Customer detail

TheOregonClinic

3
live contracts
21
cannot fire
17
calc types
0
SQL bodies
0
of those blocked
0
map conflicts

Methodology mix

ModifierAdjustment34
MedicareMultipleProcedureAdjustment24
LesserOfAdjustment24
MidLevelProviderAdjustment24
MedicareBilateralSurgeryAdjustment24
MedicareMultipleRadiologyAdjustment24
FlatPercentOfCharges23
MedicareRVU14
MedicareASC11
MedicareDrug11
MedicareLab11
MedicareDME8
PercentOfFees6
MedicareAnesthesia3
MedicareMultipleEndoscopyAdjustment3
MedicareMultipleTherapyAdjustment3
NotToExceedAmountAdjustment2

Contracts

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

Aetna-Profee6 base · 17 adj
Aetna
Professional · all facilities · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 125% of Medicare drug
  2. 100% of Medicare RVU — when CodeRange in 10000–69990; CodeRange in 90000–99199; CodeRange in 99202–99499; CodeRange in 80047–89399
  3. 100% of Medicare RVU — when CodeRange in 70010–79999
  4. 140% of Medicare lab (rates as of 2024-01-01)
  5. 100% of Medicare anesthesia
  6. 80% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-procedure reduction — base codes 2
  2. Medicare multiple-endoscopy reduction
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. Medicare bilateral-surgery adjustment
  6. mid-level provider reduction (by NUCC taxonomy)
  7. modifier CQ present → 85% of the running amount
  8. modifier 22 present → 135% of the running amount
  9. modifier 62 present → 62.5% of the running amount
  10. modifier 78 present → 70% of the running amount
  11. modifier 80 present → 16% of the running amount
  12. modifier 54 present → 75% of the running amount
  13. modifier 55 present → 25% of the running amount
  14. modifier 81 present → 16% of the running amount
  15. modifier 82 present → 16% of the running amount
  16. modifier AS present → 14% of the running amount
  17. cap each charge and the account total at 100% of billed charges
First Choice-Profee5 base · 17 adj
First Choice
Professional · all facilities · 2025-01-01 → 2025-12-31
Base terms — first match wins
  1. 132.5% of Medicare drug
  2. 100% of Medicare RVU — when CodeRange in 10000–69999; CodeRange in 90000–99999; CodeRange in 88291–88369
  3. 100% of Medicare RVU — when CodeRange in 70010–79999
  4. 140% of Medicare lab (rates as of 2024-01-01)
  5. 80% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-procedure reduction — base codes 2
  2. Medicare multiple-endoscopy reduction
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. Medicare bilateral-surgery adjustment
  6. mid-level provider reduction (by NUCC taxonomy)
  7. modifier CQ present → 85% of the running amount
  8. modifier 22 present → 135% of the running amount
  9. modifier 62 present → 62.5% of the running amount
  10. modifier 78 present → 70% of the running amount
  11. modifier 80 present → 16% of the running amount
  12. modifier 54 present → 75% of the running amount
  13. modifier 55 present → 25% of the running amount
  14. modifier 81 present → 16% of the running amount
  15. modifier 82 present → 16% of the running amount
  16. modifier AS present → 14% of the running amount
  17. cap each charge and the account total at 100% of billed charges
First Choice-Profee-20265 base · 17 adj
First Choice
Professional · all facilities · 2025-01-01 → 2025-12-31
Base terms — first match wins
  1. 132.5% of Medicare drug
  2. 100% of Medicare RVU — when CodeRange in 10000–69999; CodeRange in 90000–99999; CodeRange in 88291–88369
  3. 100% of Medicare RVU — when CodeRange in 70010–79999
  4. 140% of Medicare lab (rates as of 2024-01-01)
  5. 80% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-procedure reduction — base codes 2
  2. Medicare multiple-endoscopy reduction
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. Medicare bilateral-surgery adjustment
  6. mid-level provider reduction (by NUCC taxonomy)
  7. modifier CQ present → 85% of the running amount
  8. modifier 22 present → 135% of the running amount
  9. modifier 62 present → 62.5% of the running amount
  10. modifier 78 present → 70% of the running amount
  11. modifier 80 present → 16% of the running amount
  12. modifier 54 present → 75% of the running amount
  13. modifier 55 present → 25% of the running amount
  14. modifier 81 present → 16% of the running amount
  15. modifier 82 present → 16% of the running amount
  16. modifier AS present → 14% of the running amount
  17. cap each charge and the account total at 100% of billed charges

Cannot fire (21)

These have no contract map, or one whose insurance / bill-type / facility selection is empty, so nothing can ever resolve to them.

