Select a Default SIM Pricing Region Library for an Enterprise

File Maintenance Help for NextGen® Enterprise

Set Up a SIM Pricing Region

The SIM Pricing Regions library enables you to set prices based on geographical regions that vary by payer. The library contains a group of pricing regions, the Service Item library for each pricing region, and the specific locations that belong to each pricing region. Open File Maintenance and select Libraries > SIM Pricing Region. The Pricing Regions Library List window opens. Select the open menu button and then select New. The Add pricing Regions Library window opens. Enter a library name, and then from the open menu button, select New. Note: You can modify an existing region by selecting it from the list and making the required changes. The Add pricing Region window opens. Enter a name in the Pricing Region Description field, and then select a SIM library to use for the pricing region. Select open menu button and then select New. The Add Pricing Region Location window opens. Select a location, enter the effective and expiration dates, and then select OK. Note: You cannot attach th

File Maintenance Help for NextGen® Enterprise 8

Select a Default SIM Pricing Region Library for an Enterprise

The system uses a pricing region associated with the enterprise only when there is no pricing region associated with the payer or if the encounter is self pay. Access the Enterprise Preferences > Libraries tab. Select a default region in the following fields: Pricing Region Library for Self Pay field – The system uses this pricing region if an encounter is self-pay and, therefore, has no payer. Default Pricing Region Library field – The system uses this pricing region if the encounter has a payer but no pricing region is selected for the payer (the Pricing Regions Library field in the Payer master file > Payer Defaults-1 tab is blank). This pricing region is also used when the Pricing Region Library for Self Pay field is blank. Select OK. Parent topic: SIM Pricing Regions Library

File Maintenance Help for NextGen® Enterprise 8

SIM Pricing Regions Library

The SIM Pricing Regions library enables you to set prices based on geographical regions that vary by payer. The library contains a group of pricing regions, the Service Item library for each pricing region, and the specific locations that belong to each pricing region. After you set up the library, you can attach it to: A payer in the Payers master file > Payer Defaults - 1 tab > Pricing Regions Library field. Enterprise Preferences > Libraries tab > Default Pricing Region Library field. Enterprise Preferences > Libraries tab > Pricing Region Library for Self Pay field NextGen® Enterprise PM determines the SIM library to use based on the following conditions: If the encounter has a payer, then it uses the SIM Pricing Regions Library specified in the Payer master file. If the encounter has a payer with no pricing region selected (the Pricing Regions Library field in the Payer master file > Payer Defaults-1 tab is blank), then it uses the library specified in the Enterprise Preferences >

File Maintenance Help for NextGen® Enterprise

Set Up Enterprise Preferences for Payment Libraries

To open the Enterprise Preferences window, do one of the following: From NextGen® Enterprise PM, select Admin > > Preferences > Enterprise. From File Maintenance, select Master Files > System > Enterprises, and from the list, choose an enterprise and then select Preferences. From Preference List, select Libraries. To turn on all features that allow users to set prices by configuring locations into payer-centric groupings, select Enable Advanced Service Item Library Mode. Note: You cannot turn off this feature after you have turned it on. In Default Pricing Region Library for Self Pay, select the appropriate SIM pricing regions library that defines the pricing for self-pay encounters. In Default Pricing Region Library, select the appropriate SIM pricing regions library that defines the pricing for payers in this enterprise. For more information, go to NextGen Healthcare Success Community, and download the latest File Maintenance Libraries Guide for NextGen Enterprise. In User Defined Pr

File Maintenance Help for NextGen® Enterprise 8

Libraries Tab - Enterprise Preferences Descriptions

The following table provides descriptions of the fields located in the Libraries Enterprise Preferences. Field Description Enable Advanced Service Item Library Mode Caution: Once you enable this feature, you cannot disable it. This check box turns on all features that enable you to set prices by configuring locations into payer-centric groupings. For example, Medicare might have different regional groupings than Aetna, and pricing would be determined accordingly. Default Pricing Region Library for Self Pay Select the appropriate SIM Pricing Regions library that defines the pricing when an encounter is self-pay. For more information, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide for NextGen Enterprise. Default Pricing Region Library Select the appropriate SIM Pricing Regions library that defines the pricing for payers of this enterprise. For more information, go to NextGen Healthcare Success Community and download the latest File Mai

File Maintenance Help for NextGen® Enterprise 8

Preventing Use of Default SIM Library to Determine Charges

When your practice uses Advanced Service Item Library Mode, you will require an effective location to be selected in the pricing regions before the application can determine which Service Items library to use. When Default Pricing Region Library for Self Pay and Default Pricing Region Library are defined in the Enterprise Preferences, but no effective location exists, then when a user enters a procedure, the Service Item library selected in the Libraries Practice Preferences is used, by default. You can prevent the practice-level Service Item library from being used by selecting Require Effective Location in Pricing Region check box in the Enterprise Preferences Libraries tab. Requiring an effective location provides more control over which payer a user can attach to a charge or procedure. For example, users will be unable to select a payer that is not affiliated with a location. When a user enters a procedure, a message displays that a location is not selected in the pricing region. T

Select a Default SIM Pricing Region Library for an Enterprise

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