ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page1
Contract management and analysis is one of the most critical focus points of revenue cycle
management. Hospital Financial Managers need a tool to manage, evaluate and optimize
reimbursementtoachievetherequiredreturns.ToprovideasneededongoingContractManagement
Modeling,AnalysisandConsulting.
ThePARADataEditor(PDE)Contracttabprovidesthefollowing:
1. Contracttrackingforrenewalsandkeyterms
2. Settlementofclaimsbypatienttypewithsimpleprioritytieredpaymentstructure
3. CalculationofStopLossimpact
4. Calculationofindividualclaimcapimpact
5. Calculationofannualinflationcapimpact
6. Comparisonofsettlementtohospitalspecificcostdata
7. ComparisonofsettlementtoMedicarereimbursement
8. Calculationimpactforpro‐forma“whatif”analysis
9. Calculationof“LesserofCharge”orfeescheduleimpact
TheContracttabisacomponentofthe PARADataEditor,amulti‐functionweb basedrevenuecycle
managementandanalysistool.
ContractManagementandAnalysis
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DataTableRequirements
ThetablesrequiredtoloadtheContractManagementsystemareasfollows:
1. ChargeDescriptionMaster
2. AccountHeadersandDetailTransactions
3. PatientTypeandInsuranceCrosswalks
4. HIMICD‐10codesfordiagnosisandprocedures
5. PayerContractsormatrix
PastedbelowisalinktothePARADataRequirements
PARA Data Requirements
DataTablesaretransmittedtoPARAusingtheSecureFileTransferlinkpastedbelow
PARA Secure File Transfer User Guide
PARAtracksalldatatablesbyclientandproject,withautomaticemailrequeststodesignatedUsersto
refreshthetables.

ContractManagementandAnalysis
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ContractSummaryTab
ThePDEContractSummarytabpagecontainsthe“dashboard”fortheContactsystem.
Thetabcontainsbasiccontractnotificationandsettlementtermswhichapplytoallpatienttypes,along
withanumberoffunctions:
1. Linkingofmultiple“sibling”contractstoasingle“parent”
2. Selectionofindividualcontractsforpaymenttermanalysis

ContractManagementandAnalysis
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ContractSummaryTab(continued)
3. Sortingofcontracts–Providesfocusandquickretrievalofterms
a. TotalCharges
b. ContractMnemonic
c. InsuranceName
4. Copytermsfromonecontracttoanother

ContractManagementandAnalysis
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ContractSummaryTab(continued)
5. Reporting‐Thereareanumberofdifferentreportingoptions
a. ContractSummaryReports
b. ContractAuditReports
c. Forecasting/ProForma–ProofandClaim
EachreportoptionoffersseveraldifferentreportsfortheUser to analyze reimbursement received
versusthereimbursementexpected.
TheContractSummaryReportsgivetheUseranoverallviewofthecontracttermsincluding
acompletelistingofthesettlementmethodforalltypesofservices,
allStopLosstermsfromtheCommercialcontractsinacombinedview,and
thehierarchythatPARAhasassignedtothecontracts.
ContractManagementandAnalysis
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ContractSummaryTab‐Reporting(continued)
TheContractSummaryreportsofferthefollowingoptionstoviewthetermsofeachcontractwithinthe
PDE.Theyinclude:
ComprehensiveTermSummary–acompletelistingofalltermsforallcontracts
ComprehensiveStopLosstermSummary–acompletelistingofallStopLossterms
ContractHierarchy–asummaryofthehierarchyPARAhasassignedtothecontracts,withthe
insuranceplanwiththehighestrevenueassignedastheparent,allotherplansthatfallunder
thatcontractassignedaschildren,sothattermsremainconsistentacrossallplansunderthat
contract.

ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
TheabovesampleoftheComprehensiveContractTermSummarydisplaysthefollowinginformation:
ContractID–theFSCnumberorPayerID
PatientType‐thepatienttypeslistedinthecontractasreimbursable
Contract‐thecontractnameandwhetherornotitisaparentorchildcontract
ReimbursementMethod–Howthepatienttypeisreimbursed
CodeRange‐iftheReimbursementMethodiscode‐based,thecoderangeisdisplayed
Value‐thedollaramountoftheFeeScheduleReimbursementorpercentageofchargerate
ClaimCap–anylimitonchargesthatwillbereimbursedisdisplayed
ThresholdType–ifthereisathresholdlimitation(daysofservice,percase,hours,charges)
ThresholdUnit–thenumberofthelimitation(i.e.2days)
NotToExceedLimit–ifthereimbursementislimitedtoaspecificdollaramountortimelimit
Comments–notesonthatparticularreimbursement
ContractManagementandAnalysis
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ContractSummaryTab‐Reporting(continued)
Iftherearestoplosstermsassociatedwithanyofthecontracts,theComprehensiveStopLossTerm
Summarywilldisplaythefollowingfields:
ContractID–FSCnumberorPayerID
Contract–Nameofthecontract/payer
Startdate–beginningdateofStopLossTerm
EndDate–EndingdateofStopLossTerm
Threshold–TheamountofthelimitonchargesorperdiemsbeforeStopLossbegins
ThresholdType–Perdiemortotalcharges
%ofBilledCharge–ThepercentagepaidonceStopLossthresholdisreached
Method–Thetypeofreimbursementtoreachthreshold(Firstdollar,SecondDollar,dayafter)
$NottoExceed–Thedollaramountofchargeslimitedbythereimbursementmethod
NottoExceedType–Perdiem,case,orLevelofcare
NottoExceedQuantity–thequantityoftheabove
Exclusions–andcodeorservicetypethatareexcludedfromStopLosscalculation
Exclusiondefinitions–parametersthatfurtherdefinetheexcludedtypesofservice
ExclusionCodes–thelistofcodesthatareexcludedfromStopLosscalculation
ContractManagementandAnalysis
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ContractSummaryTab‐Reporting(continued)
The Contract Hierarchy report will display all contracts loadedintothePDE,inorderofContractID,
whetherornotthatcontracthasbeendesignatedaParentcontract,andidentifythecontractsassigned
aschildrenoftheparentcontract.Anypayersthatdonotfallunderacontractarelistedwithnoparent
assigned.

ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
ThefollowingreportsareavailableintheContractAuditReports:
SettlementSummary
InsuranceProofSettlement
DepartmentPayerSettlement
Top100ClaimsbysettlementlessthanMedicareSettlement
Top100ClaimsbyChargeslessthanContractSettlement
Top100ClaimsbyShortPaymentsvs.ContractSettlement
CustomAccountSearch
ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
TheSettlementSummaryreportfirstrequirestheselectionofapatienttype.

ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
TheSettlementSummarydisplaysavarietyofdatafields:
AccountNumber–Thepatientaccountnumber
ContractID–TheidentifierPARAhasassignedtothecontract
InsuranceDescription–Theinsuranceplanname
PatientType–Inpatient,Outpatient,Emergency,AmbulatorySurgical,Non‐Patient
TotalCharges
TotalPayments–Totalpaymentsreceived
TotalAdjustments‐Totaladjustmentsonaccount
Transactions–numberoftransactionsforclaim
MedicareReimbursement–totalpaymentsexpectedfromMedicarebasedoncodes
EstimatedReimbursement–reimbursementexpectedfromplanbasedoncontract
PercentageofdifferencetoMedicareReimbursement
PercentageofdifferenceinPaymentstoestimatedreimbursement
ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
TheInsuranceProofSettlementReportrequirestheselectionofaPricingIteration,aswellasapatient
type.
ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
TheInsuranceProofSettlementReportdisplaysthefollowingfields:
HeadID–IDnumberfromtheHeaderFilereceivedfromtheFacility
AccountNumber–Thepatientaccountnumber
Insurance–Theinsuranceplancode
PTP–PatientTypeDetail
PatientType–Inpatient,Outpatient,Emergency,AmbulatorySurgical,Non‐Patient
RevenueCode–Therevenuecodeforthelineitemontheclaim
AdmitDate–AsrepresentedinthePatientHeaderFile
DischargeDate–AsrepresentedinthePatientHeaderFile
LOS–Lengthofstay
Payments–Totalpaymentsreceived
Adjustments–Totaladjustmentsonaccount
DRG–DiagnosisrelatedgroupasrepresentedinthePatientHeaderFile
TransID–UniqueIDcalculatedonthetransactionlevelforeachclaim
VisitID–UniqueIDcalculatedonthedateofserviceforeachclaim
DepartmentCode‐LinkstotheCDM,costcenter
ProcedureCode–LinkstotheCDM,chargecode
ProcedureDescription–ItemdescriptionfromtheCDM
OldPrice–PricefromCDMusedtocreateiteration
NewPrice–Newpricefromiteration
CPT®Code–TheCPT®codeforthelineitemontheclaim
Revenue–Totalchargesforitem,usingpricexquantity
ReimbursementMethod–howitemisreimbursedincontractterms
ReimbursementType–Fixed(FeeSchedule)orPercentageofCharge(Variable)
ReimbursementAmount–Finalreimbursementamountforitembasedoncontractterms
ReimbursementPercentage–Finalpercentcalculatedforitemforvariableterms
ReimbursementNotes–anynotescreatedduringsettlement
ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
The Department Payer Settlement Report requires the selection of a Pricing Iteration, a Department,
andaPatientType.
ContractManagementandAnalysis
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ContractSummaryTab–Reporting(continued)
Thisreportdisplaysthefollowingdata:
HeadID–IDnumberfromtheHeaderFilereceivedfromtheFacility
TransID–UniqueIDcalculatedonthetransactionlevelforeachclaim
VisitID–UniqueIDcalculatedonthedateofserviceforeachclaim
TransDate–thedateofserviceforthelineitem
DepartmentCode‐LinkstotheCDM,costcenter
ProcedureCode–LinkstotheCDM,chargecode
ProcedureDescription–ItemdescriptionfromtheCDM
AccountNumber–Thepatientaccountnumber
Insurance–Theinsuranceplancode
PTP–PatientTypeDetail
PatientType–Inpatient,Outpatient,Emergency,AmbulatorySurgical,Non‐Patient
RevenueCode–Therevenuecodeforthelineitemontheclaim
AdmitDate–AsrepresentedinthePatientHeaderFile
DischargeDate–AsrepresentedinthePatientHeaderFile
LOS–Lengthofstay
TotalCharges–totalchargeforitem,basedontransactiondata
Payments–Totalpaymentsreceived
Adjustments–Totaladjustmentsonaccount
Revenue–Totalchargesforitem,usingpricexquantity
OldPrice–PricefromCDMusedtocreateiteration
NewPrice–Newpricefromiteration
DRG–DiagnosisrelatedgroupasrepresentedinthePatientHeaderFile
RevenueCode–Therevenuecodeassignedtothelineitem
CPT®Code–TheCPT®codeforthelineitemontheclaim
Quantity–Theusageofanitem
ReimbursementMethod–howitemisreimbursedincontractterms
ReimbursementType–Fixed(FeeSchedule)orPercentageofCharge(Variable)
ReimbursementAmount–Finalreimbursementamountforitembasedoncontractterms
ReimbursementPercentage–Finalpercentcalculatedforitemforvariableterms
ReimbursementMatch–anymatchestothereimbursementratesfoundinthecontract
ReimbursementNotes–anynotescreatedduringsettlement
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page17
ContractSummaryTab–Reporting(continued)
Aswiththepreviousreports,theTop100ClaimsbysettlementlessthanMedicareSettlementrequires
selectionofapatienttype.
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page18
ContractSummaryTab‐Reporting(continued)
