Add or Modify an Institutional Billing Library

File Maintenance Help for NextGen® Enterprise 8

Setup the Define TOB by Rev Code

The TOB by Rev Code tab on the Institutional Billing Maintenance window allows the Type of Bill (TOB) for claims to be defined by revenue code for the selected payers. The system creates a claim break based on TOB. Therefore, all SIM codes that have a revenue code with the same TOB are grouped together on one claim. Note: TOB populates the 2300 CLM05 segment on electronic 837I claims, and FL 4 on paper UB04 claims. From the Institutional Billing Maintenance window, select the Define TOB by Rev Code tab. In the Type of Bill by Revenue Code section, do one of the following: To add a new TOB by revenue code rule, select open menu button and select New. To modify an existing TOB by revenue code rule, select the row for the rule in the list, select open menu button and select Open. The Define Type of Bill by Revenue Code Category window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates canno

File Maintenance Help for NextGen® Enterprise 8

Add or Modify an Institutional Billing Library

Open File Maintenance. Select Libraries, and then Institutional Billing. The Institutional Billing List window opens. Do one of the following: To add a new library, select open menu button and select New. To modify an existing library, select the row for the library in the list, select open menu button and select Open. Institutional Billing Library Maintenance window opens. In the Institutional Billing Library Name field, enter a descriptive name for the library. This field is required. In the Payer Rules for Institutional Billing section, existing payer configurations display as separate rows in descending date order. This section is required. Do one of the following: To add new payer rules, select open menu button and select New. To modify existing payer rules, select the row for the rule set in the list, select open menu button and select Open. To copy existing payer rules, select the row for the rule set in the list, select open menu button and select Copy. The Institutional Billin

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claim Rules by TOB Tab

The Claim Rules by TOB tab on the Institutional Billing Maintenance window allows the Type of Bill (TOB) to control whether specific fields are populated on claims for the selected payers. From the Institutional Billing Maintenance window, select the Claim Rules by TOB tab. In the Claim Rules by Type of Bill section, do one of the following: To add a new claim rule by TOB, select open menu button and select New. To modify an existing claim rule by TOB, select the row for the rule in the list, select the open menu button and select Open. The Claim Rules by Type of Bill Range window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates cannot overlap between rules for the same TOB range. If dates overlap, the following prompt displays when the OK button is selected: Effective/Expiration dates overlap with [Claim Rules by TOB Name]. In the Description field, enter a descriptive name for the ru

File Maintenance Help for NextGen® Enterprise

Institutional Billing Library Reports

The following File Maintenance reports are available for the Institutional Billing library: Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Parent topic: File Maintenance Library Reports

Help Guide for NextGen® Enterprise PM 8

Institutional Billing Library Reports

The following File Maintenance reports are available for the Institutional Billing library: Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Parent topic: File Maintenance Library Reports

File Maintenance Help for NextGen® Enterprise 8

Institutional Billing Library Reports

The following File Maintenance reports are available for the Institutional Billing library: Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Parent topic: File Maintenance Library Reports

Add or Modify an Institutional Billing Library

Recommendations

Setup the Define TOB by Rev Code

Add or Modify an Institutional Billing Library

Set Up the Claim Rules by TOB Tab

Institutional Billing Library Reports

Institutional Billing Library Reports

Institutional Billing Library Reports

Setup the Define TOB by Rev Code

Add or Modify an Institutional Billing Library

Set Up the Claim Rules by TOB Tab

Institutional Billing Library Reports

Institutional Billing Library Reports

Institutional Billing Library Reports