ICE - Coded Division of Financial Responsibility Now Available

From: 1
Date: 2/13/2017 7:16:33 PM
Subject: ICE - Coded Division of Financial Responsibility Now Available

The Division of Financial Responsibility, or DOFR, is a tool used in the contracting process by health plans, physician organizations and hospitals in capitated or shared risk payment arrangements to define which party is financially responsible for services rendered.
The DOFR provides a framework for health plan and provider organizations when allocating financial responsibilities for services and includes a standard set of health care service categories and over 10,000 associated billing and revenue codes. It gives plans and providers a uniform starting point for capitated payment negotiations and assignment of risk, while reducing payment ambiguities, administrative burdens associated with managing multiple risk relationships, and misdirected claims ('claims ping-pong') which has led to consumer frustration.
The DOFR, developed through a collaborative process led by the Integrated Healthcare Association (IHA) and transitioned to ICE in 2016, lists service categories typically used in managed care contracting, and defines those service categories by mapping them to healthcare billing codes: CPT®, HCPCS, ICD-10, and hospital revenue codes. The product applies to HMO, Managed POS, and Medicare Advantage products. The product does not yet cover Medicaid products.
This standardized template is updated for annual coding releases, and vetted by a multi-stakeholder ICE workgroup representing various healthcare sectors.
As a value-added service for ICE membership, the ICE Board of Directors has approved offering the DOFR at no cost. However, since ICE was required to obtain a licensing agreement with the American Medical Association (AMA) and pays a royalty fee per user on an annual basis for use of the CPT® codes in the DOFR, no more than five (5) people in any one organization will be able to have access to the DOFR on an annual basis.
The ICE workgroup has completed their review and update of the 2016 annual release of the DOFR and it is now available for use. To access the DOFR registration system, you need to be logged into your ICE website account, and once logged in, you will see the 'Coded DOFR' menu option where you will be able to request access to the document and download it if access is granted based on the availability limitation noted above.
If you have any questions or need assistance with the registration process, please contact the ICE Administrative Operations Coordinator at Thank you.
CPT is a registered trademark of the American Medical Association

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