Code
|
Display
|
Definition
|
claims-processing
|
Claim Processing |
Request for data necessary from payers to support claims for services. |
preauth-processing
|
Pre-authorization Processing |
Request for data necessary from payers to support pre-authorization for services. |
risk-adjustment
|
Risk Adjustment |
Request for data from payers to calculate differences in beneficiary-level risk factors that can affect quality outcomes or medical costs, regardless of the care provided. |
quality-metrics
|
Quality Metrics |
Request for data used for aggregation, calculation and analysis, and ultimately reporting of quality measures. |
referral
|
Referral |
Request for additional clinical information from referring provider to support performing the requested service. |
social-care
|
Social Care |
Request for data from payers to support the non-medical social needs of individuals, especially the elderly, vulnerable or with special needs. |
authorization-other
|
Other Authorization |
Request for data from payers for other authorization request not otherwise specified. |
care-coordination
|
Care Coordination |
Request for data from payers to create a complete clinical record for each of their members to improve care coordination and provide optimum medical care. |
documentation-general
|
General Documentation |
Request for data used from payers or providers for general documentation. |
orders
|
Orders |
Request for additional clinical information from referring provider to support orders. |
patient-status
|
Patient Status |
Requests for patient health record information from payers to support their payer member records. |
signature
|
Signature |
Request for signatures from payers or providers on requested data. |