Alternate Payer Configuration Report Columns

Column	Description	Data Populates From
Payer Name	The name of the payer.	Payer Name field on the Payer Defaults-1 tab.
Alt Payer Name	The name of the alternate payer.	Alt Payer field on the Alt Payer Carve Out Criteria window
Eff Date	The effective date of the alternate payer.	Eff Date field on the Alt Payer Carve Out Criteria window
Exp Date	The expiration date of the alternate payer.	Exp Date field on the Alt Payer Carve Out Criteria window
Desc	The description of the alternate payer carve-out criteria.	Description field on the Alt Payer Carve Out Criteria window
Locations	The valid service locations for the alternate payer.	Valid Locations field on the Alt Payer Carve Out Criteria window
SIM Ranges	The service code ranges for the alternate payer.	SIM Ranges section on the Alt Payer Carve Out Criteria window
Diag Ranges	The diagnosis code ranges for the alternate payer.	ICD Ranges section on the Alt Payer Carve Out Criteria window
Rend Providers	The rendering providers for the alternate payer.	Rendering Provider field on the Alt Payer Carve Out Criteria window
Alt RTE Payer ID	The in-line edits payer ID for the alternate payer.	In-Line Edits Payer ID field on the Alt Payer Carve Out Criteria window
Taxonomy Code	The group/billing provider taxonomy code for the alternate payer.	Taxonomy Code field on the Alt Payer Carve Out Criteria window
Provider NPI	The group/billing provider NPI for the alternate payer.	National Provider ID field on the Alt Payer Carve Out Criteria window
Provider Number	The group provider number for the alternate payer.	Provider Number field on the Alt Payer Carve Out Criteria window
Hide	Delete Indicator	Hide check box on the Alt Payer Carve Out Criteria window

File Maintenance Help for NextGen® Enterprise 8

Generate Alternate Payer Configuration Report

To generate the Alt Payer Configuration report, do the following: In File maintenance, select Master Files > System > PM and then select Payers. The Payers List window opens. From the Payers list, select a payer and do one of the following: Select open menu and then select Print > Alt Payer Configuration. Right-click a payer and then select Print > Alt Payer Configuration. The NextGen Report Filter: Alt Payer Configuration window opens. From the Settings list, select the required columns, and filters options for the Alt Payer Configuration report. To generate the report, select OK. The Alt Payer Configuration report opens. For information on customizing header/footer, memorized reports, report options, and report toolbars, go toNextGen Healthcare Success Communityand download the latestReports User Guide for NextGen Enterprise PM. Alternate Payer Configuration Report Columns You can select the columns to appear on the Alt Payer Configuration report. Column Filters in Alternate Payer Co

Help Guide for NextGen® Enterprise PM 8

Create an Alternate Payer Carve-Out Criteria

In File maintenance, select Master Files > System > PM and then select Payers. The Payers List window opens. Double-click a payer. The Modify Payer Information window opens. Select the Alt Payer tab. To create an alternate payer carve-out criteria, select open menu and then select New. The Add Alt Payer Carve Out Criteria window opens. In the Alt Payer Criteria section, do the following: Select an alternate payer from the list. You can also create a new alternate payer by selecting the open menu in the Alt Payer Criteria section. Select the effective and expiration date. Enter the description for the alternate payer carve-out criteria. Note: The alternate payer carve-out criteria details are practice specific. Select the required location. Note: When you select a location, the fields in the Billing Provider Information section are enabled. To enter the SIM range, select open menu and then select New. The Alt Payer Number SIM Range window opens. Enter the SIM range. Select the Populate

File Maintenance Help for NextGen® Enterprise 8

Create an Alternate Payer Carve-Out Criteria

In File maintenance, select Master Files > System > PM and then select Payers. The Payers List window opens. Double-click a payer. The Modify Payer Information window opens. Select the Alt Payer tab. To create an alternate payer carve-out criteria, select open menu and then select New. The Add Alt Payer Carve Out Criteria window opens. In the Alt Payer Criteria section, do the following: Select an alternate payer from the list. You can also create a new alternate payer by selecting the open menu in the Alt Payer Criteria section. Select the effective and expiration date. Enter the description for the alternate payer carve-out criteria. Note: The alternate payer carve-out criteria details are practice specific. Select the required location. Note: When you select a location, the fields in the Billing Provider Information section are enabled. To enter the SIM range, select open menu and then select New. The Alt Payer Number SIM Range window opens. Enter the SIM range. Select the Populate

File Maintenance Help for NextGen® Enterprise 8

Additional Billing Provider Information

The following table provides additional information on billing providers for an alternate payer. Field Description Taxonomy Code The taxonomy code you select on the Alt Payer Carve Out Criteria window overrides the taxonomy code you selected in the Groups master file. Provider Number This is the facility location provider number. National Provider ID This setting overrides the group-level NPI for alternate payer claims. If this field is blank, then the group NPI is used. Note: NPI is a standard unique identifier for health care providers and is used in filing and processing healthcare claims and other transactions. In-Line Edits Payer ID The in-line edits payer ID identifies the client and payer that represents a set of edits done from the NextGen In-line Edits engine. Note: The in-line edits payer ID supports 13 characters. The first 6 characters denote the client ID and the last 7 characters denote the payer ID. The in-line edits payer ID overrides the enterprise-level, practice-leve

Help Guide for NextGen® Enterprise PM 8

Additional Billing Provider Information

The following table provides additional information on billing providers for an alternate payer. Field Description Taxonomy Code The taxonomy code you select on the Alt Payer Carve Out Criteria window overrides the taxonomy code you selected in the Groups master file. Provider Number This is the facility location provider number. National Provider ID This setting overrides the group-level NPI for alternate payer claims. If this field is blank, then the group NPI is used. Note: NPI is a standard unique identifier for health care providers and is used in filing and processing healthcare claims and other transactions. In-Line Edits Payer ID The in-line edits payer ID identifies the client and payer that represents a set of edits done from the NextGen In-line Edits engine. Note: The in-line edits payer ID supports 13 characters. The first 6 characters denote the client ID and the last 7 characters denote the payer ID. The in-line edits payer ID overrides the enterprise-level, practice-leve

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report Columns

The following columns are available on the Claim Production Status report. Column Name Description Data Populates From Chrg Amt SIM Total Charge Amount Charge Posting Claim Edit Billing Reviews the encounter for additional information needed: Validates if a line-item referral is required for the encounter and not present on the encounter. Checks the CPT code and verifies if a test result or test date is needed. Claim Edits Library COB COB Indicator 1 = Primary 2 = Secondary 3 = Tertiary Edit ID Claim Edit ID Claim Edits Library Enc Age Encounter Age Current Date - Create Date = Encounter Age Enc Referring Encounter Referring Provider Encounter Maintenance Encounter Source Number Encounter Maintenance Enc Created By Encounter Created By Encounter Maintenance Enc Create Dt Encounter Create Date Encounter Maintenance Err Number of Errors Encounters Claim Production Status Report Form Claim Form Payers Master File or SIM Library Help Text Claim Edit Help Text Claim Edits Library Insured In

Alternate Payer Configuration Report Columns

Recommendations

Generate Alternate Payer Configuration Report

Create an Alternate Payer Carve-Out Criteria

Create an Alternate Payer Carve-Out Criteria

Additional Billing Provider Information

Additional Billing Provider Information

Claim Production Status Report Columns

Generate Alternate Payer Configuration Report

Create an Alternate Payer Carve-Out Criteria

Create an Alternate Payer Carve-Out Criteria

Additional Billing Provider Information

Additional Billing Provider Information

Claim Production Status Report Columns