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Setting Up a New Contract Exception

You can charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider, payer, or location level in order to apply the exceptions to charges. If you have a CPT4 code that requires more than one exception, you must first set up a new contract exception with a unique name for each instance of the exception. To set up more than one exception per CPT4 code, you must set up a new contract exception using a different contract exception name for each exception with the same CPT4 code.

  1. In File Maintenance, select Libraries > Contract.
    The Contract List window opens.
  2. Right-click the library, and then select Contract Exceptions.
    The Contract Exceptions List window opens.
  3. Select Open Menu , and then select New.
    The Contract Exception Maintenance window opens.
  4. In Contract Exception Name, enter a name for the Contract Exception that describes the group of exceptions.
    Setting Contract Exception in the Contract Exception Maintenance Window

  5. To use the contract as the base contract, select Use as Base Contract.
  6. Enter the Filter Criteria to control which CPT4 items display in the CPT4 list and the contract exception information.
  7. Enter the contract exception information for each CPT4 item listed.
  8. Enter the next exception for the next CPT4 item.
    • If your library has less than 50 CPT4 items, then all the CPT4 codes display in the spreadsheet. You can move to the next CPT4 item to enter an exception for it.
    • If your library has 50 or more CPT4 items, select Type the first number(s) of the CPT4 item you want to locate and enter the next CPT4 item and an exception for it.
  9. Enter all of your exceptions, and then select OK.
Setting Up a New Contract Exception