Add or Modify an Encounter Rate Billing Library

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claim SIM Options Tab

The Claim SIM Options tab on the Encounter Rate Billing Library Maintenance window contains options that provide the capability to show non-Encounter Rate SIMs on claims or affect automatic adjustments. Open an Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claim SIM Options tab. In the Claim Service Range Options section, select open menu button and select New. The Alt Payer Number SIM Range window opens. Enter the SIM number or the beginning SIM number for a range of SIMs that you want to apply to a claim SIM option. For a range of SIM numbers, enter the ending SIM number. The ending SIM is required, but can be the same as the beginning SIM, functionally choosing that as a single SIM. Select OK. The claim SIM options are available for selection. Select the applicable option based on the following descriptions: Exclude from Encounter Rate Insertion: Select this option to make the service exempt from the Encounter Rate. This opti

File Maintenance Help for NextGen® Enterprise

Add or Modify an Encounter Rate Billing Library

Before you begin A SIM with an appropriate CPT4 code must be set up in the SIM Library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing Library, the SIM configuration hierarchy and the encounter rate information are also copied. Encounter Rate Billing Library provides flexibility to set up multiple rate codes to accommodate different billing requirements of individual payers. You can generate both Encounter Rate Library Listing and Encounter Rate Library with Claim Detail Rules reports from the Encounter Rate Billing Library. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library, select the library from the list, select the open menu button and th

Help Guide for NextGen® Enterprise PM 8

Add or Modify an Encounter Rate Billing Library

The Encounter Rate Billing library enables you to configure the billing process for payers who require a flat encounter rate. This library is used to configure the business rules applicable to a payer. The Encounter Rate Billing library provide the flexibility to set up multiple rate codes to accommodate the different billing requirements of individual payers. The appropriate library can then be attached to the payer. A SIM with the appropriate CPT4 code must be set up in the SIM library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing library, the SIM Configuration Hierarchy and the encounter rate information are also copied. To add or modify an Encounter Rate Billing library, do the following: Access File Maintenance. Select Libraries, and then Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select Open Menu and select New. To modify a library, select the library from the list, and

Help Guide for NextGen® Enterprise PM 8

Add or Modify an Encounter Rate Billing Library

The Encounter Rate Billing library enables you to configure the billing process for payers who require a flat encounter rate. This library is used to configure the business rules applicable to a payer. The Encounter Rate Billing library provide the flexibility to set up multiple rate codes to accommodate the different billing requirements of individual payers. The appropriate library can then be attached to the payer. A SIM with the appropriate CPT4 code must be set up in the SIM library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing library, the SIM Configuration Hierarchy and the encounter rate information are also copied. To add or modify an Encounter Rate Billing library, do the following: Access File Maintenance. Select Libraries, and then Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select Open Menu and select New. To modify a library, select the library from the list, and

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Add or Modify an Encounter Rate Billing Library

Before you begin

Recommendations

Set Up the Claim SIM Options Tab

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Set Up Payers for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Set Up the Claim SIM Options Tab

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Set Up Payers for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing