In File Maintenance, select Libraries and then Contracts.
The Contracts Libraries window opens.
To add a new contract, select the open menu button, and choose New.
To modify an existing contract, highlight the contract, select the open menu button, and then select Open.
The Contract Library Maintenance window opens.
Enter or modify the Contract Name, Effective Date, and Expiration Date.
Enter or modify the Contract Defaults information.
Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, enable the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box.
Enter or modify the information in the Automatic Adjustments section that applies.
Select the Fee Schedule tab.
Enter or modify the CPT4 code that is applicable to the contract in the CPT4 field using the open menu button or the button.
To find a CPT4 code, select the open menu button and select Lookup to display a list of CPT4 codes and descriptions. When you select a CPT4 code, information from that code automatically fills in on the Fee Schedule tab of the Contract Library Maintenance window.
The CPT4 search field functions like the SIM List Search in the Service Item Library.
Enter or modify the Effective and Expiration dates under Date Range.
Under the Co-Pay columns, you can enter either the co-pay % or the co-pay Amount. If you enter both, the amount overrides the percentage. Therefore, enter the information in one of the following fields:
Enter a percentage in the % field and then press the Tab key. The system calculates the amount and displays it in the Amount field. After you refresh the window, the % field becomes blank, but the amount still displays in the Amount field.
Enter an amount in the Amount field.
Note: The Co-Pay fields enable you to enter and maintain a co-pay amount on a per CPT4 code basis by contract. If a charge has a co-payment specified, it is accounted for in the patient responsibility calculation when the charge is prorated. The line item co-pay patient responsibility calculation applies to both Fees for Service and Capitated contracts.
Enter or modify the diagnosis or modifier codes for the CPT4 code if the payer requires them as part of the contract. Select the open record button next to the Required Diagnoses list to enter a diagnosis code.
To enter a modifier code as text, next to the Required Modifiers box at the bottom of the window, select the open menu button to enter a modifier code as text.
You can add a new modifier, edit an existing record, or delete a record.
To add a modifier, select New.
The Add Required Modifiers Information window opens.
Type in the modifier required for the charge. This modifier becomes part of the edits that run when a charge associated with this contract is entered.
Select OK.
Note: If the fee scale changes for the CPT4 code for the payer, add a new Effective Date range.