Thefieldsdisplayedinthereportare:
Rank–Whereinthetop100theclaimfalls
AccountNumber–UniquepatientidentifierfromthePatientHeaderFile
InsuranceMnemonic–InsuranceplancodeorFSC
InsuranceName–nameofInsurancePlanintransactionfile
PatientTypeDetail–Hospitalpatienttype
PatientType–Inpatient,Outpatient,Emergency,AmbulatorySurgical,orNon‐patient
AdmitDate–AsrepresentedinthePatientHeaderFile
DischargeDate–AsrepresentedinthePatientHeaderFile
TotalCharges–totalchargeforitem,basedontransactiondata
TotalPayments–Totalpaymentsreceived
TotalAdjustments–Totaladjustmentsonaccount
MedicareReimbursement–WhatMedicarewouldpayonitemorclaim
Revenue–CDMpricemultipliedbyusagequantity
RevenueCode–revenuecodeassignedtoitem
DepartmentCode–LinkstoCDM,costcenter
ProcedureCode–LinkstoCDM,chargecode
TransactionDate–dateofpostingtoaccountforpayments,dateofserviceforcharges
Quantity–quantitypostedtoaccount
ReimbursementMethod–howitemisreimbursedundercontractterms
Charges,Payments,Adjustments,andMedicareReimbursement,andQuantityarealltotaledattheend
ofeachaccount.
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page19
ContractSummaryTab‐Reporting(continued)
As with the previous reports, the Top 100 Claims by charges less than Contract Settlement requires
selectionofapatienttype.
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page20
ContractSummaryTab–Reporting(continued)
Thefieldsdisplayedinthereportare:
Rank–Whereinthetop100theclaimfalls
AccountNumber–UniquepatientidentifierfromthePatientHeaderFile
InsuranceMnemonic–InsuranceplancodeorFSC
InsuranceName–nameofInsurancePlanintransactionfile
PatientTypeDetail–Hospitalpatienttype
PatientType–Inpatient,Outpatient,Emergency,AmbulatorySurgical,orNon‐patient
AdmitDate–AsrepresentedinthePatientHeaderFile
DischargeDate–AsrepresentedinthePatientHeaderFile
TotalCharges–totalchargeforitem,basedontransactiondata
TotalPayments–Totalpaymentsreceived
TotalAdjustments–Totaladjustmentsonaccount
MedicareReimbursement–WhatMedicarewouldpayonitemorclaim
Revenue–CDMpricemultipliedbyusagequantity
RevenueCode–revenuecodeassignedtoitem
DepartmentCode–LinkstoCDM,costcenter
ProcedureCode–LinkstoCDM,chargecode
TransactionDate–dateofpostingtoaccountforpayments,dateofserviceforcharges
Quantity–quantitypostedtoaccount
ReimbursementMethod–howitemisreimbursedundercontractterms
ReimbursementAmount–Finalreimbursementamountforitembasedoncontractterms
ReimbursementMatch–anymatchestothereimbursementratesfoundinthecontract
ReimbursementPercentage–Finalpercentcalculatedforitemforvariableterms
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page21
ContractSummaryTab‐Reporting(continued)
Thefieldsdisplayedinthereportare:
Rank–Whereinthetop100theclaimfalls
AccountNumber–UniquepatientidentifierfromthePatientHeaderFile
InsuranceMnemonic–InsuranceplancodeorFSC
InsuranceName–nameofInsurancePlanintransactionfile
PatientTypeDetail–Hospitalpatienttype
PatientType–Inpatient,Outpatient,Emergency,AmbulatorySurgical,orNon‐patient
AdmitDate–AsrepresentedinthePatientHeaderFile
DischargeDate–AsrepresentedinthePatientHeaderFile
TotalCharges–totalchargeforitem,basedontransactiondata
TotalPayments–Totalpaymentsreceived
TotalAdjustments–Totaladjustmentsonaccount
MedicareReimbursement–WhatMedicarewouldpayonitemorclaim
Revenue–CDMpricemultipliedbyusagequantity
RevenueCode–revenuecodeassignedtoitem
DepartmentCode–LinkstoCDM,costcenter
ProcedureCode–LinkstoCDM,chargecode
TransactionDate–dateofpostingtoaccountforpayments,dateofserviceforcharges
Quantity–quantitypostedtoaccount
ReimbursementMethod–howitemisreimbursedundercontractterms
ReimbursementAmount–Finalreimbursementamountforitembasedoncontractterms
ReimbursementMatch–anymatchestothereimbursementratesfoundinthecontract
ReimbursementPercentage–Finalpercentcalculatedforitemforvariableterms
ReimbursementNotes–anynotescreatedduringsettlement
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page22
ContractSummaryTab‐Reporting(continued)
The Custom Account Search allows the User to select a specific account by entering the account
number.
ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page23
ContractSummaryTab(continued)
6. Forecasting/ProForma–AssignmentofProFormacontracttocurrentcontract
TheForecastingmodelprovidesanefficienttooltodeterminetheimpactofachangetoacontractand
quantitytheimpactagainstanexistingbookofbusiness.

