3 ms·
To save anyone else similarly curious the trouble, here's a sample record from the Humana data set: {'REPORTING_ENTITY_NAME': 'Humana Inc', 'REPORTING_ENT
by xdmr 4y ago
To save anyone else similarly curious the trouble, here's a sample record from the Humana data set:
{'REPORTING_ENTITY_NAME': 'Humana Inc',
'REPORTING_ENTITY_TYPE': 'Health Insurance Issuer',
'LAST_UPDATED_ON': '2022-08-24',
'VERSION': '1.0.0',
'NPI': '1629053517,1659354272',
'TIN': '593279318',
'TYPE': 'ein',
'NEGOTIATION_ARRANGEMENT': 'ffs',
'NAME': 'Nasal Prosthesis Replacement See Also Code 21087',
'BILLING_CODE_TYPE': 'CDT',
'BILLING_CODE_TYPE_VERSION': '2022',
'BILLING_CODE': 'D5926',
'DESCRIPTION': 'Nasal Prosthesis Replacement See Also Code 21087',
'NEGOTIATED_TYPE': 'negotiated',
'NEGOTIATED_RATE': '906.98',
'EXPIRATION_DATE': '9999-12-31',
'SERVICE_CODE': '',
'BILLING_CLASS': 'professional',
'BILLING_CODE_MODIFIER': '',
'ADDITIONAL_INFO': '',
'BUNDLED_BILLING_CODE_TYPE': '',
'BUNDLED_BILLING_CODE_VERSION': '',
'BUNDLED_BILLING_CODE': '',
'BUNDLED_DESCRIPTION': ''}
I think I agree about the negotiation arrangement
- xdmr 4y agoFor comparison, here's the first bit of an Anthem file (which contains some of the data that's just another row in the Humana record), along with the first record "reporting_entity_name": "Excellus BlueCross BlueShield", "reporting_entity_type": "Health Insurance Issuer", "last_updated_on": "2022-06-14", "version": "1.0.0", "provider_references": [ { "provider_group_id": 302.1518360704, "location": "https://mrf.healthsparq.com/exc-egress.nophi.kyruushsq.com/prd/mrf/EXC_I/EXC/providerReference/Providers/S-000000001063.json" } ], "in_network": [ { "negotiation_arrangement": "ffs", "name": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a benefi", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0081", "description": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a benefi", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "fee schedule", "negotiated_rate": 51.1, "expiration_date": "9999-12-31", "service_code": [ "11" ], "billing_class": "professional" } ], "provider_references": [ 302.1518360704 ] } ] },
- FPGAhacker 4y ago> "negotiation_arrangement": "ffs" Negotiation arrangement: for fuck’s sake
- skue 4y ago:) I couldn’t help but read it that way as well, even though I know it’s most likely “fee for service.”