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            Create a Payment Agreement and Define Payment Terms for a Contract

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            Create a Payment Agreement and Define Payment Terms for a Contract

            Use Health Cloud's comprehensive contract management solution to define the payment agreement terms from within the context of a contract.

            Required Editions

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud
            User Permissions Needed
            To create a contract payment agreement and define payment terms
            • Create, Read, and Update access on Contract object
            • Create, Read, Update, and Delete access on Contract Payment Agreement object
            • Create, Read, Update, and Delete access on Standard Care Fee Agreement, Categorized Care Fee Agreement, Percentile Care Fee Agreement, Shared Saving Payment Agreement, Capitation Care Fee Agreement, Bundled Care Fee Agreement, and Preventive Care Agreement objects
            • Create, Read, Update, and Delete access on the custom object that your admin created for custom agreement type
            1. From the App Launcher, go to Contracts, and select the appropriate provider network contract.
            2. In the Contract Payment Agreement related list, click New.
            3. Provide the required details and select an agreement type.
            4. For Standard Care Fee Agreement types, select a fee schedule definition and enter the standard fee calculation percentage to determine the effective fee.
            5. For Capitation and Shared Savings Agreement types, enter one or more procedure codes.
            6. Save your changes.
              The contract payment agreement record is created
            7. Click the new payment agreement record name and go to the Agreement Terms tab.
            8. Click New and provide detailed payment information for the contract payment agreement record. Payment terms vary for each payment agreement type. Add more records as needed.
            9. Back on the Details tab, activate the contract payment agreement by changing the status to Activated.
              Note
              Note You can’t edit an activated contract payment agreement.

            That’s it. The payment terms of the contract are now ready for use.

            • Standard Care Fee Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Standard Care Fee Agreement. This agreement type supports the Fee for Service payment type in which healthcare providers are paid a negotiated amount for each service they perform. For example, patient visits. Fees are based on the comprehensive fee schedule definition set up by CMS (Centers for Medicare and Medicaid Services).
            • Categorized Care Fee Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Categorized Care Fee Agreement. This agreement type supports the Category-Based payment type in which healthcare providers are paid based on a defined negotiation for each procedure category that they work on. For example, vaccines.
            • Percentile Care Fee Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Percentile Care Fee Agreement. This agreement type supports the Percentile-Based payment type in which providers are paid based on the percentile range for that member. Each percentile range has a fee that is determined by factors such as the member's age.
            • Shared Saving Payment Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Shared Savings Payment Agreement. This agreement type supports the Shared Savings payment type in which the payer shares the profit and loss with the provider and provider groups.
            • Capitation Care Fee Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Capitation Care Fee Agreement. This agreement type supports the Capitated Payment type in which providers are paid a fixed amount for each member every month for a fixed set of services. As part of the program, the payer can also decide to withhold some amount and pay it later as a bonus amount based on the performance.
            • Bundled Care Fee Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Bundled Care Fee Agreement. This agreement type supports the Bundled Payment type in which providers are paid for each procedure bundle they perform. Bundles are a group of procedures that are offered together by the provider. Bundled payment is tier-based and can have different prices depending on the services and care offered.
            • Preventive Care Agreement Fields
              Use these fields to define payment terms for a contract of agreement type Preventive Care Agreement. This agreement type supports the Preventive Care payment type in which providers are paid a bonus amount when they reach an agreed upon target. Targets can include achievements such as reducing admission or readmission rates to a certain percentage.
             
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