Plan/Contracts Setup

Menu Path

Finance Setup > Payer/Contract Setup > Payers > Plans/Contracts Setup 

Plan Setup Information

• Active? - Select this option to make the plan/contract available for assigning to clients.
• Payer - The funder who the contract is under.
• Name/Description - Enter the identifier or descriptor that will display in pick lists and listings that use the contract.
• County - Enter a county. This field is primarily used for reporting.
• Scheme - The programs and services selected under the scheme will apply to this contract. The one selected will then produce the programs and services defined in that Scheme in Plan/Contracts Rates. They will appear in Revenue Setup (Billing) and Expenses Setup (Accounts Payable).
• Submitter Information - Select who is supplying this billing to the Receiver.
• Receiver Information - When a bill is sent under this contract, it will be sent to this Receiver selected who will forward it to this Funder.
• % Plan Will Pay - If a contract is only responsible for paying a percent of the rates, enter that percent here. This is mostly used for private insurance billing. It would apply if, for example, clients in the contract only pay 80% of the Agency's contract/plan rate for all services.  (Note: Co-pay and deductions as this component also has the same effect on a client basis when necessary).
  Note: Only enter the percent when it applies to all clients who are designated for this contract.
  If a percent applies to individual clients, co-pay and deductions, it is entered in Benefit Assignments Co-Pay and Claim Deduction.
• Default Billing Physician - The default billing physician is a blanket License # used for all that is billed under that contract where the service provider does not have a license #. If you want some staff to use one supervisor's license # and others to use another, you do so by entering that license # (the one of the supervisor) on each staff and for that contract on their staff information.
• Use prior year account for all GL transactions when service dates appear in prior fiscal year - This option applies to R3, R4, or V actions where revenue is removed on the original claim and the DR to revenue should hit the prior year revenue account.

In Contract (Tab)

• Is in Contract/Network - This specifies what is done if the full amount is not paid:
  • Not Checked: If the full amount is not paid, the remaining amount based on the Agency's rate will try to be collected from the next priority. Also, if the rate has different Agency and Plan Amounts on the Rate Setup, the Agency rate will be booked to revenue.
  • Checked: If the full amount is not paid, the remaining amount based on the Contract's rate will try to be collected from the next priority. Also, if the rate has different Agency and Plan Amounts on the Rate Setup, the Plan rate will be booked to revenue.

Example:

When Is in Contract/Network is enabled, the following fields become available. If both are selected, the remainder will be written off:

• Contractual Allowance Revenue
  If you enter a Contractual Allowance Revenue account here, then any difference between the Agency rate and what is allowed by contract to be paid (plan rate) will be allocated to this Revenue Account. For example, this will result in the unpaid balance of $60 in the example above. If you do not enter an account here, then the system will not allocate this difference to any GL Account – meaning that you do not do ledger accounting for the unpaid balance.
• Contractual Allowance Expense Acct:
  Whenever something is being written off for this contract, this will be the Contra Expense Account. This account was setup in Chart of Accounts.
  So  when automatically written-off:

• Output Agency Rate - Use this flag to output the agency rate on HCFA, 837, or General Statement Outputs. In addition, depending on the other settings in this tab, note the following:
  If the contract is marked as In Contract:

1. Only the Plan amount will be booked in GLs or
   Example:
   DR AR  $ plan Amount
   CR Revenue $ plan amount
2. f you select a Expense and Revenue account in the fields that follow this checkbox, then the difference between the Agency and Plan amount will be booked to those accounts
   Example:
   DR AR $plan Amount
   CR Revenue $ plan amount
   
   DR Expense account Picked $ Agency minus Plan Amount
   CR Revenue account picked $ Agency minus Plan Amount

Dealing with Unbilled/Unpaid Amount (Tab)

• Contra Account - GL Account used when there is a remainder and it is not written off [setup in Define Contra Account].
• Write-Off Expense (Bad Debt) Account
  This corresponds with the Write-off GL account in the Remittance Screen. This account was setup in Chart of Accounts. When Write-off remainder is used in the previous selection or the remainder of the claim is written off during remittance processing, the GL Revenue code is used to offset that write-off.  In this situation, the Write-off expense defined below will be used as the DR and this account would be used as the offsetting revenue credit. With this, you have the ability to use a different revenue account for these types of write-offs as opposed to those defined previously.
• Write Off Revenue Account - If applicable, select the appropriate revenue account for write-offs.

When Need to Return Money or Overpaid (Tab)

Use this tab when dealing with bills that were sent out and paid when they shouldn't have been sent.

• Liability Account for Void Claims - This is the Holding Area/Liability Account that is used. Void Claim in Remittance Area. This amount will be deducted the next time a bill is paid.

• cont.
  • AP Account for Credit Invoices - If a check needs to be cut to cover this paid amount, setup AP account here to offset transaction. This account was setup in Chart of Accounts.
  • Vendor to Refund - Select the Vendor who will receive the refund. This can include a Payer. Since vendor code is required in the system to send money, it is mandatory to enter a vendor code here. Vendors are setup in Vendors, and Payers can be flagged as Vendors in Payer Information.
  • Overpayment Account (OP1 action on Remit) - The Account to be used to allocate this overpayment against must be entered here (this can be any account the agency chooses).
    The following remittance action will use the account entered here.
    OP1- Allocate Overpayment to Overpayment Account. Typically this would be a Revenue or Liability account so as to track the $ separately.  To reduce the liability or return the revenue, one would enter (debit) a manual invoice against the account that was credited.
• Submission Overwrites (Tab) - Allows users on the setup on each contract change information.  This includes Payer Name, ID, a Secondary ID Type, and the allowance to change dates on Claims.
  Allow to change dates on Claims - When flagged, service dates for claims created for this contract can be modified before being submitted.
  It is not recommended that you set this to true unless advised by Netsmart - The option was requested for a special unique situation which will allow all claims created for this contract to have the ability to have their service dates on the claims to be modified before being submitted.
  Remittance Reason Actions *

Additional Receivers (Tab)

Use this tab to define other receivers that can send you payments for this contract.