Specifications include, but are not limited to:. WSI seeks a distinct and separate nation-wide data base of medical procedure codes and corresponding payment to provide Usual, Customary, and Reasonable (UCR) reimbursement amounts. The data base will provide access to objective, independent data as a foundation for decision-making. It also offers an approach to effectively managing risk, negotiating fees, and assists in developing pricing models that are competitive and sustainable. The data base should be updated routinely. This data base is used by identifying the zip code location of where medical treatment is provided. The corresponding medical code and percentile of payment is used to determine WSI reimbursement to providers. WSI utilizes this data base for four reasons: When WSI does not have a reimbursement level for an establish procedure code Upon a provider’s request for adjustment As a starting point for negotiating with out-of-state providers that will not allow access to care according to WSI fee schedule In establishing WSI dental fee schedule Specific modules needed are: Medical Module - Complete Dental Module - Complete Anesthesia Module – Complete
