Product A Release Notes

Release N000 | Version N.0.NNNN | System Version N.0.NNNN.0

Published N/N/2021

Our product release notes provide information regarding the latest updates and enhancements to
Product A. Some of these items may evolve over multiple releases as we work to continuously provide
you with valuable and improved features and offerings.

Note: To simplify our release versioning, we have implemented a new numbering sequence, starting
at release N000, for our product releases.

User Interface and Functionality Updates

This release includes new, updated, and resolved enhancements to our interface.

New Features
Product A01 Audit Archive—For users who processed claims in Product A01, this feature allows you to
view those claims in Product A for reference and archival purposes. This is a licensed feature that we
made available in the Product A release NNN and is only applicable to certain clients. We've updated
the provider type filter so that the Professional provider type option encompasses claims for Physician
Medicare (Non-Par), Physician Assistant, Nurse Mid-Wife, and Clinical Social Worker providers and
so that the listed options reflect the appropriate Medicaid provider type(s) you had access to in Product
A01.

Updated Features
Auto Provider Type Determination—Made the following updates to the auto provider type determination
(APTD) logic:
Added taxonomies for the Professional (MC01) and Suppliers (MC02) provider types.
Updated the APTD to additionally evaluate claims reported with type of bill 87x.
Updated the APTD to no longer evaluate the accept assignment field for the Professional provider
type.
Product A Code Collections—Removed CPT® code 36468 from the Product A – HCPCS/CPT® Codes
Inappropriate for Laterality Modifiers code collection under Design > Code Collections . This code
collection contains a stock list of codes and functions as a parameter for edit 003170 (Modifier
Appropriateness Laterality Procedure).

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 Claim Field Conditions—Added the following as claim field condition options when setting up custom edits,
edit exceptions, and service categories:
Client System ID—The identifier of the system or process that submitted the claim. This appears as an
option under Service Group.
Claim Level: Header
Format: Up to 50 characters
Values: Single value or multiple values separated by commas
OSCAR—The Medicare/Medicaid provider number. This appears as an option under CMS-1500 & UB-
04 and is also available when setting up code collections.
Claim Level: Header
Format: 6 characters
Values: Single value or multiple values separated by commas
CMS Data Reference—Added the following data warehouse views:
HHAHIPPS Codes—View details for HHA HIPPS codes including weights, number of allowed therapy
visits, and effective dates. This view is under the Payment Policies data category and applies to the
HHA provider type.
SNF HIPPS Codes—View details for SNF HIPPS codes including code descriptions, assessment
indicators, and effective dates. This view is under the Payment Policies data category and applies to
the SNF Part A provider type.
ESRD Providers—View details for ESRD facilities including CCNs and NPIs, facility names, and
geographic details. This view is under the Providers data category and applies to the ESRD provider
type.
MUE ASC—View details for Medically Unlikely Edits (MUE) for HCPCS/CPT® codes including code
descriptions, maximum allowed units, and effective dates. This view is under the Payment Policies
data category and applies to the ASC provider type.
Exporting Message Mapping Overrides—When you select a mapping column and export the edit list view
in a configuration, you can now view all the message mapping overrides for the selected mapping system.
This can be useful to identify message mapping overrides for edits that share multiple provider types. The
mapping overrides can be found under the new Override Mapping for [Mapping System] and Provider
Type columns in the .xlsx file.
Individual Claim Inquiry—Added the new filters HCPCS/CPT® and Total Line Charges (the sum of all line
charges) in the Individual Claim Inquiry so you can search for your claims with greater specificity. You can
use these filters separately, together, or leave them blank. Note that when using the Total Line Charges
filter, any denied lines are excluded from the total when the Ignore Denied Lines system setting is turned
on.
Stock Configuration—Updated the Product A 100% Medicare and the Product A 100% Medicare
Advantage configurations to include the new and updated CMS edits and pricers in this release.

Features with Known Issue Resolutions

Importing a Configuration—Resolved an issue when importing a configuration so it now includes any
message mapping overrides for edit exceptions.

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 Individual Claim Inquiry—Resolved an issue viewing a processed claim with a system-level edit, e.g.,
SE0001 (Provider Type Cannot Be Determined) or SE0002 (Provider Type Not Found in Configuration).
Message Mapping—Resolved an issue when attempting to publish message mapping after remapping an
edit that was previously mapped to two message mapping systems. Previously, the message "Failed to
publish System Integration Mapping" appeared.
Service Category—Resolved an issue where a service category inadvertently appeared under a different
provider type on a rate sheet in a configuration. This issue only impacted certain clients.