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page24
ContractTermsandSettlementSubTabs
Each of the “summary” patient types defined on the summary tab to link to a sub tab for term
constructionandsettlement,thecomponentsofeachofthesubtabsisasfollows:
1. ReimbursementMethod–howthechargeissettled(i.e.,FeeScheduleorpercentofcharge)
2. Linkto/byRowNumber–ifathresholdexistsforthatsettlement,thenadifferentrateapplies
3. Priority–theorderinwhichchargesaresettled
4. CodeType–settlementbyDRG,HCPCS,Revenuecode
5. CodeFrom/To–rangeofthecodes
6. Value–paymentrateorpercentageofcharges
7. NTE–NotToExceedamount(reimbursementlimitation)
8. ClaimCap–limitonchargesforservice
9. Type–limitertype(days,totalcharges)
10. Unit‐numberofdaysoramountoftotalcharges
11. ThresholdLinktoRow#‐identifiestherowoftheinitialreimbursementrate

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page25
Inpatient
Theavailabletermsareasfollows:
1. CaseRate
2. CaseRate–PercentofCharges
3. CaseRate–PercentofCharges[LesserOf]
4. CaseRate–LesserOf
5. CaseRatewithCarveOut
6. DRG–ContractSpecific[LesserOf]
7. DRG–MedicareWeight
8. DRG–MedicareWeight‐InsurancePerDiem
9. DRG–MedicareWeight[LesserOf]
10. DRG–SpecialWeight
11. DRG–SpecialWeightwithCarveOut
12. PerDiem
13. PerDiem[LesserOf]
14. PerDiem–LowerofPercentDiscountorDailyLimit
15. PerDiemwithCarveOut
16. PercentofCharges
17. PercentofCharges‐subjecttoClaimLimit
18. PercentofCharges–subjecttoClaimLimitw/CarveOut
19. Cost‐SubjecttoSettlement

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page26
Outpatient
Theavailabletermsareasfollows:
1. Feeschedule–ContractSpecific[LesserOf]
2. Feeschedule–ProFee
3. Feeschedule–ContractSpecific
4. Feeschedule–ContractSpecific‐multicodediscount
5. Feeschedule–ContractSpecific‐multicodediscount[LesserOf]
6. FeeSchedule–CostPlus
7. Feeschedule–LabMedicare
8. PercentofCharges
9. PercentofCharges–notsubjecttoFeeSchedule
10. PercentofCharges‐subjecttoClaimLimit
11. PercentofCharges–subjecttoClaimLimitw/CarveOut
12. PerVisit‐BasedonFeeSchedule
13. PerVisit–BasedonFeeSchedule[LesserOf]
14. PerVisit‐BasedonFeeSchedulew/CarveOut

