NextGen Knowledge Center

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering.

These rules determine which provider goes on the claim and includes the following criteria:

  • Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios.
  • If None is selected, then claims are created using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim.
  • If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim.
  1. In File Maintenance, select Libraries, and then select Anesthesia.
    The Anesthesia Library Payer Maintenance window opens.
  2. Select Claim Options.
  3. Enter the following claim option parameters for the selected valid payer:
    • Send surgical as SV item: Select this option to enter the surgical procedure from the Surg Proc field in the Charge Posting window as the service line item on the claim.
    • Send surgical as HI*BP: Select this option to enter the surgical procedure from the Surg Proc field in the Charge Posting window as the 2300 HI*BE on the 5010 837P claim. This option is selected by default.
  4. Select OK.
  5. For Non-Split Billing, do the following:
    1. Select Use Encounter MDA to use the MDA from the encounter. If MDA is not present on the encounter, then use the rendering provider from the encounter.
    2. Select Use MDA from the First Anesthesia Charge Line to use the MDA from the first anesthesia charge line. If MDA is not present on the first anesthesia charge line, then you can use the rendering provider from the first charge line.
    3. Select Use the MDA with the Greatest Total Time to use the MDA from the charge line with the greatest total time. If MDA is not present on the charge line with the greatest total time, then you can use the rendering from the charge line. When there are two providers with equal total time, the first of those two providers on the encounter is selected for the claim.
  6. For Split Billing, do the following:
    1. Select Use Encounter Provider, when the encounter rendering provider is for the CRNA claim and the encounter MDA is for the MDA claim.
    2. Select Use Rendering from the First Anesthesia Charge Line, when the rendering provider from the first anesthesia CRNA charge line is for the CRNA claim and the rendering provider from the first MDA anesthesia charge line is for the MDA claim.
    3. Select Use the Rendering with the Greatest Total Time, when the rendering provider from the CRNA charge line and MDA charge line uses the total time for the CRNA claim and MDA Claim respectively. When there are two providers with equal total time, the first of the two providers on the encounter is selected for the claim.
Set Up Claim Options for Anesthesia Billing