Automated Claims Interface

This release includes new properties to the JSON structure. We recommend you evaluate any impact on your
claims processing workflow.

New Properties
Claim Response—Added the following Medicare ESRD PPS Pricer (P0014) detail to the EditData under
PriceOutput Lines for the ESRD provider type:
ESRD Network Reduction—Identifies the calculated ESRD network reduction or the daily per diem
network reduction.
DisplayName: ESRD Network Reduction
SymbolicName: EsrdNetworkReduction
Data Type: Numeric
Size: (3,2)

Pricer Updates
This release includes updated and resolved pricers.

Updated Pricers
Pricer 0001—Medicare RBRVS Pricer
Updated Parameter: The Use Accept Assignment parameter is now turned off by default.

Note: This update affects new configurations. Your existing configurations continue to use the
existing parameter setting. You may want to consider checking this pricer parameter in your
current configurations.

Pricer 0014—Medicare ESRD PPS Pricer

Pricer Type: Medicare
Updated Provider Type: ESRD
Updated Logic: If the Apply ESRD Network Reduction parameter is turned on for claims with a From
date on or after 1/1/2021, the pricer now applies the full ESRD PPS network reduction rate ($0.50 per

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 treatment) or the daily network reduction rate for home dialysis ($0.21 per treatment) to applicable
claim lines.
New Parameter: Apply ESRD Network Reduction—The ESRD network reduction is $0.50 per
covered treatment for the full ESRD PPS rate or $0.21 for the daily network reduction for home
dialysis. This parameter is turned on by default.

Note: If you use this pricer in a configuration, please reset the pricer (remove and re-add it) to see
the new pricer parameter.

Supporting References: ESRD Network Organizations and Transmittal 10576 (CR 11871)
Pricer 0048—Medicare ASC Pricer
Updated Logic: The pricer now uses CY 2021 CBSA rates when calculating the wage index for dates
of service on or after 1/1/2021.
Pricer 0074—RJ Health Pricer
Updated Logic: The pricer now prices the claim line based on the NDC code if the line allowance
cannot be determined by the HCPCS/CPT® code.

Pricers with Known Issue Resolutions

Pricer 0015—Medicare FQHC Pricer
Updated Logic: The pricer now applies the specified percentage of fee schedule and the lesser of
charges adjustment to the appropriate HCPCS codes when both these parameters are turned on.
Previously, the correct charges were not being returned when both parameters were turned on and the
Percent of Fee Schedule parameter was set to 150%, causing edit 003520 (FQHC Lesser of Policy
Applied) to inadvertently trigger at times.

Edit Updates
This release includes new, updated, and resolved edits.

New Edits
Edit Availability—Made the edits listed below available to more users. These edits are for all Medicare
providers under the Burgess edit source. Previously, these edits were only available under certain client
licenses:
Edit 001066—Age Appropriateness ICD Diagnosis Code with Dataset
Default Disposition: Claim Rejection
Description: The descriptor for an ICD-10 diagnosis code sometimes defines the code to be
applicable to only a certain set of ages. Categories to which some diagnosis codes are assigned
include newborn (under age 1), pediatric (ages 1-17), maternity (ages 9-65), and adult (age 18 or
older). The default diagnoses and their age ranges for this edit are in a Burgess dataset, which you

