Fee Schedule Details

Unique identifier for each Detail record on this Fee Schedule. Note: The database will apply a default value of 0 for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of 0 to meet the API requirements and ensure that the functionality occurs as expected.

This option allows the ‘Fee Schedule’ to price above the billed amount. Note: The database will apply a default value of False for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of False to meet the API requirements and ensure that the functionality occurs as expected.

This field is currently informational only. Note: The database will apply a default value of False for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of False to meet the API requirements and ensure that the functionality occurs as expected.

Price based upon a percentage of the billed amount that will be applied to the matching claim detail record through the ‘Fee Schedule’.

Requires a matching diagnosis code on the claim for adjudication matching. Start of a range of diagnosis codes when combined with 'Diag Thru'.

End of the diagnosis range when combined with ‘Diag.’.

Indicates the ICD version associated with the selected Diagnosis Codes.

This will require a matching ‘Drug Code’ within a claim line during adjudication.

Date when the schedule should begin applying to claims. This date will be compared to the date of service on the claim.

User that first added the record to the system.

Date when the record was first added to the system.

Applies the provided Ex Code to any claim that has been repriced by this ‘Fee Schedule Fee’.

Unique name given to the Fee Scheudle.

Starting point for the range of acceptable ages for the Fee Schedule.

Starting point for the range of acceptable number of units within a claim for matching during adjudication.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Price based upon a percentage of the billed amount that is used for Out of Network claims that could not be matched with a usual and customary rate.

Requires a matching place of service on the claim for adjudication matching. Start of a range of PoS when combined with 'PoS Thru'.

End of the PoS range when combined with ‘PoS’.

Price that will be applied to the matching claim detail record through the ‘Fee Schedule’. This will be multiplied by the number of units within the claim.

This allows the price to be applied to all procedures within a selected procedure cluster.

This section can contain CPT, HCPC, or revenue codes. Every line requires the first procedure code field to be completed, even when using a procedure cluster. Note: If entering a range of codes, the fee entered on that line will apply to all codes in the range.

This section can contain CPT, HCPC, or revenue codes. This field is compared to the 'Procedure Code 2' field on the claim's detail line.

This section can contain CPT, HCPC, or Revenue codes. Every line requires the first procedure code field to be completed, even when using a procedure cluster. Note: If entering a range of codes, the fee entered on that line will apply to all codes in the range.

Requires a matching Provider type on the claim for adjudication matching.

This field is currently informational only.

Requires a matching specialty code on the claim for adjudication matching.

Ending point for the range of acceptable ages for the Fee Schedule.

Ending point for the range of acceptable number of units within a claim for matching during adjudication.

No longer in use.

Allows the User to select an existing rate group to base their pricing upon. For instance, if you are building a ‘Fee Schedule’ that uses a percentage of Medicare rates. These rate groups need to be provided by the User and uploaded by VBA.

The desired percentage applied from the selected rate group to the matching claim.

User that last updated the record in the system.

Unique identifier for each Detail record on this Fee Schedule. Note: The database will apply a default value of 0 for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of 0 to meet the API requirements and ensure that the functionality occurs as expected.

This option allows the ‘Fee Schedule’ to price above the billed amount. Note: The database will apply a default value of False for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of False to meet the API requirements and ensure that the functionality occurs as expected.

This field is currently informational only. Note: The database will apply a default value of False for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of False to meet the API requirements and ensure that the functionality occurs as expected.

Price based upon a percentage of the billed amount that will be applied to the matching claim detail record through the ‘Fee Schedule’.

Requires a matching diagnosis code on the claim for adjudication matching. Start of a range of diagnosis codes when combined with 'Diag Thru'.

End of the diagnosis range when combined with ‘Diag.’.

Indicates the ICD version associated with the selected Diagnosis Codes.

This will require a matching ‘Drug Code’ within a claim line during adjudication.

Date when the schedule should begin applying to claims. This date will be compared to the date of service on the claim.

User that first added the record to the system.

Date when the record was first added to the system.

Applies the provided Ex Code to any claim that has been repriced by this ‘Fee Schedule Fee’.

Unique name given to the Fee Scheudle.

Starting point for the range of acceptable ages for the Fee Schedule.

Starting point for the range of acceptable number of units within a claim for matching during adjudication.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Modifiers applicable to codes can be entered. Each of the modifiers can be applied to a single code or multiple codes in the line. Modifier payment reductions can be set up in ‘Fee Schedule Configuration’ and can be applied each time the modifier is included on a claim.

Price based upon a percentage of the billed amount that is used for Out of Network claims that could not be matched with a usual and customary rate.

Requires a matching place of service on the claim for adjudication matching. Start of a range of PoS when combined with 'PoS Thru'.

End of the PoS range when combined with ‘PoS’.

Price that will be applied to the matching claim detail record through the ‘Fee Schedule’. This will be multiplied by the number of units within the claim.

This allows the price to be applied to all procedures within a selected procedure cluster.

This section can contain CPT, HCPC, or revenue codes. Every line requires the first procedure code field to be completed, even when using a procedure cluster. Note: If entering a range of codes, the fee entered on that line will apply to all codes in the range.

This section can contain CPT, HCPC, or revenue codes. This field is compared to the 'Procedure Code 2' field on the claim's detail line.

This section can contain CPT, HCPC, or Revenue codes. Every line requires the first procedure code field to be completed, even when using a procedure cluster. Note: If entering a range of codes, the fee entered on that line will apply to all codes in the range.

Requires a matching Provider type on the claim for adjudication matching.

This field is currently informational only.

Requires a matching specialty code on the claim for adjudication matching.

Ending point for the range of acceptable ages for the Fee Schedule.

Ending point for the range of acceptable number of units within a claim for matching during adjudication.

No longer in use.

Allows the User to select an existing rate group to base their pricing upon. For instance, if you are building a ‘Fee Schedule’ that uses a percentage of Medicare rates. These rate groups need to be provided by the User and uploaded by VBA.

The desired percentage applied from the selected rate group to the matching claim.

User that last updated the record in the system.