Documentation

Provisions

How to create and manage contract provisions within a payer contract.

Provisions are contract-level terms or conditions associated with a specific plan type. They allow you to capture special rules or stipulations that govern how a payer contract applies to specific plan members. These provisions will be evaluated over an entire claim submission.

Viewing Provisions

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

ColumnDescription
ProvisionThe text of the term or condition
PlanThe plan type this provision applies to (PPO, HMO, EPO, or POS)

Filtering Provisions

Use the Plan filter above the table to narrow provisions to a specific plan type.

Creating a Provision

  1. Open a contract from the Contracts list.
  2. Click the Provisions tab.
  3. Click + Create Provision.
  4. Fill in the form fields:
FieldRequiredNotes
ProvisionYesFree-text description of the term or condition
PlanNoThe plan type this provision applies to: PPO, HMO, EPO, or POS
  1. Click Save.
Create Provision form showing the Provision textarea and Plan dropdown

Editing and Deleting Provisions

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

Provisions tab showing two example provisions with their associated plan types

Updated 6 days ago