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Hi @nradov - We didn't receive any feedback that items/services are contracted under the X12 service type codes between the providers and payers. Is this something you've seen? |
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It's not a matter of how rates are contracted between providers and payers but rather helping providers understand how payers categorize particular billing codes. When a provider submits an X12 270 eligibility check the payer will return a 271 response with one or more service type codes. But the provider has no reliable way to know which benefit line applies to a particular billing code. Does that make sense? |
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Definitely makes sense. Generally speaking, the TiC requirements are for the contracted rates/terms and it sounds like those terms don't include X12 service type codes in the actual contracts. |
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Is there any interest in expanding the price transparency schema to include X12 EDI Service Type Codes? Generally payers categorize billing codes into service type codes. But when doing EDI 270/271 eligibility checks with payers it isn't always clear which CPT / HCPCS codes they include under a particular Service Type Code (
EQ01). It would be helpful for providers to close the loop on this if they could see Service Type Codes in the health plan MRFs.Beta Was this translation helpful? Give feedback.
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