Add an Alternate Payer

File Maintenance Help for NextGen® Enterprise 8

Copy Alternate Payer Details

You can copy the alternate payer details from an existing alternate payer master file to a new alternate payer master file. Note: When you copy an alternate payer, the billing options and transaction options (except ERA payer number and Require both payments before settling check box) are not copied. In File maintenance, select Master Files > System > PM, and then select Payers-Alt Payers. The Payers-Alt Payers List window opens. From the Payer-Alt Payers list, select an alternate payer and do one of the following: Select open menu and then select Copy. Right-click an alternate payer and then select Copy. The Copy Master File window opens. Enter a new alternate payer name. To save the changes and close the window, select OK. The new alternate payer master file is added to the list. Parent topic: Alternate Payers

File Maintenance Help for NextGen® Enterprise 8

Modify Alternate Payer Information

In File maintenance, select Master Files > System > PM, and then select Payers-Alt Payers. The Payers-Alt Payers List window opens. From the Payer-Alt Payers list, select an alternate payer and do one of the following: Select open menu and then select Open. Right-click an alternate payer and then select Open. Double-click an alternate payer. The Modify Alt Payer Information window opens. Modify the alternate payer information as required. To save the changes and close the window, select OK. Parent topic: Alternate Payers

Help Guide for NextGen® Enterprise PM 8

Add an Alternate Payer

In File Maintenance, select Master Files > System > PM, and then select Payers-Alt Payers. The Payers-Alt Payers List window opens. To add an alternate payer, select open menu and then select New. The Add Alt Payer Information window opens. In the Alt Payer Details section, do the following: Enter the alternate payer name. Enter the NEIC/Payer Number, if applicable. You can enter the number for a specific clearing house and/or a specific payer. Enter the alternate payer alias name, if applicable. Enter the in-line edits payer ID, if applicable. Note: You must have a NextGen® In-Line Edits license to use this option. Note: The alternate payer details are system specific. In the Main Address section, enter the address of the alternate payer. To define the billing options for an alternate payer, do the following on the Alt Payer Billing Option tab: Select the applicable values for the fields in the Libraries section. In the Claim Details section, select the applicable media type (electron

File Maintenance Help for NextGen® Enterprise 8

Alternate Payers

The Payers-Alt Payers master file allows you to create an alternate payer and associate the alternate payer to a payer in the Payers master file. You can associate the same alternate payer to multiple payers or associate multiple alternate payers to a payer. When you bill an encounter with a payer having alternate payers, separate claims can be generated simultaneously. For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. You can also hide or show an alternate payer by selecting open menu and then selecting Hide or Un-hide. You can generate Alternate Payer Listing report from the Payers-Alt Payers master file. For more information, go to Ne

File Maintenance Help for NextGen® Enterprise 8

Additional Information on Alternate Payer Transaction Options

The following table provides additional information on the alternate payer transaction options. Field Description ERA Payer Numbers The system checks the payer number in the ERA Payer Numbers field and the GS02 segment of the ERA file. If the payer number matches, then the payments are posted against the alternate payer. In the 835 IG, the ERA payer number can be located in the GS02 segment. Require both payments before settling If you select the Require both payments before settling check box, and the billing status shows up as waiting for another payment, then the default status on the line item is set to None to prevent further billing until you receive both the payments. Default Reason Code The default reason code exists at the line item level, and not at the transaction level. Therefore, when posting payments, the default reason code for the alternate payer will be applied to the line item. ERA Reason Code Library You must use the Reason Codes library when the payer number in the

Help Guide for NextGen® Enterprise PM 8

Set Up Default Transaction Codes for an Alternate Payer

When you are using the alternate payer functionality, you might find that the main payer on the Payer master file, and the alternate payer on the Payers-Alt Payer master file has different Default Transaction Codes. In File Maintenance, select Master Files > System > PM > Payers-Alt Payers. The Payers-Alt Payers List window opens. From the Payers-Alt Payers List window, select and open the applicable alternate payer. The Modify Alt- Payer Information - Demo Payer window opens. Select the Alt Payer Transaction Option tab. The fields under the Alt Payer Transaction Option tab appear. Select default transaction codes for the alternate payer. For more information, see Settings - default transaction codes for the alternate payer To save the changes and close the window, select OK. Note: For more information on the Payers-Alt Payers master file go to NextGen Healthcare Success Community and download the latest Claims User Guide for NextGen® Enterprise PM. Settings - default transaction codes

Add an Alternate Payer

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Copy Alternate Payer Details

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Additional Information on Alternate Payer Transaction Options

Set Up Default Transaction Codes for an Alternate Payer

Copy Alternate Payer Details

Modify Alternate Payer Information

Add an Alternate Payer

Alternate Payers

Additional Information on Alternate Payer Transaction Options

Set Up Default Transaction Codes for an Alternate Payer