If zero ($0.00) or a positive amount is found for the CPT4 code in the Co-Pay Amount column on the Contract Exception Maintenance window, the defined amount will be the patient’s co-pay for that service. If there is zero amount for the CPT4 code, the system continues with the next step in the hierarchy to derive the co-pay amount.
Note: The contract must be linked to the primary insurance on the encounter in the
Managed Care Contract field on the sub-tab of the
Payers master file. The contract exception must be linked to the rendering provider in the field on the
Practice tab of the
Providers master file. The providers must be selected in the
Participating Providers field below the
Contract field or the contract is not used for those providers.
The contract exception Co-Pay Amount is applied to a charge only if the rendering, location, and payer on the charge matches the rendering, location, payer, and contract exception setup in the Providers master file.
