Interpret Service Level Information from Sandbox Response

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{
            "code": "C",
            "name": "Deductible",
            "serviceTypeCodes": [
                "45",
                "42"
            ],
            "serviceTypes": [
                "Hospice",
                "Home Health Care"
            ],
            "insuranceTypeCode": "MA",
            "insuranceType": "Medicare Part A",
            "timeQualifierCode": "26",
            "timeQualifier": "Episode",
            "benefitAmount": "0",
            "benefitsDateInformation": {
                "benefit": "20170101-20171231"
            }
        },

How do I interpret "329 days" here in terms of co-payment?
{
"code": "B",
"name": "Co-Payment",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "MA",
"insuranceType": "Medicare Part A",
"timeQualifierCode": "7",
"timeQualifier": "Day",
"benefitAmount": "329",
"benefitsDateInformation": {
"admission": "20170101-20171231"
},
"benefitsServiceDelivery": [
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "30",
"timePeriodQualifier": "Exceeded",
"numOfPeriods": "60",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "31",
"timePeriodQualifier": "Not Exceeded",
"numOfPeriods": "90",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"timePeriodQualifierCode": "26",
"timePeriodQualifier": "Episode",
"numOfPeriods": "1"
}
]
},

In the preceding code snippet, does it mean that "0 episodes" come under deductible, that is, they are fully covered by insurance?

The following information is from the documentation.
Answer for #1. — the 'Episode' is the episode of care and '26' is the number of days in that episode.
Answer for #2. — $329 is the benefit amount.

Benefits, Time Periods, and Coverage Amounts
Every Service Type segment has more or less the same format:

ServiceType Segment Description

"serviceTypes": [ "Skilled Nursing Care" ], "insuranceTypeCode": "MA", "insuranceType": "Medicare Part A", "timeQualifierCode": "7", "timeQualifier": "Day", "benefitAmount": "164.5", "benefitsDateInformation": { "admission": "20170101-20171231" }\ Note the repetition of insuranceTypeCode. Here, it is called out to identify the insurance coverage for each individual service. This value can differ from the umbrella insuranceTypeCode value; in this case the umbrella insurance code is QM for a qualified Medicare beneficiary, and the service's insuranceTypeCode is MA for Medicare Part A.

The timequalifierCode shows the benefit billing period, which is Daily, using 7 as the EDI value (this value does NOT define a weekly time span). Our API provides the timeQualifier description, which is day, so benefit coverage is tracked daily.

The benefitAmount is added based on the timeQualifier, so the daily benefit amount of the Skilled Nursing Care service is $164.50.

ServiceType Segment	Description
`"serviceTypes": [ "Skilled Nursing Care" ], "insuranceTypeCode": "MA", "insuranceType": "Medicare Part A", "timeQualifierCode": "7", "timeQualifier": "Day", "benefitAmount": "164.5", "benefitsDateInformation": { "admission": "20170101-20171231" }\`	Note the repetition of `insuranceTypeCode`. Here, it is called out to identify the insurance coverage for each individual service. This value can differ from the umbrella `insuranceTypeCode value`; in this case the umbrella insurance code is QM for a qualified Medicare beneficiary, and the service's `insuranceTypeCode` is MA for Medicare Part A. The `timequalifierCode` shows the benefit billing period, which is Daily, using 7 as the EDI value (this value does NOT define a weekly time span). Our API provides the `timeQualifier` description, which is day, so benefit coverage is tracked daily. The `benefitAmount` is added based on the `timeQualifier`, so the daily benefit amount of the Skilled Nursing Care service is $164.50.

Updated 2 months ago