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Commercial Payers: Commercial payers generally follow CPT and CMS guidance but often layer on additional requirements

The retrospective multicentre cohort study included patients with HS exposed to GLP-1 RAs from 2017 to 2024, using data from the HS-France network and biomedical warehouses from eight French hospitals

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In order to ensure that all hospitals subject to the HPT requirements are able to calculate and encode the allowed amounts, we are requiring hospitals to use EDI 835 ERA transaction data or an alternative, equivalent source of remittance data that includes the same information as EDI 835 ERA transaction data would include (as discussed in more detail below)

Cheng, Chak Kwong, et al