Add or Modify a Contract

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

Help Guide for NextGen® Enterprise PM 8

Add or Modify Contracts

In File Maintenance, select Libraries and then Contracts. The Contracts Libraries window opens. To add a new contract, select the open menu button, and choose New. To modify an existing contract, highlight the contract, select the open menu button, and then select Open. The Contract Library Maintenance window opens. Enter or modify the Contract Name, Effective Date, and Expiration Date. Enter or modify the Contract Defaults information. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, enable the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter or modify the information in the Automatic Adjustments section that applies. Select the Fee Schedule tab. Enter or modify the CPT4 code that is applicable to t

Help Guide for NextGen® Enterprise PM 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

Help Guide for NextGen® Enterprise PM 8

Contract Co-Pay

If both a green check and a zero ($0.00) or positive amount are found for the CPT4 code in the Apply Co-Pay Amount column on the Fee Schedule tab of the Contract Library Maintenance window, the defined amount will be the patient’s co-pay for that service. If no green check is found for the CPT4 code, no patient co-pay will be applied for that service. If a green check is found with a blank Apply Co-Pay Amount for the CPT4 code, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The contract Apply Co-Pay Amount will be applied to a charge only if the contract is linked to the primary insurance on the encounter in the Managed Care Contract field on the Practice > Libraries sub-tab of the Payers master file and only for the providers checked in the Participating Provider field. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Set Up a New Contract Exception

In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Select a library and select open menu or right-click the selected library, and then select Contract Exceptions. The Contract Exceptions List window opens. Select open menu button, or right-click in the Description area of the window, and then select New. The Contract Exception Maintenance window opens. In the Contract Exception Name field, enter a name for the Contract Exception that describes the group of exceptions. Note: If you do not want this exception to display in the Contract Exceptions List window, select the Hide Exception option. To use this contract as the base contract, select the Use as Base Contract check box (instead of being used as an exception to the contract). Enter the Filter Criteria to control which CPT4 items display in the CPT4 list, as follows: Enter the first number of the CPT4 item in Type the first number(s) of the CPT4 item you want to locate. If the CPT4 column conta

File Maintenance Help for NextGen® Enterprise 8

Contract Defaults

The Contract Defaults section contains options that enable you to set informational alerts, information about co-payments, co-pay amounts, and a default percentage for expected reimbursement, among other options. Field Contract Defaults - Contractor and Co-Pay Options Descriptions Co-Payment on Office Encounters To require a co-payment, select this check box. When you attach insurance to an encounter, an alert reminds you that the contract requires a co-pay for all encounters. Default Co-Pay Amount Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when you attach the insurance to the encounter, you will be given another warning. Co-Pay Origin Select either Allowed or Reimbursed to determine whether the co-pay perce

Add or Modify a Contract

Recommendations

Set Up a Fee Schedule for Contract Payers

Add or Modify Contracts

Set Up a Fee Schedule for Contract Payers

Contract Co-Pay

Set Up a New Contract Exception

Contract Defaults

Set Up a Fee Schedule for Contract Payers

Add or Modify Contracts

Set Up a Fee Schedule for Contract Payers

Contract Co-Pay

Set Up a New Contract Exception

Contract Defaults