Fields on the Fee Schedule Tab

Field	Description
Date Range	Indicates the Effective date when the fee is to begin, and the Expiration date when the fee will end. The Date Range for the specific CPT4 code must fall within the date range for the contract as defined on the General tab. You can enter multiple date ranges for a CPT4 code in cases where you need to update your contract to meet new requirements. Note: The Fee Schedule rows display in descending date order by Effective Date. The most recent dates display first. Example: 01/01/2016 and then 01/01/2000.
Type	Specifies the Fee for Service (FFS) as the type of charge. Note: Capitated type is not supported at this time.
Non-Facility/Facility	Indicates whether the reimbursement for a service performed at a facility or non-facility service location.
Allowed	Indicates the amount allowed by the contract for the charge. An adjustment will be made between the charge amount and the allowed amount during charge entry if the Automatically adjust charges check box is selected on the General tab. If it is not selected, the adjustment will be taken when a payment from the payer attached to the contract is entered.
Participating Reimbursed	Specifies either the percentage (%) or amount of reimbursement for participating providers. You can enter the percentage, then the amount is automatically calculated. You can enter the amount, then the percentage is automatically calculated. The calculation is based on the amount in the Allowed column. These fields are used by the application to prorate the expected amount due from the payer and the patient. This information is displayed on the Encounter Balance Control window.
Non-Participating Reimbursed	Indicates the percentage (%) or amount of reimbursement for non-participating providers. The field that you do not fill in automatically displays 0.00. The proration will be correct in the Encounter Balance Control window.
Auth Req	This field specifies, if this charge requires authorization from the payer or if a referral is required for the CPT4 code. Based on your setup for alerts and contract edits, checking this field results in the following: An alert stating an authorization is required. A warning edit on the Claim Production Status report. A required edit on the Claim Production Status report.
Refer Req	This field specifies, if a referring physician is required for the CPT4 code. Based on your application alert setup and contract edits, checking these fields result: An alert stating a referring physician is required. A warning edit on the Claim Production Status report. A required edit on the Claim Production Status report.
Apply Co-Pay	If the CPT4 code requires a co-pay, select the field and then enter an amount. Enter either the Co-Pay % or the Co-Pay Amount. If you enter both, the amount overrides the percentage. If you enter a percentage in the % field and press the Tab key, the system will calculate the amount and display it in the Amount field. If the CPT4 code requires the same co-pay amount that is indicated on the General tab, you can leave the Co-Pay % and Amount fields blank. Note: If this co-pay field is not checked, the application will not calculate a co-pay for this CPT4 code, even if the Amount column is populated.
Required Diagnoses	If the charge requires a specific diagnosis to be reimbursed by the payer, select open menu and select an ICD9 code. You are allowed to enter more than 100 diagnoses.
Required Modifiers	If the charge requires a specific modifier to be reimbursed by the payer, select on open menu next to the Required Modifiers box. To add a modifier, select New and the Add Required Modifiers Information window opens. Enter the modifier required for the charge. This modifier becomes part of the edits run when a charge that is associated with this contract is entered. Note: The modifiers you enter do not rely on the Modifiers master file. From open menu , you can also edit an existing record or delete a record.