In EPIC Resolute, which statement best describes how contracts and pricing interact to determine patient bills?

• A. Bundling rules determine patient responsibility.
• B. Contracts determine allowed amounts, discount rates, and patient responsibility; pricing feeds the CDM and claim line items to apply these rules.
• C. AR aging data is used to set pricing.
• D. Pricing decisions are entirely independent of payer contracts.

Answer: (B)

In EPIC Resolute, the bill is created by applying payer contract terms to the service prices in the system. Contracts determine the allowed amounts, discount rates, and patient responsibility, while pricing provides the actual service prices by feeding the CDM (Charge Description Master) and generating the claim line items. So, pricing supplies the prices for each service, the CDM holds those prices, and the contract terms determine how those prices are adjusted to show what the payer will cover and what the patient owes. The result is the calculated payer payment based on the allowed amount and discounts, plus the patient responsibility (deductibles, coinsurance, copays) defined by the contract.