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You can select the default libraries that your practice uses. The selected libraries apply to all payers that do not have a different library assigned at the payer level. You can override these practice-level default libraries by selecting different libraries for specific payers.
| Field | Description |
|---|---|
| Diagnosis Codes Library | Select a library to create a subset of the full International Classification of Diseases - Clinical Modification (ICD-CM) list to simplify the coding process. You can add frequently used codes to a library. |
| Service Items Library | Select a library containing the services performed by the practice. Each service or SIM code includes defined parameters that affect charge posting, billing, claims, and reports in NextGen® Enterprise PM. |
| Claim Modifiers Library | Select a library to override the default Claim Modifiers library selected in practice preferences. |
| NDC Library | Select a library to create a National Drug Code (NDC) drug product list to help you manage the billing for drugs prescribed in the clinic. |
| Claim Edits Library | Select a library to override the default Claim Edits library selected in the practice preferences for libraries. |
| Self-Pay SIM Exception | Select a library that is applicable at the practice and location levels to use for self-pay encounters when patients have no insurance. |
| Eligibility Profile Library | Select a library to set up rules to automatically complete the required fields and additional data for the batch mode that you manually enter when checking eligibility status in real time. |
| Behavioral Health Billing Library | Select a library to use when no specific Behavioral Health Billing library is defined at the payer level. |
| Claim Print Library | Select a library to configure settings that determine the information printed on claim forms. You must create and associate a Claim Printing library with a practice at the practice preference level to generate a paper claim. |
| Remittance Profile Library | Select a library that is applicable to all electronic remittance advice (ERA) payers within the practice. This library defines ERA import profiles in the remittance profiles, ensuring that your system accurately interprets the ERA information received from payers or clearinghouses, where applicable. |
| Claim Status Profile Library | Select a library for submitting claim-status inquiries and setting rules for automatically filling in the necessary fields and additional data for batch mode processing. |
| Non-Coordinated SIM Library | Select a library 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, which is not reimbursed if billed to other payers. |
| Anesthesia Library | Select a library to define rules that apply to different types for payers: specific payers, all payers, and self-payers. |
| Consolidated Services Claim | Select a library to select the Consolidated Services Claim (CSC) to combine eligible claims automatically. |
| Institutional Billing Library | Select a library to set the payer-specific and claim rules. If you do not select a library, legacy Uniform Billing (UB) logic is used in NextGen® Enterprise PM. |
| EDI Claim Profile Library | Select a library to provide support for the 2400 loops and segments requested by payers when the 2300 loop details are different per charge or the same per charge. |
| Service Package Library | Select a library to define various sets of packaged services that payers authorize for patients. Each service package includes groupings of specific CPT4 code and modifier combinations with defined service unit limitations. |
| Service Swap Library | Select a library to dynamically swap SIM codes based on programs, payers, and service items to optimize reimbursement without changing charge amounts on claims for secondary and tertiary payers. |