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Back  RFI # 997: Multiple Medical Policy URLs

Formal vs. Informal Help Informal Formal

Submitter

Craig Keene

Description

What is the accepted guideline when multiple medical policy URLs are needed? The TR3 specifically says payers are expected to report NCD codes when they are used in adjudicataion as well as local policy guidelines. What is a payer expected to report if one line on a claim has an NCD applied to it, and one line has a local policy applied, since only one medical policy URL segment is allowable per payer in an 835?

Submitter Assigned Keywords

Multiple Medical Policy URL NCD

Response

This issues is not addressed directly in guide 005010X221. The guide provides for only ONE Payer URL in the 1000A loop identifying a location for Medical Policy information. Please see the recommendation for a suggested handling.

Recommendation

While the guide only provides a link to a single location, that location can be a web page that identifies links to specific other sites for various policy code lists. In this way, the URL listed in the 1000A PER Web Site Segment can include a link to NDC Policies and another link for non-NDC Medical Policies.
Submission 3/22/2010
Status Date 5/21/2010
Status F - Final
Primary References
Document 005010X221
Section2.4
Page100
Set ID835