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 can replace with your own age-range dataset. This edit triggers when an age-specific diagnosis
code is submitted for a patient outside of the age range specified in the age-range dataset.
Edit 001105—Modifier Appropriateness Coronary Procedure
Default Disposition: Line Rejection
Description: According to CPT® guidelines, some modifiers may only be appropriate for certain
HCPCS/CPT codes. This edit triggers when a coronary modifier (LC, LD, LM, RC, or RI) is billed
with an inappropriate HCPCS/CPT code. The default services that are appropriate to bill with a
coronary modifier are in a Burgess code collection, which you can replace with a custom code
collection.
Edit 001106—Modifier Appropriateness Eyelid Procedure
Default Disposition: Line Rejection
Description: According to CPT® guidelines, certain eyelid procedures should be reported with
appropriate upper- or lower-eyelid modifiers for the left or right side. This edit triggers when an
eyelid modifier is billed with an inappropriate HCPCS/CPT code or an eyelid procedure is
appended by an inappropriate eyelid modifier. The default services that are appropriate to bill with
eyelid modifiers, upper-eyelid modifiers only, and lower-eyelid modifiers only are in three Burgess
code collections, which you can replace with custom code collections.
Edit 001107—Modifier Appropriateness Finger Procedure
Default Disposition: Line Rejection
Description: According to CPT® guidelines, some modifiers may only be appropriate for certain
HCPCS/CPT codes. This edit triggers when a finger modifier (F1, F2, F3, F4, F5, F6, F7, F8, F9,
FA) is billed with an inappropriate HCPCS/CPT code. The default services that are appropriate to
bill with a finger modifier are in a Burgess code collection, which you can replace with a custom
code collection.
Edit 001108—Modifier Appropriateness Left Side
Default Disposition: Line Rejection
Description: According to CPT® guidelines, some modifiers may only be appropriate for certain
HCPCS/CPT codes. This edit triggers when a left-side modifier (LT, E1, E2, F1, F2, F3, F4, FA,
T1, T2, T3, T4, or TA) is appended to a HCPCS/CPT code that is designated for the right side. The
default services that are designated for the right side are in a Burgess code collection, which you
can replace with a custom code collection.
Edit 001114—Modifier Appropriateness Right Side
Default Disposition: Line Rejection
Description: According to CPT® guidelines, some modifiers may only be appropriate for certain
HCPCS/CPT codes. This edit triggers when a right-side modifier (RT, E3, E4, F6, F7, F8, F9, F5,
T5, T6, T7, T8, or T9) is appended to a HCPCS/CPT code that is designated for the left side. The
default HCPCS/CPT codes that are designated for the left side are in a Burgess code collection,
which you can replace with a custom code collection.

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 Edit 001116—Modifier Appropriateness Toe Procedure
Default Disposition: Line Rejection
Description: According to CPT® guidelines, some modifiers may only be appropriate for certain
HPCPS/CPT codes.This edit triggers when a toe modifier (T1, T2, T3, T4, T5, T6, T7, T8, T9, TA)
is billed with an inappropriate HCPCS/CPT code. The default services that are appropriate to bill
with a toe modifier are in a Product A code collection, which you can replace with a custom code
collection.
Edit 003402—ASA Qualifying Circumstances Billed without Anesthesia Code with Optional History
Edit Source: ASA
Provider Type: Professional
Default Disposition: Line Rejection
Description: According to the American Society of Anesthesiologists® (ASA), qualifying
circumstances are payable as add-on codes when billed with an anesthesia CPT® code. This edit
triggers when a qualifying circumstances code is billed without an anesthesia code or a crosswalk
anesthesia code appended with an anesthesia modifier for the same rendering NPI on the current
claim. However, this edit has parameters to identify the same provider for furnished services (if at all),
to exclude crosswalk anesthesia codes, and to also evaluate the patient’s claim history for qualifying
circumstances and anesthesia codes.
Supporting Reference: Anesthesia Payment Basics Series 5 Qualifying Circumstances
Edit 003561—Outpatient Hospital Non-OTP Service Billed by OTP Provider
Edit Source: CMS
Provider Types: HOPD and Outpatient CAH
Default Disposition: Line Rejection
Description: According to CMS, opioid treatment program (OTP) providers may only bill OTP HCPCS
codes, effective 1/1/2021. This edit triggers when a non-OTP HCPCS code is reported on a claim with
type of bill (TOB) 87x, TOB 13x with condition code 89, or TOB 85x with condition code 89.
Supporting References:
Medicare Claims Processing Manual: Opioid Treatment Programs
OTP Medicare Billing and Payment Fact Sheet
Transmittal 10521 (CR 11856)
Edit 003562—Outpatient Maryland Hospital ZIP Code Invalid
Edit Source: CMS
Provider Type: Outpatient Maryland
Default Disposition: Claim Rejection
Description: The ZIP code for Maryland outpatient providers should be a valid Maryland ZIP code. This
edit triggers when the submitted billing NPI or CCN indicates a Maryland outpatient provider, but the
facility or billing ZIP code is not in the State of Maryland.
Edit 003572—Hospital Outpatient Blood or Blood Products Adjustment
Edit Source: CMS
Provider Type: HOPD
Default Disposition: Adjustment

