Diagnosis Exclusions by Group

Version 2

File Name: v2_gr_exclusions_by_diagnoses.csv

This version accepts only ICD-10 codes. If a different coding system or ICD version is required, Osigu can provide an updated processor to accommodate other coding systems and transform received codes into corresponding ICD-10 codes.

The required fields are marked in bold.

#	Field Name	Type	Description
1	insurer_slug	String[64]	Slug of the Payer provided by Osigu.
2	policy_number	String[32]	Policy/plan number, must match a record included in the `v2_policies.csv` file.
3	group_code	String[32]	Group code belonging to the policy, specified in the `v2_groups.csv` file.
4	diagnosis_code	String[32]	ICD-10 diagnosis code.

Version 3

File Name: v3_gr_exclusions_by_diagnoses.csv

This version accepts ICD-9 and ICD-10 codes. The coding_system column specifies the version of ICD used for each entry.

The required fields are marked in bold.

#	Field Name	Type	Description
1	insurer_slug	String[64]	Slug of the Payer provided by Osigu.
2	policy_number	String[32]	Policy/plan number, must match a record included in the `v2_policies.csv` file.
3	group_code	String[32]	Group code belonging to the policy, specified in the `v2_groups.csv` file.
4	diagnosis_code	String[32]	Diagnosis code.
5	coding_system	Enum ( ICD-9 \| ICD-10 )	Field indicating which coding system and version is being used.

Notes

Use this file to configure diagnosis exclusions at the group level within a policy.
Version 3 adds flexibility to accommodate multiple coding systems, ensuring compatibility with payer requirements.