Aetna-Commercial-ASC · contract map selects nothing2 base · 5 adj
Aetna
Facility · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Aetna-Comm-ASC-Fees fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
Aetna-Medicare-ASC · contract map selects nothing2 base · 5 adj
Aetna Medicare
Facility · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Aetna-Medicare-ASC-Fees fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
Aetna-Medicare-Profee · contract map selects nothing6 base · 5 adj
Aetna Medicare
Professional · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the Aetna-Medicare-Inflectra-Profee fee schedule
  2. 100% of Medicare lab (OR) ⚠︎ named “131% Medicare Lab - OR” but configured at 100%
  3. 131% of Medicare drug
  4. 131% of Medicare DME (OR)
  5. 131% of Medicare RVU
  6. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
AtrioHealth-Facility · contract map selects nothing2 base · 5 adj
Atrio Health
Facility · — nothing selected — · 2025-01-01 → 2025-12-31
Base terms — first match wins
  1. 120% of Medicare ASC
  2. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
AtrioHealth-Facility-2026 · contract map selects nothing2 base · 5 adj
Atrio Health
Facility · — nothing selected — · 2026-01-01 → 2099-12-31
Base terms — first match wins
  1. 123% of Medicare ASC
  2. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
AtrioHealth-Medicare-Facility · contract map selects nothing2 base · 5 adj
Atrio Health Medicare
Facility · — nothing selected — · 2024-01-01 → 2099-12-31
Base terms — first match wins
  1. 120% of Medicare ASC
  2. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
AtrioHealth-Medicare-Profee · contract map selects nothing6 base · 5 adj
Atrio Health Medicare
Professional · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the AtrioHealth-Medicare-Inflectra-Profee fee schedule
  2. 120% of Medicare lab (OR)
  3. 120% of Medicare drug
  4. 120% of Medicare DME (OR)
  5. 120% of Medicare RVU
  6. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
AtrioHealth-Profee · contract map selects nothing7 base · 5 adj
Atrio Health
Professional · — nothing selected — · 2025-01-01 → 2025-12-31
Base terms — first match wins
  1. 100% of the AtrioHealth-Medicare-Inflectra-Profee fee schedule
  2. 100% of Medicare lab
  3. 100% of Medicare drug
  4. 100% of Medicare DME (OR)
  5. 100% of Medicare RVU
  6. 100% of Medicare anesthesia
  7. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
AtrioHealth-Profee-2026 · contract map selects nothing7 base · 5 adj
Atrio Health
Professional · — nothing selected — · 2026-01-01 → 2099-12-31
Base terms — first match wins
  1. 100% of the AtrioHealth-Medicare-Inflectra-Profee fee schedule
  2. 100% of Medicare lab
  3. 100% of Medicare drug
  4. 100% of Medicare DME (OR)
  5. 100% of Medicare RVU
  6. 100% of Medicare anesthesia
  7. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
CareOregon-Medicare-Facility · contract map selects nothing1 base · 5 adj
Oregon Care Medicare
Facility · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 110% of Medicare ASC
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
CareOregon-Medicare-Profee · contract map selects nothing5 base · 5 adj
Oregon Care Medicare
Professional · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 125% of Medicare lab (OR)
  2. 125% of Medicare drug
  3. 110% of Medicare DME (OR)
  4. 125% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
CareOregon-OHP-Facility · contract map selects nothing2 base · 5 adj
Oregon Care OHP
Facility · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 110% of Medicare ASC
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
First Choice-HealthNetwork-ASC · contract map selects nothing2 base · 7 adj
First Choice
Facility · — nothing selected — · 2025-01-01 → 2025-12-31
Base terms — first match wins
  1. 283.7% of Medicare ASC (rates as of 2024-01-01)
  2. 80% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. modifier 52 present → 50% of the running amount
  6. modifier 73 present → 50% of the running amount
  7. cap each charge and the account total at 100% of billed charges
First Choice-HealthNetwork-ASC · contract map selects nothing2 base · 7 adj
First Choice
Facility · — nothing selected — · 2026-01-01 → 2999-12-31
Base terms — first match wins
  1. 297.89% of Medicare ASC (rates as of 2024-01-01)
  2. 80% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. modifier 52 present → 50% of the running amount
  6. modifier 73 present → 50% of the running amount
  7. cap each charge and the account total at 100% of billed charges
HealthNet-Commercial-ASC · contract map selects nothing2 base · 6 adj
Health Net
Facility · — nothing selected — · 2025-01-01 → 2025-12-31
Base terms — first match wins
  1. 305.79% of Medicare ASC (rates as of 2024-01-01)
  2. 65% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap the account at $1000.00
  6. cap each charge and the account total at 100% of billed charges
HealthNet-Commercial-ASC · contract map selects nothing2 base · 6 adj
Health Net
Facility · — nothing selected — · 2026-01-01 → 2999-12-31
Base terms — first match wins
  1. 321.08% of Medicare ASC (rates as of 2024-01-01)
  2. 65% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
  6. cap the account at $1000
Medicare-ASC · contract map selects nothing2 base · 5 adj
— no insurance selected —
— no bill type selected — · — nothing selected — · 2026-05-19 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare ASC
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
Medicare-Profee · contract map selects nothing5 base · 5 adj
— no insurance selected —
— no bill type selected — · — nothing selected — · 2026-05-19 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare lab (OR)
  2. 100% of Medicare drug
  3. 100% of Medicare DME (OR)
  4. 100% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
Regence-Medicare-Profee · contract map selects nothing5 base · 5 adj
Regence Medicare
Professional · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 120% of Medicare lab
  2. 124% of Medicare drug
  3. 124% of Medicare DME
  4. 124% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
TriWest-Facility · contract map selects nothing2 base · 5 adj
TriWest
Facility · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare ASC
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges
TriWest-Profee · contract map selects nothing5 base · 5 adj
TriWest
Professional · — nothing selected — · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare lab (OR)
  2. 100% of Medicare drug
  3. 100% of Medicare DME (OR)
  4. 100% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50%
  4. mid-level provider reduction (by NUCC taxonomy)
  5. cap each charge and the account total at 100% of billed charges