{
  "reporting_entity_name": "Nova Healthcare Administrators, Inc.",
  "reporting_entity_type": "Third-Party Administrator",
  "version": "1.0.0",

  "in_network": [{
    "negotiation_arrangement": "ffs",
    "name": "Telehealth visit",
    "billing_code_type": "CPT",
    "billing_code_type_version": "2020",
    "billing_code": "99441",
    "description": "Telephone evaluation/management by a physician or other qualified health care professional, 5-10 minutes",
    "negotiated_rates": [{
      "provider_groups": [{
        "npi": [1245403567],
        "tin":{
          "type": "ein",
          "value": "201020949"
        }
      }],
      "negotiated_prices": [{
        "negotiated_type": "negotiated",
        "negotiated_rate": 55.00,
        "expiration_date": "2022-12-31",
        "service_code": ["02", "10"],
        "billing_class": "professional"
      }]
    }]
  }
    ,{
    "negotiation_arrangement": "ffs",
    "name": "Telehealth visit",
    "billing_code_type": "CPT",
    "billing_code_type_version": "2020",
    "billing_code": "99442",
    "description": "Telephone evaluation/management by a physician or other qualified health care professional, 11-20 minutes",
    "negotiated_rates": [{
      "provider_groups": [{
        "npi": [1245403567],
        "tin":{
          "type": "ein",
          "value": "201020949"
        }
      }],
      "negotiated_prices": [{
        "negotiated_type": "negotiated",
        "negotiated_rate": 55.00,
        "expiration_date": "2022-12-31",
        "service_code": ["02", "10"],
        "billing_class": "professional"
      }]
    }]
  }
    ,{
    "negotiation_arrangement": "ffs",
    "name": "Telehealth visit",
    "billing_code_type": "CPT",
    "billing_code_type_version": "2020",
    "billing_code": "99443",
    "description": "Telephone evaluation/management by a physician or other qualified health care professional, 21-30 minutes",
    "negotiated_rates": [{
      "provider_groups": [{
        "npi": [1245403567],
        "tin":{
          "type": "ein",
          "value": "201020949"
        }
      }],
      "negotiated_prices": [{
        "negotiated_type": "negotiated",
        "negotiated_rate": 55.00,
        "expiration_date": "2022-12-31",
        "service_code": ["02", "10"],
        "billing_class": "professional"
      }]
    }]
  }
  ]
}