Shared Costs by Plan

File Name: v2_po_costs_sharings.csv

This file contains information about copayments and coinsurance applicable to each insured individual within a policy. It also defines the minimum required amount for authorization to qualify for direct billing.

The product group names come from a predefined list provided by Osigu during the integration process. Here are some examples:

#	Group Name	Description
1	generic-drug	Group containing all medications considered generic.
2	non-generic-drug	Group containing branded medications.
3	x-ray	Group for diagnostic tests under the X-ray category.
4	medical-evaluation	Group for services related to medical evaluations, such as general outpatient consultations or pediatric evaluations.

The information in this file applies to all insured individuals under the specified policy number.

Structure

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 in the `v2_policies.csv` file.
3	currency_code	String[3] using the ISO 4217	Currency code in which the amounts are expressed.
4	product_group	String[128]	Name of the product/service group affected by this configuration.
5	provider_category	String[64]	Provider category to which this configuration applies. If not applicable, send the value `DEFAULT`.
6	minimum_total_amount	Decimal(15,5)	Minimum amount required for direct billing to apply.
7	copayment_amount	Decimal(15,5)	Fixed monetary amount as the insured individual's copayment.
8	coinsurance_percent	Decimal(15,5)	Percentage of the insured individual's coinsurance.

Notes

This file provides detailed configurations for shared costs (copayments and coinsurance) across various product groups and provider categories. These configurations are essential for ensuring accurate billing and compliance with policy terms.