Access Contract Library Maintenance

Help Guide for NextGen® Enterprise PM 8

Access Contract Library Maintenance

Access the Contract Library Maintenance window, to create contract defaults, such as co-payments, deductibles, and physician referrals and authorizations. In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Double-click the applicable library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Parent topic: Contracts Library

File Maintenance Help for NextGen® Enterprise 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on 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. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. 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

File Maintenance Help for NextGen® Enterprise 8

Contracts Library

Contracts can be set up for payers to indicate: The amount you expect to be reimbursed for procedures. When an authorization is required. When a referral is required. Other contract specific items, for example, the ability to send $0.00 claims such as capitated with contracts, you can: Attach payers to the contract. Create contract subgroupings for reporting purposes. For more information on contract subgrouping, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide for NextGen® Enterprise, and refer to the Contract Subgrouping section. Access Contract Library Maintenance Setup an Exception Through the Contract Library

File Maintenance Help for NextGen® Enterprise 8

General Tab of Contract Library Maintenance

The General tab of Contract Library Maintenance window consists of the following sections: Contract Information Contract Defaults Alerts and Edits Allowed and FFS/Balance Distribution Automatic Adjustments Contract Information Contract Defaults Alerts and Edits Allowed and FFS/Balance Distribution Automatic Adjustments Parent topic: Access Contract Library Maintenance

File Maintenance Help for NextGen® Enterprise 8

Contract Exceptions

You can charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider/payer/location level in order to apply the exceptions to charges. Parent topic: Access Contract Library Maintenance

File Maintenance Help for NextGen® Enterprise 8

Payer/Provider Tab

The Payer/Providers tab lists all payers attached to the contract library. When a payer is selected, all participating and non Participating providers for the target payer display on the tab. You can add and remove participating and non-participating providers by using the blue arrows. Selections are saved when you highlight the provider name and then select an arrow. Parent topic: Access Contract Library Maintenance

Access Contract Library Maintenance

Recommendations

Access Contract Library Maintenance

Set Up a Fee Schedule for Contract Payers

Contracts Library

General Tab of Contract Library Maintenance

Contract Exceptions

Payer/Provider Tab

Access Contract Library Maintenance

Access Contract Library Maintenance

Set Up a Fee Schedule for Contract Payers

Contracts Library

General Tab of Contract Library Maintenance

Contract Exceptions

Payer/Provider Tab