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For home infusion therapy (typical billed with HCPC) the negotiated rate is based on AWP, AMP, or WAC which is not known until the provider submits the bill for the services. I liken this reimbursement method to the % of billed charges/invoice. How should this be listed on the in-network MRF? It is simple for the Allowed Amount file- only if billed by a non-participating provider.
Should another negotiated rate type be added for home infusion such as AWP/AMP/WAC and the value = to the % that the carrier has negotiated to pay?
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For home infusion therapy (typical billed with HCPC) the negotiated rate is based on AWP, AMP, or WAC which is not known until the provider submits the bill for the services. I liken this reimbursement method to the % of billed charges/invoice. How should this be listed on the in-network MRF? It is simple for the Allowed Amount file- only if billed by a non-participating provider.
Should another negotiated rate type be added for home infusion such as AWP/AMP/WAC and the value = to the % that the carrier has negotiated to pay?
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