Create a line-item limit

When a limit is defined on a line-item clause or term, it no longer compares the final reimbursement for that clause or term to the limit, but instead compares the reimbursement to the limit on a line-by-line basis. The most common way to use the line-item limit is by capping fee schedules at the charge amount. The capping of fee schedules is language common to several managed care contracts, which typically would state that all fees are paid the lesser of charges or the pre-determined fee scheduled amount.

To create a line item limit for a clause or term:

1. Create the clause or term, or navigate to an existing clause or term that has a line item calculation basis.
2. In the Limits column, click the Limit icon ().
3. On the Limits page, select either the Maximum or Minimum check box.
4. From the Description drop-down, select a description.
5. From the Calc Basis drop-down, select Line Item Code.
6. From the Calc Type drop-down, select Dollar Rate.
7. From the Calc Measure drop-down, select Per Line Item.
8. Click Save.
9. Below the Rates field, click the Rates button and attach your fee schedule to the clause/term. See Import rates for a clause or term for detailed instructions on attaching fee schedules.