NextGen Knowledge Center

Billing Options Field Descriptions

Use the following table to setup billing options.

FieldDescription
Select Place of Service on roll-up:
Select Override Place of ServiceDetermines which Place of Service (POS) code is used on claims when multiple Behavioral Health (BH) charges on an encounter with different POS codes roll-up to a single line item on the claim.

You can select one of the following options:

  • Send POS from first line item: Enters claims with the POS code from the first BH charge on the encounter.
  • Send POS from charge with highest Chg Amt: Enters claims with the POS code from the BH charge on the encounter that has the highest charge amount.
  • Send POS from encounter Service Location: Ignores the BH charge-level POS codes, and instead populate claims with the POS code linked to the encounter-level service location.
  • Select Default POS: Selects a specific Default Place of Service to be used on claims. It is a required field.
  • Do not roll up when POS different: Prevents multiple BH charges on an encounter with different POS codes from rolling-up to a single line item on claims. Each BH charge on the encounter is listed separately on the claim with its corresponding POS code.
Select Diagnosis Codes on roll-up:
Select Override Diagnosis CodesDetermines which ICD codes are used on claims when multiple Behavioral Health (BH) charges on an encounter with different diagnoses codes roll-up to a single line item on the claim.

You can select one of the following:

  • Send diagnosis codes from first Behavioral Health line item: Enters claims with the diagnosis codes from the first BH charge on the encounter.
  • Send diagnosis codes from Behavioral Health line item with the highest charge amount: Enters claims with the diagnosis codes from the BH charge on the encounter that has the highest charge amount.
  • Do not roll up when diagnosis codes are different or not in the same order: Prevents multiple BH charges on an encounter with different diagnosis codes, or with the same diagnosis codes but in a different order, from rolling-up to a single line item on claims. Each BH charge on the encounter is listed separately on the claim with its corresponding diagnosis codes.
Auto-balance variance amount on COB claims:
Adjustment Reason Code for CAS SegmentWhen a variance charge is added during the billing process for a non-primary payer, the prior payer's billed amount does not match, and the secondary or tertiary electronic claim is thrown out of balance. This causes the secondary or tertiary claim to be rejected by the clearinghouse or payer.

To auto-balance the variance amount on COB claims, you can select a code from the HIPAA X12 Standard Reason Codes library.

The selected reason code and the variance amount enters the CAS segment on COB claims, and the Payment Entry > COB window. This keeps the COB claim in balance and prevents the need for manual manipulation.

Billing Options Field Descriptions