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 Description: According to CMS, blood and blood product HCPCS/CPT® codes (status indicator R)
billed with revenue code 038x and modifier BL should be submitted with a duplicate charge line and
revenue code 039x. A payment adjustment applies to these codes that splits the allowance for one unit
of a covered service between the duplicate lines. This edit triggers when revenue codes 038x and 039x
are billed with modifier BL as well as the same HCPCS/CPT code, units, and date of service and
appropriately splits the allowance between the two lines. However, this edit has a parameter to control
whether the edit runs for the applicable Medicare provider types based on the submitted type of bill
(default option) or only for provider types other than the applicable Medicare provider types.
Parameter: Provider Type Options—This parameter allows the edit to run either for the applicable
Medicare provider types based on the submitted type of bill (default option) or only for provider types
other than the applicable Medicare provider types.
Edit 3M0076—Denied-Services not covered when related to SRE or OPPC
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Non-reimbursable SREs or OPPCs are submitted with TOB 110. Per MassHealth, this
claim is denied.
Edit 3M0077—Denied-Services not covered when related to SRE or OPPC
Edit Source: 3M
Provider Type: HOPD
Default Disposition: Line Rejection
Description: Per MassHealth guidelines, non-reimbursable SREs or OPPCs are billed on TOB 130.
Claim denied.
Edit 3M0078—Denied-discharge status required
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Patient status is missing or invalid and was needed for APR-DRG assignment.
Edit 3M0079—Denied-Principal diagnosis invalid as discharge diagnosis
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Principal diagnosis code is invalid as discharge diagnosis.
Edit 3M0080—Denied - Incorrect billing according to Medicaid guidelines
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Birth weight is missing or invalid, the combination of gestational and birth weight reported,
or the birth weight is missing or does not match the diagnosis code.
Edit 3M0081—Denied-Invalid DRG
Edit Source: 3M
Provider Type: Acute Inpatient

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 Default Disposition: Claim Rejection
Description: Record does not meet criteria for any DRG. Unable to assign an APR-DRG.
Edit 3M0085—Denied-not paid separately
Edit Source: 3M
Provider Type: HOPD
Default Disposition: Line Rejection
Description: Line item is not separately payable.
Edit 3M0086—No DRG assigned
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Record does not meet criteria for any DRG, i.e., the Sex of the patient does not agree with
the principal diagnosis, for v34 and lower. This return code is not valid for v35 and higher.
Edit 003574—COVID-19 Janssen Vaccine on Pause
Edit Source: CMS
Provider Type: All Medicare provider types
Default Disposition: Line Rejection
Description: The CDC and the FDA recommended a pause in the use of the Janssen COVID-19
vaccine (Johnson & Johnson), effective 4/13/2021 – 4/23/2021. This edit triggers when either CPT®
code 91303 or 0031A is billed for a date of service between 4/13/2021 and 4/23/2021.
Supporting Reference: CDC-FDA Joint Statement: Johnson & Johnson’s Janssen COVID-19 Vaccine
Edit 003576—Professional OTP Service Billed by Non-OTP Provider
Edit Source: CMS
Provider Type: Professional
Default Disposition: Line Rejection
Description: According to CMS, opioid treatment services should only be billed by certified opioid
treatment program (OTP) providers (identified by CMS specialty code D5 based on the submitted
taxonomy), effective 1/1/2020. This edit triggers when an opioid treatment service HCPCS code is
billed by a non-OTP provider.
Supporting Reference: Transmittal 4486 (CR 11353)
Edit 3M0087—No age available
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Invalid age in years or admission age in days, i.e., age is needed for grouping and Age is
missing or not within 0-124 years or 0-366 days.
Edit 3M0088—Sex Invalid
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Invalid sex, i.e., sex is needed for grouping and Sex not 1, 2, M, m, F, or f (v35 and lower).
This return code is not valid for v36 and higher.

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 Edit 3M0089—APR-DRG- Discharge Days missing
Edit Source: 3M
Provider Type: Acute Inpatient
Default Disposition: Claim Rejection
Description: Invalid discharge age in days, i.e., discharge age in days is needed for grouping and
Discharge Age In Days is missing or not within 0-42591.

