Overview
The Reference subsystem provides the necessary user interface to maintain a comprehensive source of all reference codes and pricing conditions applicable to bills processing, adjustments, and prior authorizations. The Reference component supports flexible pricing methodologies related to all bill types and services.
Maintenance of reference files is necessary to support the reporting requirements and is an essential tool for conducting research and answering questions. Reference file data sets play an important role in production of Federal reports, statistical analyses, efforts to detect and deter fraud and abuse, provider and claimant management and outreach, and ad hoc queries.