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| Field | Contract Defaults - Contractor and Co-Pay Options Descriptions |
|---|---|
| Co-Payment on Office Encounters | To require a co-payment, select this check box. When you attach insurance to an encounter, an alert reminds you that the contract requires a co-pay for all encounters. |
| Default Co-Pay Amount | Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when you attach the insurance to the encounter, you will be given another warning. |
| Co-Pay Origin | Select either Allowed or Reimbursed to determine whether the co-pay percent will be multiplied by the allowed or the reimbursed amount. The Co-Pay Origin can be set to use either an allowed amount or a reimbursed amount to calculate a co-pay that is due. This option is used with the Co-Pay % that is set at the payer-level. In addition, the percentage co-pay will only be calculated for individual CPT4 codes designated on the Fee Schedule tab. |
| Deductible in Effect | If the contract requires a deductible amount, select this check box. When entering insurance information for the patient, an alert warns you that a deductible is required. |
| Multiply Fee Schedule Co-Pay by Quantity | Select this check box so that the fee schedule co-pay multiplies by the charge line item quantity. For example, if based on the fee schedule, there is a $100 charge where $50 is allowed, 80% (or $40) is reimbursed for participating, and the copay is 20% (or $10). When you enter that charge with a quantity of 5, the amount for the one-time 20% copay is multiplied by 5. The result is $10 x 5 = $50. |
| Apply Co-Pay to First Line Item (default) | Select this check box to apply a co-pay to the first charge line item only. The co-pay amount pulls from the contract's Fee Schedule tab, if set up. Otherwise, the co-pay amount pulls from Insurance Maintenance. |
| Apply Co-Pay to All Line Items | Select this check box to apply a co-pay to all charge line items, including those that are not listed on the contract's Fee Schedule tab. The co-pay amount pulls from the Fee Schedule tab, if set up. Otherwise, the co-pay amount pulls from Insurance Maintenance. |
| Apply Co-Pay to All Line Items in the Fee Schedule | Select this check box to apply a co-pay to all charge line items that are listed on the contract's Fee Schedule tab that have an entry in the Co-Pay Amount field and a green check mark. Otherwise, a co-pay amount is not applied. |
| Contract Subgrouping 1 & 2 | Select the contract subgroup that indicates what kind of contract this is.
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| Note | Enter any additional information about the contract library. This note is visible only within the current library. |