Contract Exception Maintenance Filter Criteria and Contract Exception Definitions
Enter the Filter Criteria using the table below.
| Filter Criteria | Action/Required Information |
|---|---|
| Enter the first number(s) of the CPT4 item you want to locate | If the CPT4 column contains a lot of items, you can use this field to help you find a CPT4 code. Enter the first few numbers of the CPT4 code until the CPT4 item displays in the spreadsheet area of the window. |
| Include Past CPT4 Items | Select this check box to display all expired CPT4 items. |
| Exception CPT4s only | Select this check box to display CPT4 exceptions only. |
Enter the contract exception information for each CPT4 item listed using the table below:
| Filter Criteria | Action/Required Information |
|---|---|
| CPT4 and Date Range | These fields display the CPT4 code information from the contract that you selected to create this exception. |
| Allowed | Enter the dollar amount allowed by the contract exception for the CPT4 code. |
| Participating % | Enter the percentage of the allowed fee that you expect to receive for services rendered by participating providers. |
| Participating Reimbursed | Enter the dollar amount that you expect to receive for services rendered by participating providers. |
| Non-Participating % | Enter the percentage of the allowed fee that you expect to receive for non-participating providers. |
| Non-Participating Reimbursed | Enter the dollar amount that you expect to receive for non-participating providers. |
| Auth Req | Select this check box if authorization is required from the payer for this charge. |
| Refer Req | Select this check box if a referral is required from the payer for this charge. |
| Co-Pay % | Enter the percentage of the allowed fee for the co-pay for the specified CPT4 code by contract exception. |
| Co-Pay Amount | Enter the dollar amount for the co-pay for the specified CPT4 code by contract. |