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page27
AmbulatorySurgical
Theavailabletermsareasfollows:
1. ASC–ContractSpecific[LesserOf]
2. ASC–PercentofMedicare
3. ASC‐ContractSpecific
4. ASC–Medicare
5. ASCGroups1‐92009
6. ASCUngroupable‐FeeSchedule
7. ASCUngroupable‐PercentageofCharge
8. Feeschedule–ContractSpecific[LesserOf]
9. Feeschedule–ProFee
10. Feeschedule–ContractSpecific
11. Feeschedule–ContractSpecific‐multicodediscount
12. Feeschedule–ContractSpecific‐multicodediscount[LesserOf]
13. FeeSchedule–CostPlus
14. Feeschedule–LabMedicare
15. PercentofCharges
16. PercentofCharges–notsubjecttoFeeSchedule
17. PercentofCharges‐subjecttoClaimLimit
18. PercentofCharges–subjecttoClaimLimitw/CarveOut
19. PerVisit‐BasedonFeeSchedule
20. PerVisit–BasedonFeeSchedule[LesserOf]
21. PerVisit‐BasedonFeeSchedulew/CarveOut

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page28
Emergency
Theavailabletermsareasfollows:
1. Feeschedule–ContractSpecific[LesserOf]
2. Feeschedule–ProFee
3. Feeschedule–ContractSpecific
4. Feeschedule–ContractSpecific‐multicodediscount
5. Feeschedule–ContractSpecific‐multicodediscount[LesserOf]
6. FeeSchedule–CostPlus
7. Feeschedule–LabMedicare
8. PercentofCharges
9. PercentofCharges–notsubjecttoFeeSchedule
10. PercentofCharges‐subjecttoClaimLimit
11. PercentofCharges–subjecttoClaimLimitw/CarveOut
12. PerVisit‐BasedonFeeSchedule
13. PerVisit–BasedonFeeSchedule[LesserOf]
14. PerVisit‐BasedonFeeSchedulew/CarveOut

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page29
UrgentCare
Theavailabletermsareasfollows:
1. Feeschedule–ContractSpecific[LesserOf]
2. Feeschedule–ProFee
3. Feeschedule–ContractSpecific
4. Feeschedule–ContractSpecific‐multicodediscount
5. Feeschedule–ContractSpecific‐multicodediscount[LesserOf]
6. FeeSchedule–CostPlus
7. Feeschedule–LabMedicare
8. PercentofCharges
9. PercentofCharges–notsubjecttoFeeSchedule
10. PercentofCharges‐subjecttoClaimLimit
11. PercentofCharges–subjecttoClaimLimitw/CarveOut
12. PerVisit‐BasedonFeeSchedule
13. PerVisit–BasedonFeeSchedule[LesserOf]
14. PerVisit‐BasedonFeeSchedulew/CarveOut

ContractManagementandAnalysis
©PARAHealthcareFinancialServicesDecember2016 Page30
NonPatient
Theavailabletermsareasfollows:
1. Feeschedule–ContractSpecific[LesserOf]
2. Feeschedule–ProFee
3. Feeschedule–ContractSpecific
4. Feeschedule–ContractSpecific‐multicodediscount
5. Feeschedule–ContractSpecific‐multicodediscount[LesserOf]
6. FeeSchedule–CostPlus
7. Feeschedule–LabMedicare
8. PercentofCharges
9. PercentofCharges–notsubjecttoFeeSchedule
10. PercentofCharges‐subjecttoClaimLimit
11. PercentofCharges–subjecttoClaimLimitw/CarveOut
12. PerVisit‐BasedonFeeSchedule
13. PerVisit–BasedonFeeSchedule[LesserOf]
14. PerVisit‐BasedonFeeSchedulew/CarveOut
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ContractManagementandAnalysis
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StopLoss
Thestoplosstermsettlementcomponentsareasfollows:
1. Start/EndDates
2. DollarThreshold
3. ThresholdType
4. PercentageofBilledCharges
5. Method
6. DollarsNottoExceed
7. NottoExceedType
8. NottoExceedQuantity
9. Exclusions
10. ExclusionDefinition
11. ExclusionCodes
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ContractManagementandAnalysis
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BlendedRate
Comments/Notes
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ContractManagementandAnalysis
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Contacts
ADDB
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ContractManagementandAnalysis
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TheContractManagementsystemisalsousedfortheChargeQuoteandPricingmodules.
ChargeQuote
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ContractManagementandAnalysis
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Pricing