Add a Service Type to a Contract Profile

When setting up your contract profile, you may add service types from the Universal table and any other table associated with the profile.

  1. Access the Add Service Type Reimbursement page.
    • Select Go To > Contract Loading > Contract Profile Management. The Contract Profile Management page opens.
    • Click a link in the Contract Name column for a Contract that is checked out to you. The Edit Contract Profile page opens.
    • Click Add Service Type. The Add Service Type Reimbursement page opens.
  2. Select the Service Type, and then click View Details to display the details of the selected service type definition.
  3. Select the TAC Section.
  4. Select or clear the remaining options as needed.
  5. Select the Level of Care options for this service type.
    • Level of Care (LOC) refers to Medical, Surgical, DOU, ICU, or CCU levels that apply with a corresponding per diem rate. LOC indicates that the per diem rate that applies to the patient's level of care will be reimbursed (in addition to the case rate) for each day a patient needs to stay due to their clinical condition that exceeds the number of days included in the case rate. These days may include patient days required either pre-op or post-op.
    • The LOC days can start from the start of the claim, the procedure date, or the primary procedure date.
    • If you select any option other than None, you must enter the number of LOC days in the Level of Care days field.
    • If you select the procedure date or primary procedure date, you must either enter the procedure code to use in the Procedure code field or select a procedure lookup table from the Lookup table list.
  6. Click Add Service Type. The Service Type Reimbursement Editor page opens. For more information, refer to Define Reimbursement for a Service Type.

The following table describes the fields on the Add Service Type Reimbursement page.

Field

Description

Calculate Daily Charges And Units

Option to reimburse a certain amount per unique day

Charges In Service Type

Option to reduced by service type; typically used for outpatient claims

Contract

Name of the contract profile

Days In Service Type

Option to reduce by days; typically used for inpatient claims

Level of care days

Indicates the number of Level of Care days for this service type

Level of care from start of claim

Indicates that Level of Care (LOC) days should be applied from the start of the claim. You must specify the number of LOC days in the Level of care days field.

Level of care starting at the procedure date

Indicates that Level of Care (LOC) days should be applied from the start date of a specified procedure code. You must specify the number of LOC days in the Level of care days field. You must also specify a procedure code in the Procedure code field or select a procedure lookup table from the Lookup table list.

Level of care starting at the primary procedure date

Indicates that Level of Care (LOC) days should be applied from the start date of a specified primary procedure code. You must specify the number of LOC days in the Level of care days field. You must also specify a primary procedure code in the Procedure code field or select a procedure lookup table from the Lookup table list.

Lookup table

Allows you to select a procedure lookup table to use when applying Level of Care days. This option is only active if you selected either the Level of care starting at the procedure date or Level of care starting at the primary procedure date option.

None

Indicates that Level of Care does not apply to this service type

Override Defined Rank

Indicates whether you want to override the service type’s current rank with the rank you type

Procedure code

Allows you to type a procedure code to use when applying Level of Care days. This option is only active if you selected either the Level of care starting at the procedure date or Level of care starting at the primary procedure date option.

Process No Other Service Types After This One

Option to stop processing after the selected item

Reduce Available Resource By The Following

Option to reduce resources during repricing

Reduce Billed Charges Prior To Discount

Only available when the Pass-Through TAC section is selected

Reimburse At Level Of Care After X Days

Option to reimburse at level of care after the number of days typed

Service Type

Service type code

TAC Section

Section of the TAC to which the service type is added