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Ex. 20610 - ARTHROCENTESIS MAJOR/JOINT
If no type is selected, 'CPT' will be entered.
If no setting is selected, 'both' will be entered.
If 'percent of total billed charge' is selected, this field is required.

To upload tblData:

  1. The worksheet must be named tblData.
  2. The columns must be named:
    • payeeName: This must be the string name of the payer and must match exactly (case sensative) the names in tblPayee.
    • procedureName: This must be the string name of the procedure and must match exactly (case sensative) the names in tblProcedure.
    • avgCharge
    • avgPayment
    • caseRate
    • setting: Valid values are: 'inpatient', 'outpatient', 'both'. Blank entries will default to 'outpatient'.
    • contractingMethod: Valid values are: 'case rate', 'fee schedule', 'percent of total billed charges', 'per diem', 'other'.
    • additionalPayerNotes
    • standardChargePercent
    • billingClass: Valid values are: 'professional', 'facility'
    • setting: Valid values are: 'inpatient', 'outpatient', 'both'

To upload tblPayee:

  1. The worksheet must be named tblPayee.
  2. The columns must be named:
    • name: This must be the string name of the payer and must match exactly (case sensative) the names in tblData. NOTE: The payorName and planName used in the machine-readable file are derived from this field. The format MUST be payorName_planName.
    • inflatorMultiplier
    • pct1
    • pct2
    • pct3
    • pct4
    • pct5
    • pct6
    • pct7
    • pct8
    • pct9
    • pct10
    • pct11
    • pct12
    • pct13
    • pct14
    • pct15
    • pct16
    • pct17
    • pct18
    • pct19
    • pct20
    • implantPct

To upload tblProcedure:

  1. The worksheet must be named tblProcedures.
  2. The columns must be named:
    • name: This must be the string name of the procedure and must match exactly (case sensative) the names in tblData.
    • type: Valid values are: 'CPT', 'HCPCS', 'ICD', 'MS-DRG', 'R-DRG', 'S-DRG', 'APS-DRG', 'AP-DRG', 'APR-DRG', 'APC', 'NDC', 'HIPPS', 'LOCAL', 'EAPG', 'CDT', 'RC', 'CDM'. Blank entries will default to 'CPT'.
    • additionalGenericNotes
    • NOTE: The code is split out of the name. The split occurs on " - " (includes the space before and after. This is used to pull in the professional charges for tblData.

Percent Charged
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