General Information fields

The General tab of Contract Library Maintenance window consists of the following sections:

Contract Information
Contract Defaults
Alerts and Edits
Allowed and FFS/Balance Distribution
Automatic Adjustments

Contract Information

Field	Contract Information Descriptions
Contract Name	Indicates the contract name.
Effective Date	Indicates the date that the contract becomes effective.
Expiration Date	Indicates the date that the contract becomes expired.

Contract Defaults

Field	Contract Defaults - Contractor and Co-Pay Options Descriptions
Co-Payment on Office Encounters	Requires a co-pay for the contract while attaching insurance to an encounter.
Default Co-Pay Amount	Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when you attach the insurance to the encounter, you will be given another warning.
Co-Pay Origin	Determines whether the co-pay percent will be multiplied by the Allowed or the Reimbursed amount. The Co-Pay Origin can be set to use either an allowed amount or a reimbursed amount to calculate a co-pay that is due. This option is used with the Co-Pay % that is set at the payer-level. In addition, the percentage co-pay will only be calculated for individual CPT4 codes designated on the Fee Schedule tab.
Deductible in Effect	Requires a deductible amount when entering insurance information for the patient.
Multiply Fee Schedule Co-Pay by Quantity	Multiplies the fee schedule co-pay by the charge line item quantity. If based on the fee schedule, there is a $100 charge where $50 is allowed, 80% (or $40) is reimbursed for participating, and the copay is 20% (or $10). When you enter that charge with a quantity of 5, the amount for the one-time 20% copay is multiplied by 5. The result is $10 x 5 = $50.
Apply Co-Pay to First Line Item (default)	Applies co-pay to the first charge line item only. The co-pay amount pulls from the contract's Fee Schedule tab, if set up. Otherwise, the co-pay amount pulls from Insurance Maintenance.
Apply Co-Pay to All Line Items	Applies co-pay to all charge line items, including those that are not listed on the contract's Fee Schedule tab. The co-pay amount pulls from the Fee Schedule tab, if set up. Otherwise, the co-pay amount pulls from Insurance Maintenance.
Apply Co-Pay to All Line Items in the Fee Schedule	Applies co-pay to all charge line items that are listed on the contract's Fee Schedule tab that have an entry in the Co-Pay Amount field and a green check mark. Otherwise, a co-pay amount is not applied.
Contract Subgrouping 1 & 2	Indicates the contract subgroup. Note: The field names you see may be different because they come from the names entered in the Contract Subgrouping fields on the General tab under the Enterprise Preferences.
Note	Enters any additional information about the contract library. This note is visible only within the current library.

Alerts and Edits

Field	Alerts and Edits Descriptions
Referring Physician Required	If the contract calls for a referring physician, select this check box.
Enable Build Level Edits	Displays Contract Edits on the Claim Production Status report as Build or Warning level claim edits when an encounter is billed. The Enable Build Level Edits option turns some contract edits from a warning to required during the billing process. When the edits are not passed, a claim will not be created. This option works with the Contract Edit options in Practice Preferences.
Authorization Required	If the contract calls for authorization, select this check box. When you enter charges for an encounter, an alert appears warning you that the contract for the payer requires an authorization for all CPT4 codes.

Allowed and FFS/Balance Distribution

Field	Allowed and FFS/Balance Distribution Descriptions
Fee for Service	Enters the percentage of the full fee that you expect to get for participating and non-participating physicians.
% of Allowed Amount for Participants	Enters the percentage of the allowed amount a participating provider expects to be reimbursed. A provider is a participant when the contract is selected for it in the Providers master file.
% of Allowed Amount for Non-Participants	Enters the percentage of the allowed amount a non-participating provider expects to be reimbursed.
Prorate Insurance Balance	If this option is selected and it is also selected on Other tab (of Practice in the Add/Modify Payer Information window) then: The patient's charges will be prorated between the Primary Insurance and the Secondary or Patient bucket. The proration is based on the Fee for Service percentages. The prorated balances can be viewed in the patient's Balance Control window. Note: If you prorate the patient's charges, you can get a better idea of your true Account Receivable status. Your reports will reflect the true percentage that you expect to get from each of your insurance companies, rather than showing it all under the primary payer. Note: When the Prorate Insurance Balance option is checked, balances are allocated to responsible parties based on the % of Allowed Amount for the option or the specifics of a CPT4 line item. This selection works in conjunction with the Prorate Insurance Balance option Fee for Service on the Payer master file.
Enable Drug Allowed Amount	Enables you to bill drug codes to Medicare and view three digits display after the decimal in the Allowed column in the Contract Library Maintenance Fee Schedule tab. For example, 20.244 instead of 20.24. The Reimbursed columns also display three digits because they are based on the Allowed column amounts. Note: The Medicare Part B Drug Average Sales Price (ASP) drug pricing files use three digits.
Fully Capitated	Automatically adjust the total charge on the claim. To activate this function you must: select Default contract amounts when payer selected in the Transaction window in the Practice Preferences. The adjusted amount appears in the Adj column on the Transaction window.
Produce Claim for documentation	Prints a claim.

Automatic Adjustments

Table 1. The Automatic Adjustments section enables you to automatically adjust charges to the expected allowed amount at the time they are entered. This section is used in conjunction with the Fee Schedule tab.
Field	Automatic Adjustments Descriptions
Automatically adjust charges	Select this check box so that adjustments are automatically made for the items at the time charges are entered on the Charge Posting window. This check box enables the remaining fields in the section.
Adjustable Allowed Amount	Determines the write off automatic adjustment based on the patient co-pay plus the contract reimbursement amount. If you select this option, the Co-Pay Origin field changes to Reimbursed and, in the Fee Schedule tab, the Allowed column becomes disabled.
Default Auto-Adj Transaction	You can select the transaction code to associate with the automatic transactions. Note: The codes listed are set up in the Transaction Codes master file as an Adjustment type and have the source as Third party.
Allow positive adjustments	Allows the patient to have a credit adjustment applied to the charge. If the amount that your contract specifies for is a charge more than the amount normally allowed, then a positive adjustment should be made. Note: When the charge is less than the allowed amount then the Allow positive adjustments option will adjust the charge up to the allowed amount. If you do not choose this option, an adjustment will be taken if the allowed amount is more than the charge.
If Rendering Not Entered Assume Participating	If you select If Rendering Not Entered Assume Participating and a rendering is not entered in the Charge Posting window, then the system will assume that the rendering was a participant. The fee for service will be adjusted accordingly. If left unchecked, then the charge will be adjusted for a non-participant.
Create Zero Dollar Claim	You can select Create Zero Dollar Claim if you want 1500 claims to be created when the dollar amount is zero on the encounter. When this check box is not selected and the charge amount is $0.00, the encounter is treated as "patient pay" and the claim is not created.

General Information fields