To override service-line reimbursement, you access the Claims Policy Tab of the contract and enter an extension and type into the Claim Pricing Code Table.

• A. Not possible
• B. False
• C. It depends
• D. True

Answer: (D)

The ability to override service-line reimbursement is achieved through the contract’s Claims Policy. You create an extension within that policy that targets the specific service lines, and then you enter the override details into the Claim Pricing Code Table. The extension defines when the override should apply (for example, to certain payer/service-line combinations), and the Claim Pricing Code Table holds the actual override values (pricing codes, fixed prices, or calculated overrides). When a claim line matches the extension criteria, the system uses the values from the Claim Pricing Code Table, so the reimbursement for that service line is overridden as intended. This is why the statement is true.