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What Is Procedure Code Rates?

Rates are groups of tables that are contained within the Reference Functional Area. The Procedure Code group of tables contains the rates and fee schedules required to price claims. This includes rates from Clinical Laboratory Improvements Amendment (CLIA) and Medicare, as well as North Dakota specific rates maintained at various levels such as provider/procedure code/modifier rates.

The following procedure code rate tables can be established for ND MMIS and used in the pricing step of claims adjudication:

 

ClosedProcedure Code/Benefit Plan ID Rates
ClosedProcedure Code/Category of Service (COS) Rates
ClosedProcedure Code/Place of Service Rates
ClosedProcedure Code/Procedure Modifier Rates

 

ClosedProcedure Code/Provider ID/Network ID Rates
ClosedProcedure Code/Provider ID/Network ID/Benefit Plan ID Rates
ClosedProcedure Code/Provider Specialty Rates
ClosedProcedure Code/Provider Taxonomy Rates
ClosedProcedure Code/Provider Type Rates

See Also

About Rates

About Rules Management

 

Version as of 5/16/14.

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