Updated Edits
American Society of Anesthesiologists® (ASA) Applicable Edits—The CMS edits below now also have the
ASA attribute and fall under ASA reimbursement rules, when applicable.
Edit 001022—Professional Multiple Anesthesia Procedures with History
Edit 001142—Medical Direction 2-4 Concurrent Pro (QK)
Edit 001143—Medical Direction of CRNA Service (QX)
Edit 001144—Anesthesiologist Directs One CRNA (QY)
Edit 001305—Anesthesia Modifiers
Edit 001337—Anesthesia Modifier AD
Edit 002699—Professional Multiple Anesthesia Procedures
Edit 002211—APC CY 2018 340B Modifiers
Provider Type: HOPD
Edit Source: CMS
Updated Logic: The edit now additionally does not trigger for Essential Access Community Hospitals
(EACHs) or EACH / Rural Referral Centers when the reported geographic CBSA or wage index CBSA
is 2 digits.
Supporting Reference: Billing 340B Modifiers under the Hospital Outpatient PPS
Edit 002803—OCE Edit 109
Edit Source: CMS
Provider Type: HOPD
Updated Logic: The edit now triggers for claims billed with type of bill (TOB) 13x with condition code 41
or TOB 76x and triggers, as appropriate, when the ICD version indicator is 0 on claims with a From
date on or after 10/1/2018.
Edit 003170—Modifier Appropriateness Laterality Procedure
Edit Source: CMS
Provider Types : All Medicare providers
Updated Logic : The edit no longer triggers for CPT® code 36468 when used with the default code
collection Burgess – HCPCS/CPT® Codes Inappropriate for Laterality Modifiers.
Edit 003394—Inpatient Provider Not Located in Maryland
Edit Source: CMS
Provider Type: Inpatient Maryland
Updated Logic: This edit now also considers the ZIP code cascading logic function if your organization
opted to use this setting. This function uses a hierarchy for claim inputs such as service facility ZIP

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 code, rendering NPI, billing NPI, and billing ZIP code. This applies for non-certified providers or when
no billing/rendering NPI is submitted on the claim.
Updated Description: This edit triggers when the provider is not located in Maryland, based on the
submitted CCN, billing ZIP code, facility ZIP code, rendering NPI, or billing NPI.
Updated Message: Based on the submitted {0}, this provider is not located in Maryland.
Updated Message Variable: {0} - “CCN”, “billing ZIP code”, “facility ZIP code”, “rendering NPI”, or
“billing NPI”
Edit 003428—COVID-19 Pfizer Vaccine Inappropriate Dosage with History
Edit Source: CMS
Updated Provider Types : All Medicare providers
Edit 003440—COVID-19 Moderna Vaccine Inappropriate Dosage with History
Edit Source: CMS
Updated Provider Types : All Medicare providers
Edit 003447—COVID-19 Vaccine Administration Code Rejected When Vaccine Code Rejected
Edit Source: CMS
Updated Provider Types : All Medicare providers

Edits with Known Issue Resolutions

Inpatient Edits and Ignore Denied Lines System Setting—The edits below now appropriately evaluate any
denied lines according to the Ignore Denied Lines system setting in the Admin workspace. These are
Information edits; therefore, this update does not impact pricing.
Allowance Available / Not Available—When the Ignore Denied Lines setting is on, claim lines that
submit "D" as the denied line indicator now trigger the appropriate allowance not available edit.
Conversely, when this setting is off, claim lines that submit "D" as the denied line indicator now trigger
the appropriate allowance available edit.
Edit 003375—Acute Inpatient Allowance Available
Edit 003376—Acute Inpatient Allowance Not Available
Edit 003377—IRF Allowance Available
Edit 003378—IRF Allowance Not Available
Edit 003379—IPF Allowance Available
Edit 003380—IPF Allowance Not Available
Edit 003381—LTCH Allowance Available
Edit 003382—LTCH Allowance Not Available
Edit 003383—Inpatient Maryland Allowance Available
Edit 003384—Inpatient Maryland Allowance Not Available
Edit 003385—Inpatient CAH Allowance Available
Edit 003386—Inpatient CAH Allowance Not Available
Lesser of Edits—When the Ignore Denied Lines setting is on, claim lines that submit "D" as the denied
line indicator no longer trigger the following edits:
Edit 003547—Acute Inpatient Lesser of Policy Applied
Edit 003548—Inpatient CAH Lesser of Policy Applied
Edit 003549—Inpatient Maryland Lesser of Policy Applied

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 Edit 003550—IRF Lesser of Policy Applied
Edit 003551—IPF Lesser of Policy Applied
Edit 003552—LTCH Lesser of Policy Applied
Edit 002044—OCE Edit 066
Edit Source: CMS
Provider Types: ASC and HOPD
Updated Logic: The edit no longer triggers in certain situations when the type of bill is not present.
Edit 002070—OCE Edit 101
Edit Source: CMS
Provider Types: ASC and HOPD
Updated Logic: The edit no longer triggers for claims reported with type of bill 13x and condition code
89.

