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About Rates

Rates consist of several groups of tables that contain 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.

These rates are updated periodically, normally through a batch process. However, the Rates function of Rules Management in provides the capability to do the following tasks in real-time:

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

 

ClosedAmbulatory Surgical Centers (ASC) Rate Information
ClosedInstitutional Rate Information

Procedure Code Rate Information

What Is Procedure Code Rates?

ClosedProcedure Code/Benefit Plan ID Rates
ClosedProcedure Code/Class of Service (COS) Rates
ClosedProcedure Code/Place of Service Rates
ClosedProcedure Code/Provider ID/Network ID Rates
ClosedProcedure Code/Procedure Modifier 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

 

Revenue Code Rate Information

What Is Revenue Code Rate?

ClosedRevenue Code/Revenue Type/Provider Type Rates
ClosedRevenue Code/Revenue Type/Provider ID/Network ID/Region Rates
ClosedRevenue Code/Revenue Type/Benefit Plan ID Rates
ClosedRevenue Code/Revenue Type/Provider ID/Network ID Rates

See Also

About Rates Batch Process

What Is Adjudication?

About Rules Management

Version as of 5/16/14.

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