Rules for Claim Population

File Maintenance Help for NextGen® Enterprise

Set Up CPT4 Codes at the Provider Master Level

To set up CPT4 codes at the provider master level: From the Master Files > System list, select Providers. Select the appropriate provider. Select the Practice tab. Select the drop-down arrow in the ServiceLocation field and select the location where the service is performed. A list of payers displays in the Group Information section. Under Group information, double-click the payer to which you want to add CPT4 codes. The Modify Provider Practice Payer window displays. Select the Open Record button next to the CPT4 Provider Nbrs field. The Valid Provider Numbers for [Payer Name] window displays. Select the Open Menu button and select New. Note: You can open and delete existing records. You can edit existing provider numbers, but you cannot edit the CPT4 code range. The Provider Number for CPT4 Range window displays. In the CPT4 field, enter the CPT4 code at the beginning of the range you want to set up. Use the to display the CPT4 Code Search window to search for a CPT4 code by code or

File Maintenance Help for NextGen® Enterprise 8

Rules for Claim Population

When a paper or electronic claim is generated, the claim pulls data (box 33 on the HFCA 1500) from the fields on the Provider Number for CPT4 Range dialog box based on the following rules: If data has been entered in the CPT4 and Provider Number fields, the claim pulls the provider number from this dialog box. If the Group Name field is blank, the Group # is blank on the claim. If data has been entered in the Group Name field, the claim pulls the group name, address, and phone number from the Group Information dialog box. If the Group Name field is blank, but data has been entered in the Name/Organization and address fields, then the claim pulls the Name/Organization and address information from this dialog box. If the Group Name, Name/Organization, and address fields are blank, then the claim pulls the Name/Organization, and address information from the provider/payer/location setup on the Practice tab of the Provider master. Parent topic: Assign a Provider Number at a Practice/Locati

File Maintenance Help for NextGen® Enterprise

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

You can set up a range of CPT4 codes at the practice/location/provider level. This range allows you to have a different provider number for each CPT4 code. Set Up CPT4 Codes at the Provider Master Level Rules for Claim Population Parent topic: Providers Practice Tab

File Maintenance Help for NextGen® Enterprise 8

Set Up CPT4 Codes at the Provider Master Level

To set up CPT4 codes at the provider master level: From the Master Files > System list, select Providers. Select the appropriate provider. Select the Practice tab. Select the drop-down arrow in the ServiceLocation field and select the location where the service is performed. A list of payers displays in the Group Information section. Under Group information, double-click the payer to which you want to add CPT4 codes. The Modify Provider Practice Payer window displays. Select the Open Record button next to the CPT4 Provider Nbrs field. The Valid Provider Numbers for [Payer Name] window displays. Select the Open Menu button and select New. Note: You can open and delete existing records. You can edit existing provider numbers, but you cannot edit the CPT4 code range. The Provider Number for CPT4 Range window displays. In the CPT4 field, enter the CPT4 code at the beginning of the range you want to set up. Use the to display the CPT4 Code Search window to search for a CPT4 code by code or

File Maintenance Help for NextGen® Enterprise 8

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

You can set up a range of CPT4 codes at the practice/location/provider level. This range allows you to have a different provider number for each CPT4 code. Set Up CPT4 Codes at the Provider Master Level Rules for Claim Population Parent topic: Providers Practice Tab

Help Guide for NextGen® Enterprise PM 8

Set Up a Default Location for Group Provider Numbers

To set up a group that has the same Group Provider number for payers at all or several practice locations, do the following: In File Maintenance, under Master Files, select Practice > Groups. The Groups List window opens. Double-click a group. The Group Information window opens. From the Service Location list, select the <Default> option. Select one of the following options based on the following information: To set up the group on the default payer, double-click the Default row listed under the Payer Name column. The Group Information window opens additional fields. This set up is for the default payer and the Payer Name field is disabled. To set up a specific payer for the group, right-click in the Group Information section, then select New. The Group Information window opens additional fields. Because this setup is for a specific payer, the Payer Name field is available. From the Payer Name list, select a payer. In the Group Number field, enter the group number. In the Opt Group Val

Rules for Claim Population

Recommendations

Set Up CPT4 Codes at the Provider Master Level

Rules for Claim Population

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

Set Up CPT4 Codes at the Provider Master Level

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

Set Up a Default Location for Group Provider Numbers

Rules for Claim Population

Set Up CPT4 Codes at the Provider Master Level

Rules for Claim Population

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

Set Up CPT4 Codes at the Provider Master Level

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

Set Up a Default Location for Group Provider Numbers