Business impacts of eliminating local procedure, diagnosis, modifier, and other trading partner specific codes. This paper reviews how providers and payers might mitigate those problems, and other issues. Some examples are anesthesia services, dental codes, DME, home infusion, and others. Other codes, which are not governed by the DSMO's, may require mapping to enable payers to utilize them for processing purposes. This paper considers how these mappings might be developed into best practices for greater consistency across the industry.
Examples are taxonomy and adjudication reason codes.
The implementation guide requires that the claim be filed with the medical code structure in effect at the time services were rendered, while other code sets are required to follow the standard in effect at the time the transaction is generated. This white paper is finding a number of issues related to data content, including explicit vs. derived data, stringent vs. reasonable field length requirements. I have included an electronic copy of this draft white paper with my testimony for your convenience. Batch vs. Real Time. In today's environment, many health plans process eligibility either by phone or voice response systems, which is a real-time process.