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Account Information

The first step to create any contract is to fill this page. A contract has to be created in order to track any status associated with it. 

Status

  1. Inbound Request
  2. In Review
  3. Rejected
  4. Negotiate Terms/Rates
  5. In Progress
  6. Ready for Signature
  7. Submitted
  8. Accepted
  9. Negotiation Complete
  10. Active
  11. Terminated
  12. Archived
  13. Non-Renewed
  14. Renewed

Contract Display Picture

This picture also reflects in the credentialing module and on the provider portal in relevance to enrollments.

Line of Business

Every contract has to be marked under one of the identified line of businesses

  • Medicare
  • Medicaid
  • Tricare
  • CHAMPVA
  • Group Health Plan
  • FECA BLK LUNG
  • Other
  • Not Applicable

Funder Name

This is a contract common name which could be separate from legal name. This name appears on the page which lists all your contracts. Also, this is the most commonly used field in reports so it’s important to add an easily recognizable contract name here which meets your nomenclature protocol. 

Account Number

This is a system generated unique number for every contract.

Legal Name

This can be the same as a funder name in some cases. This is the precise legal name of the contract. 

Contract Type

  • Insurance
  • School
  • Regional Center
  • Private Pay
  • Grant
  • Military
  • Medicaid State
  • Medicaid Insurance
  • Other/Unclassified

Contract Sub-Type

  • Master Contract
  • SCA
  • MOU
  • LOA
  • Not Applicable (In case of PPA or other/unclassified contracts)
  • Other

Payor ID

This field is to be used if/when applicable for any contract. Not all contracts have a mention of vendor number or payor ID.

Contract Region

  • National - If a contract is applicable for all offices/service locations across the nation
  • State - If a contract is applicable for specific states
  • Office - If a contract is applicable to specific offices/service locations
  • Other

Applicable State(s)

You can select “All States” or any specific states where the contract is applicable. You can select multiple states from the dropdown.

Applicable Location(s)

You can select “All offices” or any specific office where the contract is applicable. You can select multiple offices from the dropdown.

Applicable for all patients? (Yes/No)

Generally, in case of master contracts this is selected as “Yes” which means that this contract can be utilized for any patient in the organization. 

In case of SCA or Grants or PPA etc you should select “No”, which will then ask you for the patient's reference number. 

You can add multiple patients under one contract. 

  1. Contract Details

Once a contract negotiation is complete then this section should be filled by extracting specifics from the contract. 

This mainly covers-

  • Rules related to billing and scheduling
  • Initiation and renewal date
  • Agreement Type
  • Plan Type
  1. Rates

All the rates for all service items associated with this contract can be viewed on this page. 

To add a new rate, click on “Add Rate” button.

Add Rate

Service Item

While adding a new rate you have to first select the service item for which you are adding a rate. If the rate and other relevant details are the same for multiple service items then you can select multiple service items from the dropdown.

State and Service Location

By default, the state and office selected on the ‘Account Information’ page is selected here. If the rate is different across states or offices then you can select specifics. If more than one states/offices have the same rates then you can select multiple states and offices at assign rates to all those offices at once.

Fee Type

 

Amount, Modifier, Role, Allowed Locations

In this section you can add amount (rate) as per selected fee unit, modifier which will appear in the form 1500 on selected on the specified location. 

Role (Provider Role)

This function can be used to bill by credential. For example, you can set a different rate for a BCBA vs a licensed provider for the same service. When a bill is generated, the system will bill based on the highest credentials of the provider. 

Note: Order of credentials can be set through admin > Roles section. Example: Doctor (PHD) can be the highest rank; second highest could be a BCBA etc.

 

Max Units Per Day in Authorizations and Scheduling

Adding MUE in Contracts:

  • When you add the Max Units per Day (MUE) in the contract rates, it automatically appears on the authorization page when you're creating a new authorization. This is mainly for convenience when adding a new authorization.
  • However, if the authorization is already created and you later add or change the MUE in the contract, it will not automatically update in the existing authorization.

Overriding MUE in Authorization:

  • The Max Daily Units can be added or overridden in the authorization at any time. Whatever you set in the authorization will become the scheduling limit.

Impact on Scheduling:

  • Whatever limits are displayed on the authorization page are what will be used as limits in the actual scheduler.

For example:

  • If the contract didn’t originally have an MUE and you added an authorization with a 16-unit daily limit, your schedule will only allow up to 16 units of that service per day.
  • If you then go back and add a 32-unit max daily limit in the contract, it will not automatically update in the authorization because the system assumes you intentionally set it to 16 units.
  • You would need to manually update the authorization to 32 units, and only then will the scheduler reflect the updated limit.