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The Non-Coordinated SIM library enables you to set up billing rules for payer-specific service items. This includes service items that are only reimbursed by specific payers such as a state plan, special grant program, or Medicaid, that will not be reimbursed if billed to other payers.
For example, a range of behavioral health SIM codes can be billed to Medicaid but not to any other payer. These SIM codes can be set up in this library with Medicaid selected as the only valid payer, therefore making the SIM codes non-coordinated for all other payers.
The library also defines other parameters that affect how non-coordinated SIM codes are handled during charge posting and billing. These parameters include options and settings for balance control, auto-adjustments, and claims.
You can generate the Non-Coordinated SIM report from the Non-Coordinated SIM library , go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM.
If you configure a rule with a SIM and a valid payer, then the balance will move to the valid payer or the patient if you have a matching SIM in the charge.
If you configure a rule with the combination of SIM, provider credential, and valid payer, then the non-coordinated SIM rule is applied only when you have a matching provider credential and SIM.
You can configure multiple rules with the same SIM having different combinations as follows:
When you configure multiple rules with the same SIM but different combinations, the rule with the combination of SIM, valid payer, and provider credential will be considered first. If this rule does not match, then the rule with a combination of SIM, valid payer, and prior payer will be considered. If none of the first two rules match, then the rule with matching SIM and valid payer will be considered.
If you configure multiple rules with the same SIM and a valid payer but without a matching provider credential or prior payer, then the rule with only the SIM will be considered.