Data Updates
ASC Payment System
Provider Type: ASC
Update: Updated the ASC payment system data to change the effective start date for HCPCS code
Q5122 from 4/1/2021 to 1/1/2021.
Supporting Reference: Transmittal 10702 (CR 12183)
Coronavirus (COVID-19) Codes
Provider Types: All Medicare providers
Update: Updated the effective end date to 4/16/2021 for the following monoclonal antibody treatment
HCPCS codes:
M0239
Q0239
Supporting References: COVID-19 Vaccines and Monoclonal Antibodies
Cost Reports (Quarterly Update)
Provider Types: ESRD, FQHC, HH No Plan of Care, HH Plan of Care, HOPD, Hospice, SNF Part A,
and SNF Part B
Update: Updated the providers and MAC crosswalk data based on the FY 2013-2021 cost report files.
Supporting Reference: Cost Reports
Critical Access Hospital (CAH)
Provider Types: Inpatient CAH, Outpatient CAH, and SNF
Update: Made the following CAH updates for Mercy Health–Willard Hospital, retroactive to 10/20/2020:
The new inpatient per diem is $2,844.00 for the Inpatient CAH provider type.
The new percentage of charge is 25% for the Outpatient CAH provider type.
The new swing bed per diem is $2,241.00 for the SNF provider type.
Supporting Reference: Medicare Rate Letter
HCPCS/CPT® Codes (CY 2021 Update)
Provider Types: All Medicare providers
Update: Added and updated codes according to AMA data.

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 Supporting References:
Category I Vaccine Codes
Category III Codes
CPT PLA Codes
MAAA Codes
Hospital Cost Reports (Quarterly Update)
Provider Types: Acute Inpatient, HOPD, and SNF
Update: Updated the Critical Access Hospital rates from 2552-10 for FY 2016, 2017, 2018, 2019, and
2020.
Supporting Reference: Cost Reports by Fiscal Year
Medi-Span Rates (Monthly Update)
Provider Types: Acute Inpatient, Ambulance, ASC, ESRD, FQHC, HHA, HOPD, Hospice, Inpatient
CAH, Inpatient Maryland, IPF, IRF, LTCH, Outpatient CAH, Outpatient Maryland, Professional, SNF,
and Suppliers
Update: Updated the NDC rates and HCPCS-based rates (GPPC) based on the April 2021 Medi-Span
update.
Supporting Reference: Medi-Span File
Non-Medicare National Provider Identifiers (NPIs) (Monthly Update)
Provider Types: Acute Inpatient, ASC, ESRD, FQHC, HHA, HOPD, Hospice, IPF, IRF, LTCH, and
SNF
Update: Updated the Non-Medicare certified NPI data based on the April 2021 NPPES NPI Registry.
Supporting Reference: NPPES Data
Opt Out Providers
Provider Type: Professional
Update: Updated the practitioner opt out data based on the March 2021 practitioner opt out data files.
This update has been available since Burgess Source release 267.
Supporting Reference: Opt Out Affidavits
Provider Specific File (PSF) (Quarterly Update)
Provider Types: Acute Inpatient, HHA, Hospice, IPF, IRF, LTCH, and SNF
Update: Updated the Medicare PSF rates to the April 2021 PSF data based on the March 2021
Provider of Services (POS) file.
Supporting Reference: Provider of Services
Provider Specific File (PSF) (Quarterly Update)
Provider Types: ESRD, HOPD, and Hospice
Update: Updated the Medicare PSF data based on the April 2021 PSF files.
Supporting References:
FY 2021 Final Rule
PC Pricer
Provider of Services

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 Wage Indices
Provider Type: ASC
Update: Updated provider wage indices based on new and reassigned Core-Based Statistical Areas
(CBSAs), retroactive to 1/1/2021.
Supporting Reference: Transmittal 10702 (CR 12183)

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