Additional Information on Alternate Payer Billing Options

Field	Description
Submitter Profile Library	You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill.
Claim Edit Library	When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer.
Claim Print Library	You must use the Claim Print library while creating paper claims for the alternate payer. When you do not select the Claim Print library for the alternate payer, the alternate payer will use the Claim Print library of the payer.
EDI Claim Profile Library	The EDI Claim Profile library provides support for 2400 loops and segments requested by payers when 2300 loop details are different or same per charge. The settings in this library apply to professional and institutional claims.

Help Guide for NextGen® Enterprise PM 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

File Maintenance Help for NextGen® Enterprise

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

Help Guide for NextGen® Enterprise PM 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

File Maintenance Help for NextGen® Enterprise 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

Help Guide for NextGen® Enterprise PM 8

Setting Up Claims

Before you can generate claims, you must set up options to define the following: The type of information you want to display in the various claim form fields The way you want the claim forms to print The location, payer, and provider information for a valid claim creation Specialty Billing For more information about the setup and functionality of the types of billing based on speciality, go toNextGen Healthcare Success Communityand download the following user guides: Anesthesia Billing User Guide forNextGen® Enterprise PM Behavioral Health Billing User Guide forNextGen® Enterprise PM Community Health Centers User Guide forNextGen® Enterprise PM Community Health Centers include the following types of billing: Encounter Rate Billing Roll-Up Billing Dental Billing Claim Printing Library The Claim Printing library enables you to specify options that define which information prints on claim forms. Claim Modifiers Library EDI Claim Profile Library The EDI Claim Profile library enables you to

Help Guide for NextGen® Enterprise PM 8

Setting Up Claims

Before you can generate claims, you must set up options to define the following: The type of information you want to display in the various claim form fields The way you want the claim forms to print The location, payer, and provider information for a valid claim creation Specialty BillingFor more information about the setup and functionality of the types of billing based on specialty, go to NextGen Healthcare Success Community and download the following user guides. Anesthesia Billing User Guide for NextGen® Enterprise PM Behavioral Health Billing User Guide for NextGen® Enterprise PM Community Health Centers User Guide for NextGen® Enterprise PM Claim Printing Library The Claim Printing library enables you to specify options that define which information prints on claim forms. Claim Modifiers Library EDI Claim Profile Library The EDI Claim Profile library enables you to store and configure EDI claim settings in one central library. Contracts Library Claim Edits Set Up CPT Codes in Se

Additional Information on Alternate Payer Billing Options

Recommendations

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Add an Alternate Payer

Setting Up Claims

Setting Up Claims

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Add an Alternate Payer

Setting Up Claims

Setting Up Claims