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Copy pathin-network-rates-fee-for-service-single-plan-sample.json
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in-network-rates-fee-for-service-single-plan-sample.json
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{
"reporting_entity_name": "medicare",
"reporting_entity_type": "medicare",
"plan_name": "medicaid",
"plan_id_type": "hios",
"plan_id": "11111111111",
"plan_market_type": "individual",
"last_updated_on": "2020-08-27",
"version": "1.0.0",
"provider_references":[{
"provider_group_id": 1,
"provider_groups": [{
"npi": [1111111111, 2222222222, 3333333333, 4444444444, 5555555555],
"tin":{
"type": "ein",
"value": "11-1111111"
}
},{
"npi": [1111111111, 2222222222, 3333333333, 4444444444, 5555555555],
"tin":{
"type": "ein",
"value": "22-2222222"
}
}]
},{
"provider_group_id": 2,
"location": "https://www.cms.gov/some_provider_group.json"
}],
"in_network": [{
"negotiation_arrangement": "ffs",
"name": "Knee Replacement",
"billing_code_type": "CPT",
"billing_code_type_version": "2020",
"billing_code": "27447",
"description": "Arthroplasty, knee condyle and plateau, medial and lateral compartments",
"negotiated_rates": [{
"provider_groups": [{
"npi": [1111111111, 2222222222, 3333333333, 4444444444, 5555555555],
"tin":{
"type": "ein",
"value": "11-1111111"
}
},{
"npi": [1111111111, 2222222222, 3333333333, 4444444444, 5555555555],
"tin":{
"type": "ein",
"value": "22-2222222"
}
}],
"negotiated_prices": [{
"negotiated_type": "negotiated",
"negotiated_rate": 123.45,
"expiration_date": "2022-01-01",
"service_code": ["18", "19", "11"],
"billing_class": "professional",
"billing_code_modifier": ["AS"]
},{
"negotiated_type": "negotiated",
"negotiated_rate": 1230.45,
"expiration_date": "2022-01-01",
"billing_class": "institutional"
}]
},{
"provider_groups": [{
"npi": [6666666666, 7777777777, 8888888888, 9999999999],
"tin":{
"type": "ein",
"value": "22-2222222"
}
}],
"negotiated_prices": [{
"negotiated_type": "negotiated",
"negotiated_rate": 120.45,
"expiration_date": "2022-01-01",
"service_code": ["05", "06", "07"],
"billing_class": "professional"
}]
}]
},{
"negotiation_arrangement": "ffs",
"name": "Femur and Knee Joint Repair",
"billing_code_type": "CPT",
"billing_code_type_version": "2020",
"billing_code": "27448",
"description": "Under Repair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee Joint",
"negotiated_rates": [{
"provider_references": [1],
"negotiated_prices": [{
"negotiated_type": "negotiated",
"negotiated_rate": 12003.45,
"expiration_date": "2022-01-01",
"service_code": ["18", "19", "11"],
"billing_class": "professional"
}]
},{
"provider_groups": [{
"npi": [6666666666],
"tin":{
"type": "npi",
"value": "6666666666"
}
}],
"negotiated_prices": [{
"negotiated_type": "negotiated",
"negotiated_rate": 12.45,
"expiration_date": "2022-01-01",
"service_code": ["18", "19", "11"],
"billing_class": "institutional"
}]
}]
}]
}