Charges and Contracts

Help Guide for NextGen® Enterprise PM 8

Contract Co-Pay

If both a green check and a zero ($0.00) or positive amount are found for the CPT4 code in the Apply Co-Pay Amount column on the Fee Schedule tab of the Contract Library Maintenance window, the defined amount will be the patient’s co-pay for that service. If no green check is found for the CPT4 code, no patient co-pay will be applied for that service. If a green check is found with a blank Apply Co-Pay Amount for the CPT4 code, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The contract Apply Co-Pay Amount will be applied to a charge only if the contract is linked to the primary insurance on the encounter in the Managed Care Contract field on the Practice > Libraries sub-tab of the Payers master file and only for the providers checked in the Participating Provider field. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Contract Exception Co-Pay

If zero ($0.00) or a positive amount is found for the CPT4 code in the Co-Pay Amount column on the Contract Exception Maintenance window, the defined amount will be the patient’s co-pay for that service. If there is zero amount for the CPT4 code, the system continues with the next step in the hierarchy to derive the co-pay amount. Note: The contract must be linked to the primary insurance on the encounter in the Managed Care Contract field on the Practice > Libraries sub-tab of the Payers master file. The contract exception must be linked to the rendering provider in the Service Location > Group Information > Payer > Contract Exception field on the Practice tab of the Providers master file. The providers must be selected in the Participating Providers field below the Contract field or the contract is not used for those providers. The contract exception Co-Pay Amount is applied to a charge only if the rendering, location, and payer on the charge matches the rendering, location, payer, a

File Maintenance Help for NextGen® Enterprise 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

Help Guide for NextGen® Enterprise PM 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

File Maintenance Help for NextGen® Enterprise 8

Add or Modify a Contract

In File Maintenance, select Libraries > Contracts. The Contracts Libraries window opens. To add a new contract, select open menu button and select New. The Contract Library Maintenance window opens. Enter the Contract Name, Effective Date, and Expiration Date. Enter default information for the Contract. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, select the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter the information in the Automatic Adjustments section that applies. To add the CPT 4 code applicable to the contract, select the Fee Schedule tab. Then select open menu button or question mark. To find a CPT4 code, select open menu button and select Lookup to display a list of CPT4 codes and des

Help Guide for NextGen® Enterprise PM 8

Add or Modify Contracts

In File Maintenance, select Libraries and then Contracts. The Contracts Libraries window opens. To add a new contract, select the open menu button, and choose New. To modify an existing contract, highlight the contract, select the open menu button, and then select Open. The Contract Library Maintenance window opens. Enter or modify the Contract Name, Effective Date, and Expiration Date. Enter or modify the Contract Defaults information. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, enable the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter or modify the information in the Automatic Adjustments section that applies. Select the Fee Schedule tab. Enter or modify the CPT4 code that is applicable to t

Charges and Contracts

Recommendations

Contract Co-Pay

Contract Exception Co-Pay

Set Up a Fee Schedule for Contract Payers

Set Up a Fee Schedule for Contract Payers

Add or Modify a Contract

Add or Modify Contracts

Contract Co-Pay

Contract Exception Co-Pay

Set Up a Fee Schedule for Contract Payers

Set Up a Fee Schedule for Contract Payers

Add or Modify a Contract

Add or Modify Contracts