Customer detail

CCP

15
live contracts
0
cannot fire
8
calc types
3
SQL bodies
3
of those blocked
0
map conflicts

Methodology mix

PercentOfFees16
LesserOfAdjustment13
PercentageAdjustment7
MultipleProcedureAdjustment6
ModifierAdjustment6
SqlExpression3
PercentOfCharges1
MedicareRVU1

Contracts

Each is one fee logic. Base terms are first-match-wins; adjustments all apply, in order. Expand to see the terms.

Aetna-Better-Health1 base · 1 adj
Aetna Better Health
Profee · IBAUC · 2022-06-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. cap the account total at 100% of billed charges
Amerihealth1 base · 1 adj
Amerihealth
Profee · IBAUC · 2022-06-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. cap the account total at 100% of billed charges
Charges-Profee1 base · 0 adj
Charges
Profee · all facilities · 2016-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the ChargeMaster-Profee fee schedule
Cigna1 base · 4 adj
Cigna
Profee · IBAUC · 2012-05-15 → 2999-12-31
Cigna
Profee · LA201 · 2022-02-01 → 2999-12-31
Cigna
Profee · WAPIC · 2023-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. multiple-procedure reduction (contract rules) — base codes 2; pays 100/50%
  2. modifier 50 present → 150% of the running amount
  3. rescale by a percentage read from the Mid-Level-Provider schedule
  4. cap the account total at 100% of billed charges
Cigna1 base · 4 adj
Cigna
Profee · TX102 · 2023-07-17 → 2999-12-31
Base terms — first match wins
  1. 80% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. multiple-procedure reduction (contract rules) — base codes 2; pays 100/50%
  2. modifier 50 present → 150% of the running amount
  3. rescale by a percentage read from the Mid-Level-Provider schedule
  4. cap the account total at 100% of billed charges
Cigna-EUC1 base · 4 adj
Cigna
Profee · EUC · 2023-01-01 → 2999-12-31
Base terms — first match wins
  1. 205.8% of Medicare RVU (rates as of 2018-01-01)
Adjustments — all apply, in order
  1. multiple-procedure reduction (contract rules) — base codes 2; pays 100/50%
  2. modifier 50 present → 150% of the running amount
  3. rescale by a percentage read from the Mid-Level-Provider schedule
  4. cap the account total at 100% of billed charges
Cigna-SACC2 base · 4 adj
Cigna
Profee · SACC · 2023-05-01 → 2999-12-31
Base terms — first match wins
  1. 85% of the Fixed-Fees fee schedule
  2. percent-of-charges, rate read from the Fixed-Fees-Percentage schedule
Adjustments — all apply, in order
  1. multiple-procedure reduction (contract rules) — base codes 2; pays 100/50%
  2. modifier 50 present → 150% of the running amount
  3. rescale by a percentage read from the Mid-Level-Provider schedule
  4. cap the account total at 100% of billed charges
Healthy-Blue1 base · 1 adj
Healthy Blue
Profee · IBAUC · 2022-05-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. cap the account total at 100% of billed charges
Humana-Medicaid2 base · 1 adj
Humana Medicaid
Profee · IBAUC · 2023-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
  2. 100% of the Humana-Medicaid-Carveout fee schedule
Adjustments — all apply, in order
  1. cap the account total at 100% of billed charges
LA-Health-Care-Connections1 base · 2 adj
LA Health Connections (LHCC)
Profee · IBAUC · 2022-01-01 → 2023-06-30
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. cap each charge and the account total at 100% of billed charges
  2. rescale by a percentage read from the Mid-Level-Provider-LAHC schedule
LA-Health-Care-Connections-2023-072 base · 1 adj
LA Health Connections (LHCC)
Profee · IBAUC · 2023-07-01 → 2999-12-31
Base terms — first match wins
  1. custom SQL — A Louisiana Healthcare Connections (LHCC) Medicaid mid-level-provider fee: looks up a fee from a demographic-tiered (sex+age) schedule with a most-specific-match-wins fallback, but only pays it (at 80% of the looked-up fee) when the matched schedule row's TS code indicates a mid-level-eligible tier (3 or 7). — when MidLevelProvider Mid-Level is present
  2. custom SQL — The general (non-mid-level-gated) counterpart to e33997f79cbaaf65: same demographic-tiered LHCC Medicaid fee-schedule fallback, but applies the 80% factor unconditionally to every matched code rather than only mid-level-eligible tiers.
Adjustments — all apply, in order
  1. cap each charge and the account total at 100% of billed charges
Medicaid-IBAUC1 base · 1 adj
United Healthcare Medicaid
Profee · IBAUC · 2022-01-01 → 2999-12-31
Base terms — first match wins
  1. custom SQL — Looks up a Texas Medicaid fee-schedule rate for a charge's procedure+modifier, preferring an age-banded rate for the patient's age and falling back to a generic (no age restriction) rate; excludes Assistant Surgeon (TS=2) rows for now; multiplies by units.
Adjustments — all apply, in order
  1. cap each charge and the account total at 100% of billed charges
Medicare4 base · 4 adj
Medicare
Profee · all facilities · 2023-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Medicare-Lab fee schedule
  2. 100% of the Medicare-Drug fee schedule
  3. 100% of the Medicare-DME fee schedule
  4. 100% of the Medicare-RVU-Clinic fee schedule
Adjustments — all apply, in order
  1. multiple-procedure reduction (contract rules) — base codes 2; pays 100/50%
  2. modifier 50 present → 150% of the running amount
  3. cap each charge and the account total at 100% of billed charges
  4. rescale by a percentage read from the Mid-Level-Provider-Rate schedule
Self-Pay1 base · 0 adj
Self Pay
Profee · BUC · 2023-03-01 → 2999-12-31
Self Pay
Profee · EUC · 2023-03-01 → 2999-12-31
Self Pay
Profee · TX102 · 2023-03-01 → 2999-12-31
Self Pay
Profee · IBAUC · 2023-02-01 → 2999-12-31
Self Pay
Profee · LA201 · 2023-02-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Trillium1 base · 4 adj
Trillium
Profee · EUC · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Fixed-Fees fee schedule
Adjustments — all apply, in order
  1. modifier 50 present → 150% of the running amount
  2. multiple-procedure reduction (contract rules) — base codes 2; pays 100/50%
  3. rescale by a percentage read from the Mid-Level-Provider schedule
  4. cap the account total at 100% of billed charges