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Contractual Guarantor Information Section - PM

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When adding a contractual guarantor, this section must be completed.

  • Codes defined as Adjustments in the Adjustment, Payment or Transfer field of the Posting/Adjustment Codes Definition form are available in the code fields of this section. Further specifics are identified for each field.
  1. Specify whether the guarantor uses contractual allowance by batch or through liability distribution.
     Since Contract Guarantors cannot be changed once they are set up, select Contractual Allowance by Batch if a guarantor is set up as a Contract Guarantor but later the system changed to not apply contractual allowances systematically. This way the contractual allowances will not be calculated and applied unless the batch is created and processed.

  2. In the Contractual Adjustment Code (Credit) field, select the credit adjustment code. If the service charge is greater than the contractual per-diem amount, this code is used to post a credit adjustment.

    • For a code to appear in this list, it must be defined in the Posting/Adjustment Codes Definition form, with Credit selected in the Credit Or Debit field, and Yes selected in the Is This A Contractual Adjustment Code field.

  3. In the Contractual Adjustment Code (Debit) field, select the debit adjustment code. If the service charge is less than the contractual per-diem amount, this code is used to post a debit adjustment.

    • For a code to appear in this list, it must be defined in the Posting/Adjustment Codes Definition form, with Debit selected in the Credit Or Debit field, and Yes selected in the Is This A Contractual Adjustment Code field.

  4. In the Contractual Write-off Code field, select the contractual adjustments code. This applies when the service is not a per-diem service (No selected in the Service Codes form, Per-Diem Service Code field).

    • For a code to appear in this list, it must be defined in the Posting/Adjustment Codes Definition form, with Credit selected in the Credit Or Debit field.

  5. In the Temporary Contractual Adjustment Code (Credit) field, select the temporary code for contractual adjustment credits.

    • For a code to appear in this list, it must be defined in the Posting/Adjustment Codes Definition form, with Credit selected in the Credit Or Debit field, and Yes selected in the Is This A Contractual Adjustment Code field.

  6. In the Temporary Contractual Adjustment Code (Debit) field, select the temporary code for contractual adjustment debits.

    • For a code to appear in this list, it must be defined in the Posting/Adjustment Codes Definition form, with Debit selected in the Credit Or Debit field, and Yes selected in the Is This A Contractual Adjustment Code field.

  7. In the Temporary Contractual Write-off Code field, select the contractual adjustments code for temporary write-offs.

    • For a code to appear in this list, it must be defined in the Posting/Adjustment Codes Definition form, with Credit selected in the Credit Or Debit field.

  8. In the Effective Date Of Contract field, enter the contract start date. This is the first date the contract per-diem rate will be effective.

  9. In the Expiration Date Of Contract field, enter the contract end date. Dates of service after this date are not eligible.

  10. In the Does This Guarantor Get Billed Under PPS Rules? field, select whether or not the guarantor should be billed according to PPS Billing rules for contractual adjustment processing and paper UB92/UB04/837 Institutional bill generation.

  11. In the Override 837 Institutional PPS Claim Statement Dates and Claim Frequency Code For Expired Coverage field, select whether or not to override the claim dates and code. If Yes, the Electronic Billing form will not create No-Pay ##0 Claims prior to the 60 day cycle or discharge.

  12. In the Charge Override For Room And Board Charges (UB92/UB04 Claims) field, select the method for charging room and board overrides. Charges can be assessed according to a Fee Table, a Gross Charge can be assessed, or a Per-Diem Rate charged.

  13. In the Enable Modified Contractual Allowance Calculation field, select whether liability distribution should be set to Distribute to next payor or as a Write off when contractual allowance is in effect.