Add a clause to a provision

When creating a clause, you need to define the services being reimbursed and their contracted rates. For this, you select the calculation criteria. (For information on Calc Basis The calculation basis is one of the elements that defines how a claim pays on a clause or term. The calc basis is used in conjunction with the calculation type and measure to determine a specific reimbursement method. In normal contract building rules, the Calc Basis is used to determine if a claim qualifies for the clause or term., Calc Type One of the elements that defines how a claim pays on a clause or term. The Calc Type is used with the Calc Measure to define how the claim is paid. Calc types include: Dollar Rate, a % of Charge, or a % of Cost., Calc Measures One of the elements that defines how a claim pays on a clause or term. The Calc Measure is used with the Calc Type to define how the claim is paid., and Terminal vs. Non-terminal, see Modeling clauses and terms.) You can also add attributes to a clause.

To add a new clause:

1. Navigate to the desired provision.
2. On the Provisions page, in the desired provision row, click Go to Clauses.

3. On the Clauses page above the table of clauses, click Add a New Clause.

   The Add a New Clause dialog opens.

   NOTE: The clause number is assigned by the system and cannot be edited initially, but after creating the clause and saving it, you can move it to a different position in a group of two or more clauses on a provision.

4. From the Description drop-down, do one of the following:

   • Select a description for the clause.

     TIP: In drop-downs with numerous results, like Description, you can search for a specific result: click in the Description field and begin typing a search word. Matches display in the drop-down results; click a description to select it.

   • Add a new description: click the Description field name, which is linked to the Clause/Term Descriptions page where you can add a new description if you are an administrator.
5. From the Calc Basis drop-down, select the basis for calculation.
6. If applicable (depends on the selected Calc Basis), from the Calc Type drop-down, select the calculation type.
7. If applicable, from the Calc Measure drop-down, select the measure on which the calculation is made (for example, Per Claim, Per Line Item, Per Diem).
8. From the Terminal? drop-down, select Yes for Terminal When applied to a clause, prevents a claim from progressing to the next clause under the same provision. However, the claim will continue to move through any terms on the triggered clause unless those are also set to Terminal. When applied to a term, prevents a claim from progressing to the next term under the same clause, but does not prevent the claim from moving through any clauses below that term. or No for non-terminal.
9. Do one of the following:
   • To add rates, continue to step 10.
   • To add thresholds, skip to step 11.
10. To add rates, do one of the following:

    • For a single rate, type the rate into the Rate field.

      NOTE: Some calculation bases and their associated calculation types and measures require multiple rates or rates from an uploaded file. When this occurs, the Rate field is inactive.

    • For multiple rates, enter rates manually or import rates from a file.

    NOTE: The Include clause in Global Limit check box is enabled automatically if the parent provision contains a global limit.

11. To add thresholds, do one of the following:

    • Add thresholds manually.

    • Import thresholds.

      NOTE: Not all calculation bases allow thresholds. For more information, see About Thresholds.

12. Do one of the following:

    • To save changes and keep working in the dialog, click Save.

    • To close the dialog after saving, click Save and Close.

    • To cancel your unsaved changes and close the dialog, click Close.

13. (Optional) Add an attribute.
14. If needed, add a limit.