Modifiers

How to create and manage modifiers within a payer contract.

Modifiers are billing adjustments that affect how specific charges are reimbursed under a contract. Each modifier ties a modifier code to a plan type and optionally a license number.

Viewing Modifiers

Within a contract's detail view, select the Modifiers tab. The table shows:

ColumnDescription
ModifierThe modifier name or label
Modifier CodeThe billing modifier code
License NumberThe associated license or provider number (if applicable)
PlanThe plan type this modifier applies to (PPO, HMO, EPO, or POS)
DescriptionNotes about the modifier's purpose or effect

Filtering Modifiers

Filter the list using the Modifier Code, License Number, Plan, or Description filter buttons above the table.

Creating a Modifier

  1. Open a contract from the Contracts list.
  2. Click the Modifiers tab.
  3. Click + Create Modifier.
  4. Fill in the form fields:
FieldRequiredNotes
ModifierYesThe modifier name or label
Modifier CodeYesThe billing modifier code
License NumberNoOptional license or provider number
PlanNoThe plan type this modifier applies to: PPO, HMO, EPO, or POS
DescriptionYesExplanation of the modifier's purpose or effect
  1. Click Save.
Create Modifier form showing the Modifier, Modifier Code, License Number, Plan, and Description fields

Editing and Deleting Modifiers

Click the Menu (⋮) button on a modifier row to Edit or Delete it.

Modifiers tab showing modifier codes, license numbers, plan types, and descriptions