Designating a SIM as a Purchased Service Indicator for Specific Payers

You can designate a SIM as a Purchased Service Indicator for specific payers when the Purchased Service check box is selected on the Service Item Library Maintenance window > Payer tab.

The following list outlines billing conditions and rules for Purchased Service Indicators.

• When a SIM is designated as a Purchased Service Indicator, only one Purchased Service Indicator line item per claim is allowed during billing. Therefore, if there are multiple Purchased Service Indicators entered on the Charge Posting window, then multiple claims are created.
• When this option is selected, a facility must be entered in the Facility field on the Encounter Maintenance window. If a facility is not entered, then the Claim Production Status report displays the following error when the encounter is billed:

The Laboratory/Facility Number is Required

• When a claim has a Purchased Service Indicator, then, on the HCFA 1500 claim form, the "Yes" check box is selected for Box "20. Outside Lab?" and the total charge prints under the "$ Charges" section.

Exceptions to these HCFA 1500 rules are Connecticut Medicaid claims, Michigan Medicaid claims, Michigan Blue Shield claims and Michigan Blue Cross claims. These state/claim type combinations have existing code rules which preclude the Purchased Service Indicator functionality from populating box 20.

• Billing rules for the electronic claims processing of Purchase Service Indicators are supported. If you need this functionality, contact NextGen Customer Support to verify that the clearinghouse you use is fully supported.