Alternate Type of Service Codes

State Payer	If the Standard Code is...	Then the Alternate Code is...
CT, AR, NY, PA, MD, OR, WI, SC	All Types of Service codes	Blank
WA Medicare	All Types of Service codes	Blank
SC Medicaid	All Types of Service codes	Blank
PA Blue Cross Blue Shield	All Types of Service codes	Blank
MD Blue Cross Blue Shield	All Types of Service codes	Blank
TX WorkComp	All Types of Service codes	Blank
WA Medicaid and WorkComp	All Types of Service codes	3
AL Medicare when there is no Secondary or Tertiary Payer	All Types of Service codes	Blank

File Maintenance Help for NextGen® Enterprise 8

Appendix A: Alternate Type of Service Codes

You can create a library of Alternate Type of Service codes for each payer and attach the library to the payer at the payer level. The tables that follow outline certain payers and their Alternate Type of Service code values for paper claims. If you submit claims to these payers, you must create an Alternate Type of Service code library for those payers that use these values. Alternate Type of Service codes for electronic claims types are not explained here. Type of Service Code Table The standard Type of Service codes are part of the application's Type of Service code table. Alternate Type of Service Codes You can use alternate type of service codes on paper claims for each payer.

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate Type of Service Codes Library

From the File Maintenance window, select Libraries > Type of Service. Select open menu button , and then select New. Enter the name of the new library in the Service Name field. Select open menu button , and then select New. The Add Type of Service Alternate window opens. In the Type of Service list, select the applicable standard Type of Service. The Code field is automatically populated with the standard code and the field is disabled and cannot be changed. Enter the applicable Alternate Type of Service code for: paper claims in the Alt Paper field. electronic claims in the Alt Electronic field. Note: When entering alternate type of service codes for paper or electronic claim types, you must fill in both of these fields. For example, if a payer requires an alternate type of service code for paper claims, but they want the standard type of service code for electronic claims, then you must enter the alternate code in the ALT Paper field and the standard code in the ALT Electronic field

File Maintenance Help for NextGen® Enterprise 8

Types of Service Library

The Types of Service library enables you to enter Alternate Type of Service codes that meet specific payer requirements. Alternate Type of Service codes can also be set up for specific CPT4 codes or CPT4 code ranges. In addition, Alternate Type of Service Codes can be specific, based on payer requirements, for the claim media type: either paper or electronic. After a Type of Service Library has been set up, it can be attached to a payer at the Payer Master level. When you view or print paper claims, any Alternate Type of Service codes that are set up and attached to the payer print in box 24c on the 1500 form. Set Up an Alternate Type of Service Codes Library Attach an Alternate Type of Service Library to a Payer

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate CPT4 Code

Open a Service Item library. From the Search list on the left, select a service item and then select the Payer tab. Select the applicable main payer from the drop-down list. Enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 column. Note: If there is an alternate payer attached to a main payer in the Payer Master and there are Alternate Payer Alternate CPT4 codes that need to be used on the alternate payer claim, then enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 field for the selected service item and payer that the alternate payer is attached to. Only when the location and service items on the encounter match the location and services set up on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer will Alternate Payer Alternate CPT4 codes populate to the alternate payer claim. Parent topic: Alternate CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Alternate Payers

The Payers-Alt Payers master file allows you to create an alternate payer and associate the alternate payer to a payer in the Payers master file. You can associate the same alternate payer to multiple payers or associate multiple alternate payers to a payer. When you bill an encounter with a payer having alternate payers, separate claims can be generated simultaneously. For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. You can also hide or show an alternate payer by selecting open menu and then selecting Hide or Un-hide. You can generate Alternate Payer Listing report from the Payers-Alt Payers master file. For more information, go to Ne

File Maintenance Help for NextGen® Enterprise 8

Alternate Payers

The Payers-Alt Payers master file allows you to create an alternate payer and associate the alternate payer to a payer in the Payers master file. You can associate the same alternate payer to multiple payers or associate multiple alternate payers to a payer. When you bill an encounter with a payer having alternate payers, separate claims can be generated simultaneously. For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. You can also hide or show an alternate payer by selecting open menu and then selecting Hide or Un-hide. You can generate Alternate Payer Listing report from the Payers-Alt Payers master file. For more information, go to Ne

Alternate Type of Service Codes

Recommendations

Appendix A: Alternate Type of Service Codes

Set Up an Alternate Type of Service Codes Library

Types of Service Library

Set Up an Alternate CPT4 Code

Alternate Payers

Alternate Payers

Appendix A: Alternate Type of Service Codes

Set Up an Alternate Type of Service Codes Library

Types of Service Library

Set Up an Alternate CPT4 Code

Alternate Payers

Alternate Payers