NextGen Knowledge Center

Set Up a Fee Schedule for Contract Payers

If the co-pay for a CPT4 code might be different from the default co-pay. The options in the Fee Schedule tab override the options in the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter.

Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances.

  1. In File Maintenance, select Libraries, and then select Contract.
    The Contracts List window opens.
  2. Double-click the library, and then select Fee Schedule.
  3. Enter a CPT4 Code.
    The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for a specific code, enter the CPT4 code in the field above the CPT4/Desc column and the code is highlighted.
  4. Select Open Menu , and then select New.
  5. Select Lookup to display a list of CPT4 codes and descriptions.
    When you select a CPT4 code, information for this code automatically fills in on the Fee Schedule tab of the Contract Library Maintenance window.
  6. In Fee Schedule, enter the contract exceptions.
    Contract exceptions (some charges that have a referral required or might not follow the normal percentage of reimbursement) can be entered on the Fee Schedule tab. All CPT4 codes are affected by the contract defaults set up on the General tab.
  7. In Fee Schedule, enter Date Range, Type, Non-Facility/Facility, Allowed, Participating Reimbursed, Non-Participating Reimbursed, Auth Req, Refer Req, Apply Co-Pay, Required Diagnoses, and Required Modifiers.
Set Up a Fee Schedule for Contract Payers