CPT4 Roll Up

File Maintenance Help for NextGen® Enterprise 8

Single Unit Revenue Code Roll Up

This is used primarily by CHC (Community Health Clinic) clients. The revenue code takes multiple line items that are flagged and have the same revenue code or alternate revenue code and rolls them up into a single line item and changes the quantity to one – the total sum of the charges appears on the line item. Activate a Single Unit Revenue Code Roll Up Parent topic: Payer Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

Alternate CPT4 Code

You can set up Alternate Payer Alternate CPT4 codes in the Service Item Library for the main payer that the alternate payer is attached to. If these codes are set up, they only populate the alternate payer claim when the following conditions are met: The location and service items on the encounter match the location and service items set up in Location field and Valid Alternate Payer Service Items on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer. There are Alternate Payer Alternate CPT4 ( Alt Payer CPT4) codes set up for the main payer on the Payer tab of the Service Item Library Maintenance window. Set Up an Alternate CPT4 Code Parent topic: Payer Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

Activate a CPT4 Roll Up

Open a Service Item library and then select a SIM. Select the Payer tab. Select the Single Unit CPT4 Roll Up check box. Select this check box if you want the application to roll up charges that are associated with the SIM's CPT4 code and have a quantity of 1 when claim is billed. Parent topic: CPT4 Roll Up

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific CPT4 code. This option is rarely used. It could be used for any payer that requires multiple services to be rolled-up to a single CPT4 code line item on the claim. Note: Best practice is to use encounter rate billing for both Medicare and Medicaid. In some cases, roll-up by CPT4 code will not meet the billing and claim requirements for a payer (e.g. FQHC/RHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements. With the setup, all SIM codes on an encounter with the same Alternate CPT4 Code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-up charges. In order for ch

File Maintenance Help for NextGen® Enterprise 8

Payer Tab - SIM Library

On the Payer tab in the Service Item library, all of the billing information displays that is needed to correctly set up the service item with a specific payer so that the claims are promptly paid. Field Description Payer If a payer requires an alternate CPT4 or Revenue code for the service item, then select that payer name. If you need to set multiple payers, fill out the information for the first payer, then select a new payer. The window will clear, but the first payer's information is saved. Suppress Rendering/ Attending Loop You can select the option to determine whether the Attending (2310A) and Rendering (2310B) loops should be suppressed. Do Not Sum Units for CPT4 Code You can select this check box to indicate that for a specific payer and SIM combination, multiple identical charge lines are prevented from being combined on one line and summed on the paper claim. The identical charges display on separate lines on the paper HCFA 1500 claim or are entered individually in an elect

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Add CPT4 Code Information Parent topic: Setting Up Roll-Up Billing by CPT4 Code

CPT4 Roll Up

Recommendations

Single Unit Revenue Code Roll Up

Alternate CPT4 Code

Activate a CPT4 Roll Up

Roll-Up Billing by CPT4 Code

Payer Tab - SIM Library

Set Up CPT4 Codes for Roll-Up Billing