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Practice Preferences for Billing and Claims

Field	Description
Enable Qualifying Encounter Billing	Select this option to turn on qualifying encounter billing for all encounters with line items marked as a qualifying SIM. To complete the setup for qualifying encounter billing, you must configure one or more SIMs to be a qualifying SIM.
Suppress zero balance claims	Select this option if you want to suppress claims with $0 (zero) balance during batch billing.
Suppress CLIA ID from mammography claims	Select this option to make mammography certification codes and Clinical Laboratory Improvement Amendment (CLIA) IDs mutually exclusive on electronic claims. When you select this option, NextGen® Enterprise PM identifies a mammography code on a claim and prints the mammography code, not the CLIA ID for Medicare claims. Note: To suppress CLIA ID from mammography claims, you must set a SIM as the mammography code, and the code must appear on the claim.
Include Self-Pay Encounters In Claim Billing Report	Select this option to include charges and encounters billed to patients when a SIM is flagged as a patient self-pay encounter. The billing report then displays the charges and encounters billed to both payers and patients.
Allow multiple Purchased Service lines on one claim	Select this option to include multiple purchased service charges for an encounter on one claim. Otherwise, the system generates separate claims for each purchased service item.
Do Not Sum Units for CPT4 Code	Select this option to prevent combining multiple identical charge lines on one line and summing them on the paper claim. The identical charges appear on separate lines on the paper healthcare financing administration (HCFA) 1500 claim or are entered individually in an electronically sent file. If you select this option, the NextGen® Enterprise PM application sums identical line items and indicates multiple units for billing on a paper HCFA 1500 or in an electronically sent file. This option can also be set at the SIM or payer levels.
Disable diagnosis claim break	Select this option to prevents claim breaks when a claim has more than four diagnoses. An excessive number of diagnoses to bill causes an error, preventing the production of the claim. If you do not select this option and there are more than four diagnoses, then the system automatically splits the charges into multiple separate claims to be able to handle the number of diagnoses. This option can also be set at the payer level on the Payer Defaults - 2 tab in the Payer master file.
Allow the following # of diagnoses on claims	Select the number of diagnosis codes to send electronically. Note: The option for 12 diagnosis codes is not applicable to dental claims. The first four diagnosis codes are associated with the CPT4 code. Codes 5–8 are applied at the encounter level and are not attached to a charge. Codes 9–12 are for 5010 only. The diagnosis codes appear in the Charge Posting window in NextGen® Enterprise PM and are sent on the 837 electronic claim. Note: This setting works independently from the Allow eight diagnoses option in the NextGen® Enterprise EHR practice preferences. When this field is blank, users can apply only four diagnoses codes to a claim. This setting can be overridden with the same setting in the Electronic Claims tab on the System tab in the Payers master file.
Anesthesia Units to Follow Primary Claim	Select this option to prevent the rounding setting in the Payer master file and the Anesthesia Modifiers library and to instead use the total anesthesia units calculated on the primary claim for all coordination of benefits (COB). For example, if a charge or modifier combination has different unit calculations depending on the payer, the following outcomes occur: The units are calculated with the payer settings. A primary Medicare claim has 10 total anesthesia units, while a primary Aetna claim has 12 total anesthesia units. For primary Medicare and secondary Aetna claims, both primary and secondary claims are sent with 10 units. For primary Aetna and secondary Medicare claims, both primary and secondary claims are sent with 12 units. For more information on anesthesia billing, go to NextGen Healthcare Success Community, and download the latest Anesthesia Billing User Guide for NextGen® Enterprise PM.
Enable billing of encounter diagnoses	Select this option to display Bill encounter diagnoses on the Other tab on the Practice tab in the Payers master file.
UB Claim Form	Select the information to print on the UB Claim Form. Type of Facility: Prints in the first position on UB Claim Form. The facility type also appears in the Add/Modify Payer Information window. Bill Classification: Prints in the second position on UB Claim Form. The selected bill classification also appears in the Add/Modify Payer Information window. Frequency of Bill: If the practice does regular UB claims billing, this field is optional. You can enter the frequency to print in the third position on UB Claim Form. If the field is blank, the system automatically determines the correct code based on the other entered information. Source of Admission: Set the default physician recommendation for admission. The selection appears on the UB tab of the Create Encounter window. The code prints in box 20 on the UB92 form and in box 15 on the UB04 form. Note: To make the UB Claims tab available in the Payer master file, you must select a facility and a bill classification.
In-Line Edits Default Payer ID	In the payer ID for real-time edits at the practice level, the practice-level ID is used as the default for the entire practice when payer-level IDs are blank. The payer ID identifies the client and payer. The ID is 13 characters long, where the first six characters are the client ID and the last seven characters are the payer ID. This payer ID overrides the enterprise-level ID.
Exclude subsequent payers from EDI file	Select this option to exclude subsequent payer information from the electronic data interchange (EDI) file and to display only the prior payer information. If the primary payer claim is created, the secondary and tertiary payer information are excluded for 837I and 837P claims. If the secondary payer claim is created, the tertiary payer information is excluded, and the primary and secondary payer information appears for 837I and 837P claims. If the tertiary payer claim is created, the primary, secondary, and tertiary payer information appears because there are no subsequent payers. Note: The Exclude subsequent payer from EDI file option is applicable for institutional and professional claims for Version 5010. The loops affected are 2330B, 2330A, and 2320.

Practice Preferences for Billing and Claims