com/CMSgov/price-transparency-guide/blob/master/examples/in-network-rates/in-network-rates-fee-for-service-single-plan-sample.json#L87>. Please note that in the example, the ID being referenced is "1", but it could have easily been "2" that points back to an externally referenced provider network.
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@SCShuler -- moved the "issue" to a "discussion".
The
provider_referencesin the Negotiated Rate Details Object is an array of IDs referencing theprovider_group_idin the Provider Reference Object that is found in the "header level" of the in-network MRF.This is to say, I think the way it is set up is the way that you're asking for it to be set up.
An example would be the definition of a provider network at the "header level" (aka, the root node) that is used later in the file for a negotiated item/service. Please note that in the example, the ID being referenced is "1", but it could have easily been "2" that points back to an externally referenced provider network.