Reimbursement Tools

The following describes the reimbursement tools available on the Service Type Reimbursement Editor page. The tools represent the different reimbursement methods available for repricing a claim.

Note: Most tools are specific to either Contract Manager or Contract Manager Professional. Some tools are available for both products.

Reimbursement Tool	Product
All Payer EAPG	Contract Manager
Anesthesia	Contract Manager Professional
APG	Contract Manager
APG/EAPG	Contract Manager
CCI Edits Pro	Both
CMS DME Fee Schedule	Contract Manager Professional
CMS Drug Fee Schedule	Contract Manager Professional
CMS Lab Fee Schedule	Contract Manager Professional
CMS Modifier Percentage	Contract Manager Professional
CMS Multiple Procedure Reduction	Contract Manager Professional
Component Modifier Forcing Group	Contract Manager
CPT Bundling	Contract Manager
Daily Charge Grouping	Contract Manager
Day Frequency Edits Pro	Both
DRG Lookup	Contract Manager
Fee Schedule	Both
Flat Amount	Both
Formula	Contract Manager
Group	Contract Manager
If Test	Contract Manager
Interim Value	Contract Manager
Line Item Default Percentage	Contract Manager Professional
Line Item Limit	Contract Manager Professional
Line Item Percentage	Contract Manager Professional
Lookup Tool vs. Code Tool	Contract Manager
LSS Pro	Both
Manual Entry	Contract Manager
Medicaid - Facility: Reimbursement Tool	Contract Manager
Medicare IP	Contract Manager
Medicare OP	Contract Manager
Modifier Percentage	Contract Manager Professional
MPFS	Contract Manager Professional
Multiple Procedure Reduction	Contract Manager Professional
Note	Contract Manager
Per Diem Amount	Contract Manager
Percentage	Contract Manager
Pro CPT Bundling	Contract Manager Professional
Procedure Code Reimbursement	Both
Procedure Lookup Table	Both
Provider Specialty Percentage	Contract Manager Professional
Range	Both
RBRVS	Contract Manager Professional
Second Dollar Stop Loss (Reimbursement)	Contract Manager
Second Dollar Stop Loss	Contract Manager
TRICARE: Reimbursement Tool	Contract Manager
Workers’ Compensation - Pennsylvania	Contract Manager
Workers’ Compensation	Contract Manager