Contract Validation Criteria

Use this process to set claim validation criteria.

  1. Access the Contract Validation Criteria page.
    • Select Go To > Contract Loading > Support Functions > Contract Validation. The Contract Validation Claim Research page opens.
    • Type an account number, and then click Display Claims. The Contract Validation Claim Selection page opens.
    • Select a claim, and then click Select Claim. The Contract Validation Criteria page opens.
  2. Optionally, set any of the following criteria:
    • Select the Run Type.
    • Select an Anchor Date.
    • Select a Profile (if available).
    • Select a Contract Name.
    • Click the plus sign to select Service Type Definition Tables.
  3. Click Validate. The Contract Validation Results page opens. For more information, refer to Contract Validation Results.

The following table describes the fields on the Contract Validation Criteria page.  

Field

Description

Account Number

Patient account number (for UB claims) or insured ID (for CMS-1500 claims)

Admit Date

Date of admission for the account

Anchor Date

Artificial date of service for all claims associated with the scenario

Bill Type

Bill type

Contract

Contract Profile Name

Dates of Service

The range of date of service from and date of service to for the claim

Medicare Outlier Date

The date on which Medicare Inpatient claims reach the outlier threshold, based on detail charges.

Patient Name

Patient name

Patient Type

Patient type assigned to the account

Primary Diagnosis

Primary diagnosis code. This field provides a link to additional information about the code.

  • Click the link to view basic information about the code.
  • KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code.

Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.

Product

Name of the insurance product selected

Run Type

Options: Audit or Production

Service Type Definition Tables

Name of the service type definition tables