Diagnosis Exclusions by Plan

Version 2

File Name: v2_po_exclusions_by_diagnoses.csv

This version only accepts ICD-10 codes. If another coding system or version of ICD is required, Osigu can provide an alternative processor version to accept the desired coding system and map the received codes to their 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	diagnosis_code	String[32]	ICD-10 diagnosis code.

Version 3

File Name: v3_po_exclusions_by_diagnoses.csv

This version accepts both ICD-9 and ICD-10 codes, using the coding_system column to indicate the version of ICD being used.

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	diagnosis_code	String[32]	Diagnosis code.
4	coding_system	Enum ( ICD-9 \| ICD-10 )	Field indicating the coding system and version being used.

Notes

Version 2 is restricted to ICD-10 codes, offering a straightforward setup for standard coding.
Version 3 provides flexibility by supporting both ICD-9 and ICD-10 coding systems, making it suitable for integrations requiring legacy or mixed coding standards.
If another coding system is needed, contact Osigu for a tailored processor version.

This file allows the payer to define diagnoses excluded from coverage for specific plans.
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