Contract Exception Maintenance Filter Criteria and Contract Exception Definitions

Filter Criteria	Action/Required Information
Enter the first number(s) of the CPT4 item you want to locate	If the CPT4 column contains a lot of items, you can use this field to help you find a CPT4 code. Enter the first few numbers of the CPT4 code until the CPT4 item displays in the spreadsheet area of the window.
Include Past CPT4 Items	Select this check box to display all expired CPT4 items.
Exception CPT4s only	Select this check box to display CPT4 exceptions only.

Filter Criteria	Action/Required Information
CPT4 and Date Range	These fields display the CPT4 code information from the contract that you selected to create this exception.
Allowed	Enter the dollar amount allowed by the contract exception for the CPT4 code.
Participating %	Enter the percentage of the allowed fee that you expect to receive for services rendered by participating providers.
Participating Reimbursed	Enter the dollar amount that you expect to receive for services rendered by participating providers.
Non-Participating %	Enter the percentage of the allowed fee that you expect to receive for non-participating providers.
Non-Participating Reimbursed	Enter the dollar amount that you expect to receive for non-participating providers.
Auth Req	Select this check box if authorization is required from the payer for this charge.
Refer Req	Select this check box if a referral is required from the payer for this charge.
Co-Pay %	Enter the percentage of the allowed fee for the co-pay for the specified CPT4 code by contract exception.
Co-Pay Amount	Enter the dollar amount for the co-pay for the specified CPT4 code by contract.

File Maintenance Help for NextGen® Enterprise 8

Setting Up a New Contract Exception

In File Maintenance, select Libraries > Contract. The Contract List window opens. Select a library and select open menu button or right-click the selected library, and then select Contract Exceptions. The Contract Exceptions List window opens. Select the open menu button , or right-click in the Description area of the window, and then select New. The Contract Exception Maintenance window opens. In the Contract Exception Name field, enter a name for the Contract Exception that describes the group of exceptions. Note: If you do not want this exception to display in the Contract Exceptions List window, select the Hide Exception option. To use this contract as the base contract, select the Use as Base Contract check box (instead of being used as an exception to the contract). Enter the Filter Criteria to control which CPT4 items display in the CPT4 list and the contract exception information. You can move from field to field by pressing the TAB key. Enter the contract exception information

File Maintenance Help for NextGen® Enterprise

Contract Exception Maintenance Filter Criteria

You can use the fields given below to enter the Filter Criteria for contract exception. Filter Criteria Description Enter the first number(s) of the CPT4 item you want to locate Enters the first few numbers of the CPT4 code until the CPT4 item displays in the spreadsheet area of the window. Include Past CPT4 Items Displays all expired CPT4 items. Exception CPT4s only Displays CPT4 exceptions only. You can use the fields given below to enter the contract exception information for each CPT4 item. Filter Criteria Description CPT4 and Date Range Displays the CPT4 code information from the contract that you selected to create this exception. Allowed Enters the dollar amount allowed by the contract exception for the CPT4 code. Participating % Enters the percentage of the allowed fee that you expect to receive for services rendered by participating providers. Participating Reimbursed Enters the dollar amount that you expect to receive for services rendered by participating providers. Non-Part

Help Guide for NextGen® Enterprise PM 8

Set Up a New Contract Exception

In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Select a library and select open menu or right-click the selected library, and then select Contract Exceptions. The Contract Exceptions List window opens. Select open menu button, or right-click in the Description area of the window, and then select New. The Contract Exception Maintenance window opens. In the Contract Exception Name field, enter a name for the Contract Exception that describes the group of exceptions. Note: If you do not want this exception to display in the Contract Exceptions List window, select the Hide Exception option. To use this contract as the base contract, select the Use as Base Contract check box (instead of being used as an exception to the contract). Enter the Filter Criteria to control which CPT4 items display in the CPT4 list, as follows: Enter the first number of the CPT4 item in Type the first number(s) of the CPT4 item you want to locate. If the CPT4 column conta

Help Guide for NextGen® Enterprise PM 8

Set Up a New Contract Exception

In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Select a library and select open menu or right-click the selected library, and then select Contract Exceptions. The Contract Exceptions List window opens. Select open menu button, or right-click in the Description area of the window, and then select New. The Contract Exception Maintenance window opens. In the Contract Exception Name field, enter a name for the Contract Exception that describes the group of exceptions. Note: If you do not want this exception to display in the Contract Exceptions List window, select the Hide Exception option. To use this contract as the base contract, select the Use as Base Contract check box (instead of being used as an exception to the contract). Enter the Filter Criteria to control which CPT4 items display in the CPT4 list, as follows: Enter the first number of the CPT4 item in Type the first number(s) of the CPT4 item you want to locate. If the CPT4 column conta

File Maintenance Help for NextGen® Enterprise

Setting Up a New Contract Exception

You can charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider, payer, or location level in order to apply the exceptions to charges. If you have a CPT4 code that requires more than one exception, you must first set up a new contract exception with a unique name for each instance of the exception. To set up more than one exception per CPT4 code, you must set up a new contract exception using a different contract exception name for each exception with the same CPT4 code. In File Maintenance, select Libraries > Contract. The Contract List window opens. Right-click the library, and then select Contract Exceptions. The Contract Exceptions List window opens. Select Open Menu, and then select New. The Contract Exception Maintenance window opens. In Contract

File Maintenance Help for NextGen® Enterprise 8

Fields on the Fee Schedule Tab

Field Description Date Range Indicates the Effective date when the fee is to begin, and the Expiration date when the fee will end. The Date Range for the specific CPT4 code must fall within the date range for the contract as defined on the General tab. You can enter multiple date ranges for a CPT4 code in cases where you need to update your contract to meet new requirements. Note: The Fee Schedule rows display in descending date order by Effective Date. The most recent dates display first. Example: 01/01/2016 and then 01/01/2000. Type Specifies the Fee for Service (FFS) as the type of charge. Note: Capitated type is not supported at this time. Non-Facility/Facility Indicates whether the reimbursement for a service performed at a facility or non-facility service location. Allowed Indicates the amount allowed by the contract for the charge. An adjustment will be made between the charge amount and the allowed amount during charge entry if the Automatically adjust charges check box is sele

Contract Exception Maintenance Filter Criteria and Contract Exception Definitions

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