Add, Edit, and Copy Insurance Contracts

Version 14.19
Utilities > Manage Practice >  Insurance Contracts

Overview

Insurance contracts can be added to OP for the purpose of tracking reimbursements made by Insurance companies. Some of the benefits include:

  • Unlimited number of contracts you can create.
  • Contracts retain the history of how payment schedules change over time.
  • Contracts can be applied to specific locations and providers.
  • Contracts allow you to indicate non-covered and capitated services.

Add a New Insurance Contract

  1. Open the Insurance Contracts window using the path above.
  2. Click the Insert Record button.
  3. Select either Non-Vaccine, Vaccine Only, All CPTs, or None

Note: Selecting the All CPTs radio button is recommended for tracking a reimbursement schedule for a particular payer.
  1. Select an Effective Date using the dropdown. 
  2. Click Save.  
  3. Enter a Name and Description for your contract so it can be easily identified when adding it to the Insurance Payer. The Effective Date will prefill according to the date entered in the last step. 
  4. (Optional) Enter the Anniversary Date or date in which the contact will renew and new rates will be effective.
  5. Add an Expiration Date.
  6. Enter the the following for the corresponding CPT codes.
  • Payer Allowable: This is the amount the payer will allow for this CPT code. You can leave this set to 0 for services that receive no pay.
  • Method:
    • Fee for Service: This is the most common and is the default for all converted fee schedules.
    • Capitation: Selecting this indicates that this service is covered by a capitation agreement under which no itemized payment is expected.
    • Copay only: This is a variation of capitation, mostly intended for E&M services where the payment amount varies based upon each patient’s copay.
    • Patient Responsibility Only: This is used for services that are known to be non-covered.

Edit an Insurance Contract

  1. Click on the contract to edit.
  2. Click on the Edit button  .
  3. In the top section of the window, edit the Name, Description, or Effective Date, if necessary.
  4. In the bottom section of the window, edit CPT Code, Mod, Effective Date, Amount and Method fields, if necessary.

Copy an Insurance Contract

The Clone Contract function allows you to make an exact copy of an existing contract, to enter a date upon which the new dates are to take effect, and to assign the cloned contract to every payer who is associated with the existing contract.

  1. Open the Insurance Contracts window.
  2. Select the contract to clone.
  3. Click on the Clone button .
  4. OP displays the Insurance Contract Clone Confirmation window informing you that the current contract will expire.
  5. Select the Effective Date for the cloned contract. To do so, click the drop down arrow in the Effect Date field and select a date from the drop down calendar.
Note: If the Effective Date is set to a date in the future, the original contract will be populated with an Expiration Date one day prior to the Effective Date of the cloned contract. 
  1. If you want the system to assign the cloned contract automatically to every payer who is associated with the existing contract, select the Update Associated Payers checkbox.

  1. An exact replica of the copied contract will show.
Version 14.10
Utilities > Manage Practice >  Insurance Contracts

Overview

Insurance contracts can be added to OP for the purpose of tracking reimbursements made by Insurance companies. Some of the benefits include:

  • Unlimited number of contracts you can create.
  • Contracts retain the history of how payment schedules change over time.
  • Contracts can be applied to specific locations and providers.
  • Contracts allow you to indicate non-covered and capitated services.

Add a New Insurance Contract

  1. Open the Insurance Contracts window using the path above.
  2. Click the Insert Record button.
  3. Select either Non-Vaccine, Vaccine Only, All CPTs, or None

Note: Selecting the All CPTs radio button is recommended for tracking a reimbursement schedule for a particular payer.
  1. Select an Effective Date using the dropdown. 
  2. Click Save.  
  3. Enter a Name and Description for your contract so it can be easily identified when adding it to the Insurance Payer. The Effective Date will prefill according to the date entered in the last step. 
  4. (Optional) Enter the Anniversary Date or date in which the contact will renew and new rates will be effective.
  5. Add an Expiration Date.
  6. Enter the the following for the corresponding CPT codes.
  • Payer Allowable: This is the amount the payer will allow for this CPT code. You can leave this set to 0 for services that receive no pay.
  • Method:
    • Fee for Service: This is the most common and is the default for all converted fee schedules.
    • Capitation: Selecting this indicates that this service is covered by a capitation agreement under which no itemized payment is expected.
    • Copay only: This is a variation of capitation, mostly intended for E&M services where the payment amount varies based upon each patient’s copay.
    • Patient Responsibility Only: This is used for services that are known to be non-covered.

Edit an Insurance Contract

  1. Click on the contract to edit.
  2. Click on the Edit button  .
  3. In the top section of the window, edit the Name, Description, or Effective Date, if necessary.
  4. In the bottom section of the window, edit CPT Code, Mod, Effective Date, Amount and Method fields, if necessary.

Copy an Insurance Contract

The Clone Contract function allows you to make an exact copy of an existing contract, to enter a date upon which the new dates are to take effect, and to assign the cloned contract to every payer who is associated with the existing contract.

  1. Open the Insurance Contracts window.
  2. Select the contract to clone.
  3. Click on the Clone button .
  4. OP displays the Insurance Contract Clone Confirmation window informing you that the current contract will expire.
  5. Select the Effective Date for the cloned contract. To do so, click the drop down arrow in the Effect Date field and select a date from the drop down calendar.
Note: If the Effective Date is set to a date in the future, the original contract will be populated with an Expiration Date one day prior to the Effective Date of the cloned contract. 
  1. If you want the system to assign the cloned contract automatically to every payer who is associated with the existing contract, select the Update Associated Payers checkbox.

  1. An exact replica of the copied contract will show.