Payer Acceptance of Supplemental Data

The American Academy of Family Physicians (AAFP) believes health plans should provide a mechanism for physicians in value-based contracts to submit supplemental data for all lines of business. Physicians depend on the accuracy of claims submitted and data reported back from health plans to determine physician eligibility for shared savings and other forms of value-based payments. When health plans and billing software vendors/clearinghouses accept only a limited number of codes on claims, physicians must submit supplemental data (e.g. different pieces of the medical record). Thus, accurate reporting of physician performance requires the ability of health plans and their intermediaries to accept all the data submitted by an individual physician, rather than just a limited number of codes. The consequences of a health plan’s inability to accept and record data may result in physicians not receiving payment otherwise earned under a value-based contract. (2019 COD)