The system uses the path code to determine the UCR
The Usual, Customary, and Reasonable amounts allowed for a procedure. UCR compares the charge for a procedure to the amount other doctors have charged for the procedure. UCR data can be external data obtained from HIAA or MDR by geographic area, or can be compiled internally. The allowed determination can be based on a percentile; for example, the 85th percentile would cover the charges of 85% of the doctors who submitted bills. amount for claim calculations. Some codes below refer to parameters set in the claim schedule, such as geo A grouping of zip codes with similar demographics used for UCR pricing. codes or procedure source codes.
You can view path codes for claim lines on the Cap Detail workspace field descriptions. See Claim information.