Alerts and Edits

Field	Alerts and Edits Descriptions
Referring Physician Required	If the contract calls for a referring physician, select this check box. An alert displays when you enter charges for an encounter.
Enable Build Level Edits	Select this check box to have Contract Edits display on the Claim Production Status report as Build or Warning level claim edits when an encounter is billed. The Enable Build Level Edits option turns some contract edits from a warning to required during the billing process. When the edits are not passed, a claim will not be created. This option works with the Contract Edit options in Practice Preferences.
Authorization Required	If the contract calls for authorization, select this check box. When you enter charges for an encounter, an alert displays to warn you that the contract for the payer requires an authorization for all CPT4 codes.

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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

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Automatic Adjustments

The Automatic Adjustments section enables you to automatically adjust charges to the expected allowed amount at the time they are entered. This section is used in conjunction with the Fee Schedule tab. Field Automatic Adjustments Descriptions Automatically adjust charges Select this check box so that adjustments are automatically made for the items at the time charges are entered on the Charge Posting window. This check box enables the remaining fields in the section. Adjustable Allowed Amount Select this check box to determine the write off (auto adjustment) based on the patient co-pay plus the contract reimbursement amount. If you select this option, the Co-Pay Origin field changes to Reimbursed and, on the Fee Schedule tab, the Allowed column becomes disabled. Default Auto-Adj Transaction Select the transaction code to associate with the automatic transactions. Note: The codes listed are set up in the Transaction Codes master file as an Adjustment type and have the source as Third p

Help Guide for NextGen® Enterprise PM 8

Alerts and Edits

Field Alerts and Edits Descriptions Referring Physician Required If the contract calls for a referring physician, select this check box. An alert displays when you enter charges for an encounter. Enable Build Level Edits Select this check box to have Contract Edits display on the Claim Production Status report as Build or Warning level claim edits when an encounter is billed. The Enable Build Level Edits option turns some contract edits from a warning to required during the billing process. When the edits are not passed, a claim will not be created. This option works with the Contract Edit options in Practice Preferences. Authorization Required If the contract calls for authorization, select this check box. When you enter charges for an encounter, an alert displays to warn you that the contract for the payer requires an authorization for all CPT4 codes. Parent topic: General Tab of Contract Library Maintenance

NextGen® Orthopedic Suite Help 80.2.14.0

Add an Alert

You can add alerts for preregistration templates based on the chief complaints and financial class of the encounter-level insurance. The alerts added on the Billing Configuration practice template appear on the following preregistration templates, based on the configuration. Pre Reg Clinical Approval Billing Approval Clinical 1 Clinical 2 On the Billing Configuration practice template, expand the Alerts panel. Alerts panel on the Billing Configuration template Note: The Workflow/Template field displays Pre-Reg, by default. Click the blank field below the Complaint column, and select a complaint from the list. Note: If an alert is applicable for all payers in the financial class and all complaints, select the asterisk (*) from the list. After you select the complaint, the windows for selecting the financial class name and payer open. Select the financial class name and payer. Note: If an alert is applicable for all payers in the financial class and all complaints, select the asterisk (*

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Contract Edits Practice Preferences

The Contract Edits Practice Preferences lists the Contract Edit Alerts that are triggered by certain conditions as described by each alert. The alerts are grouped according to the areas of the application where they display, which include Appointment Scheduling, Balance Control, Billing Process, Charge Entry, Insurance Modification, and Payment Entry. With the Contract Edits Practice Preferences, you can: Select the user groups that see the alerts. Require some Charge Entry Contract Edits during charge entry. Users must correct the edit in order to save a charge unless they have the right to override the Charge Entry Contract Edit Alert. Assign Contract Edit Alerts Requiring Specific Charge Entry Contract Edits Modify the Override Charge Entry Contract Edit Right Parent topic: Practice Preferences

Help Guide for NextGen® Enterprise PM 8

Run Claim Edits after Entering Charges

You must run claim edits on charges immediately after you enter charges. The edits identify errors that may need to be corrected before the encounter goes through the billing process to create a claim for the payer. Open the Patient Chart for the desired patient. On the Encounters tab, select the encounter to run the claim edits. From the main toolbar, select Edits and do one of the following: You can run edits from the Appointment Book using Edits on the appointment toolbar. You can run edits from an open claim. You can add edits to the autoflow process. When the claim edits run successfully, the Claim Production Status window opens displaying the following: Build, Critical, Custom, Required, Error, Warning, and Informational labels under the Severity column. Errors for encounters appearing in red that result in bad claims and prevent reimbursement. Warnings for encounters appearing in blue do not prevent a clean claim, but might be contractual, and should be addressed. Informational

Alerts and Edits

Recommendations

Contract Defaults

Automatic Adjustments

Alerts and Edits

Add an Alert

Contract Edits Practice Preferences

Run Claim Edits after Entering Charges

Contract Defaults

Automatic Adjustments

Alerts and Edits

Add an Alert

Contract Edits Practice Preferences

Run Claim Edits after Entering Charges