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Contract Hub

The Contract Hub is the central command center for managing payer contracts and their associated pricing rules. It allows you to link specific customizations (like Fee Schedules and DRG Tables) to contracts for defined time periods.

Overview

A Contract in Bedrock Billing represents a specific agreement with a payer (e.g., "Aetna Commercial" or "Blue Cross Medicare Advantage").

Because contracts change over time, Bedrock Billing uses Configuration Periods (or "Temporal Configs"). A Configuration Period defines exactly which pricing rules apply between a specific Effective Date and Termination Date.

managing Contracts

Creating a Contract

  1. Navigate to Customizations → Contract Hub.
  2. Click New Contract.
  3. Enter the Contract Name (e.g., "UnitedHealthcare PPO").
  4. Enter a unique Contract ID (this is the identifier used in your data files).
  5. (Optional) Toggle Use Medicare Base Fallback if you want the system to default to standard CMS pricing when no custom provider data is found.

Editing a Contract

  1. Click on a Contract in the list to view its details.
  2. Click the Edit button in the top right to change the name, description, or fallback settings.

Configuration Periods

The power of the Contract Hub lies in its ability to handle changing terms over time. You don't need to create a new contract ID when rates change; you simply add a new Configuration Period.

Adding a Period

  1. Inside a Contract Detail view, go to the Configuration Periods tab.
  2. Click Add Period.
  3. Effective Date: The start date of these rules.
  4. Termination Date: The end date (leave blank if open-ended).
  5. Link Pricing Rules:
    • Fee Schedule: Select a Custom Fee Schedule to override CPT/HCPCS pricing.
    • Custom DRG Table: Select a Custom DRG Table to override MS-DRG weights.
    • IOCE Bypass: Select an IOCE Bypass Config to change edit logic.
  6. Click Create.

[!IMPORTANT] Configuration periods for the same contract cannot overlap. The system will prevent you from creating conflicting date ranges.

Example Scenario

  • Period A (Jan 1, 2023 - Dec 31, 2023): Uses "2023 Commercial Rates" Fee Schedule.
  • Period B (Jan 1, 2024 - Open): Uses "2024 Commercial Rates" Fee Schedule and "2024 Custom DRG Weights".

When a claim is processed with a Service Date of Feb 15, 2024, the system automatically selects Period B.

Claims Processing Integration

The Contract Hub connects your customizations to the core claims engine.

  1. Provider Lookup: When a claim is received, the system checks the billing provider's record.
  2. Contract Resolution: The provider record points to a specific Contract ID.
  3. Time-Based Selection: The system looks at the claim's date of service and finds the matching Configuration Period in the Contract Hub.
  4. Rule Application:
    • Fee Schedules: If a Custom Fee Schedule is linked, it replaces standard CMS inputs.
    • Custom DRG Tables: If a Custom DRG Table is linked, its weights and LOS values are used.
    • IOCE Bypass Policies: If an IOCE Bypass Config is linked, specific edits are overridden or skipped.
    • Provider Data: Use the Medicare Base Fallback setting to control whether the system should error or proceed with standard CMS data if a specific custom provider record is missing.