Common use of Dollar Amounts Clause in Contracts

Dollar Amounts. ‌ MassHealth wants to ensure that the dollar amounts on the individual lines of the claim represent the actual or computed amounts associated with each encounter. Therefore, whenever dollar amounts are not included at the detail level, and the summary-level line is not available, the MCE should add an extra detail line with a Record Indicator of 0 and report all summary-level amounts/quantities on that line. If the summary-level line is already available in the MCE’s source system and is not artificially created, then MassHealth would expect it to have a Record Indicator value of 4 (Per diem), 5 (DRG) or 6 (Bundled Summary-Level line when none of the other payment arrangements apply). All detail lines with zero-dollar amounts (that are not artificially created and are not summary-level lines) should have any value other than 0 or 6 placed in Record Indicator field. In such case, XXX decides on the value based on the definition of the Record Indicator in the table below. For the claims covered by sub-capitation payments, MCEs must report the amounts reported by the provider/vendor on their claims in the Net Payment field (#68) or the Fee-For-Service Equivalent (FFSE) and use Record Indicator value 2 to indicate the FFSE type of payment arrangement. See “Acronyms” section for MassHealth’s expectation for an FFSE. Record Indicator Table: Record Indicator Dollar Amount Split 0: Artificial Line Dollar amounts / quantities represent numbers that are available only at a summary level.

Dollar Amounts. ‌ MassHealth wants to ensure that the dollar amounts on the individual lines of the claim represent the actual or computed amounts associated with each encounter. Therefore, whenever dollar amounts are not included at the detail level, and the summary-level line is not available, the MCE should add an extra detail line with a Record Indicator of 0 and report all summary-level amounts/quantities on that line. If the summary-level line is already available in the MCE’s source system and is not artificially created, then MassHealth would expect it to have a Record Indicator value of 4 (Per diem), 5 (DRG) or 6 (Bundled Summary-Level line when none of the other payment arrangements apply). All detail lines with zero-dollar amounts (that are not artificially created and are not summary-level lines) should have any value other than 0 or 6 placed in Record Indicator field. In such case, XXX MCE decides on the value based on the definition of the Record Indicator in the table below. For the claims covered by sub-capitation payments, MCEs must report the amounts reported by the provider/vendor on their claims in the Net Payment field (#68) or the Fee-For-Service Equivalent (FFSE) and use Record Indicator value 2 to indicate the FFSE type of payment arrangement. See “Acronyms” section for MassHealth’s expectation for an FFSE. Record Indicator Table: Record Indicator Dollar Amount Split 0: Artificial Line Dollar amounts / quantities represent numbers that are available only at a summary level.