NextGen Knowledge Center

Set Up a New Contract Exception

  1. In File Maintenance, select Libraries and then Contract.
    The Contracts List window opens.
  2. Select a library and select open menu or right-click the selected library, and then select Contract Exceptions.

    The Contract Exceptions List window opens.

  3. Select open menu button, or right-click in the Description area of the window, and then select New.
    The Contract Exception Maintenance window opens.
  4. In the Contract Exception Name field, enter a name for the Contract Exception that describes the group of exceptions.

  5. To use this contract as the base contract, select the Use as Base Contract check box (instead of being used as an exception to the contract).
  6. Enter the Filter Criteria to control which CPT4 items display in the CPT4 list, as follows:
    • Enter the first number of the CPT4 item in Type 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. Type the first few numbers of the CPT4 code until the CPT4 item displays in the spreadsheet area of the window.

    • Select Include Past CPT4 Items check box to display all expired CPT4 items.
    • Select Exception CPT4s only check box to display CPT4 exceptions only.

    You can move from field to field by pressing the Tab key.

  7. Enter the contract exception information for each CPT4 item listed.
    • Enter CPT4 and Date Range.

      These fields display the CPT4 code information from the contract that you selected to create this exception.

    • Enter the dollar amount allowed by the contract exception for the CPT4 code in the Allowed field.
    • Enter the percentage of the allowed fee that you expect to receive for services rendered by participating providers in the % field under Participating field.
    • Enter the dollar amount that you expect to receive for services rendered by participating providers in the Reimbursed field under the Participating field.
    • Enter the percentage of the allowed fee that you expect to receive for non-participating providers in the % field under the Non-Participating field.
    • Enter the dollar amount that you expect to receive for non-participating providers in the Reimbursed field under the Non-Participating field.
    • Select Auth Req check box if authorization is required from the payer for this charge.
    • Select Refer Req check box if a referral is required from the payer for this charge.

    • Enter the percentage of the allowed fee for the co-pay for the specified CPT4 code by contract exception in the % field under the Co-Pay field.

    • Enter the dollar amount for the co-pay for the specified CPT4 code by contract in the Amount field under the Co-Pay field.

  8. Enter the next exception information for the next CPT4 item. If your library has:
    • If your library has fewer than 50 CPT4 items, then all the CPT4 codes automatically display in the gray area of the spreadsheet. You can then press the Tab key or arrow keys on your keyboard to move to the next CPT4 item to enter an exception for it.
    • If your library has 50 or more CPT4 items, the items do not automatically display in that section. You must go back to the Type the first number(s) of the CPT4 item you want to locate field and type the first few numbers of the next CPT4 item to enter an exception for it. The CPT4 item then displays in the spreadsheet area of the window.
  9. Continue this process until you enter all of your exceptions, then select OK.