Examples of Payer Taxonomy Setup

Claims Used for: Main Payer/ Alt Payer	Descriptions of Which Taxonomy Code Is Used
1500/1500	The main payer claims pull the taxonomy code from the Group master file. When the taxonomy code is attached to the alternate payer, the code overrides the group taxonomy in the Group master file in the 837 Professional 2000A loop PRV segment for all Alternate Payer claims for the specific location for the payer. If the Alternate Payer Taxonomy Code field is blank, the claim pulls the taxonomy code from the Group master file for alternate payer claims.
UB/1500	When the taxonomy code is attached to the enhanced UB tab for a specific location for the main Payer, the taxonomy code overrides the group taxonomy in the Group master file in the 837 Institutional 2000A loop PRV segment. If the Taxonomy Code field is blank for a specific location on the enhanced UB tab, then the claim pulls the taxonomy code from the Group master file for UB claims. When the taxonomy code is attached to the alternate payer, the code overrides the group taxonomy in the Group master file for all Alternate Payer claims for the specific location for the payer. If the Alternate Payer Taxonomy Code field is blank, the claim pulls the taxonomy code from the Group master file for alternate payer claims.
UB/UB	When the taxonomy code is attached to the enhanced UB tab for a specific location for the main Payer, the taxonomy code overrides the group taxonomy in the Group master file. If the Taxonomy Code field is blank for a specific location on the enhanced UB tab, then the claim pulls the taxonomy code from the Group master file for the UB claims. For the Alternate Payer claims, if the taxonomy code is attached to the Alternate Payer for the specific location, then the code overrides the taxonomy code that is attached on the enhanced UB tab for a specific location. If the Taxonomy Code field is blank on the Alternate Payer tab for a specific location and is also blank on the enhanced UB tab for a specific location, the claim pulls the taxonomy from the Group master file for alternate payer claims.
1500/UB	The main payer claims pull the taxonomy code from the Group master file. When the taxonomy code is attached to the alternate payer, the code overrides the group taxonomy in the Group master file in the 837 Institutional 2000A loop PRV segment. For the Alternate Payer claims, if the taxonomy code is attached to the Alternate Payer for the specific location, then the code overrides the taxonomy code that is attached on the enhanced UB tab for a specific location. If the Taxonomy Code field is blank on the Alternate Payer tab for a specific location and is also blank on the enhanced UB tab for a specific location, the claim pulls the taxonomy from the Group master file for alternate payer claims.

File Maintenance Help for NextGen® Enterprise 8

Priority for Taxonomy Code Usage for Claims

If the Alternate Payer is a 1500 payer: Use the taxonomy code from the Alternate Payer tab Specific location. If blank on Alternate payer, use the Taxonomy Code from the Group master. If the Alternate Payer is a UB payer: Use the Taxonomy Code from the Alternate Payer Specific Location. If the Taxonomy Code is blank on Alternate Payer, use Taxonomy Code from the Enhanced UB Tab on the Payer. If the Taxonomy Code is blank on Enhanced UB Tab on Payer use the Taxonomy Code from the Group master. If the Main Payer is a 1500 payer: Use the Taxonomy Code from the Group master. If the Main Payer is a UB Payer: Use the Taxonomy Code from the Enhanced UB Tab on the Payer for the Specific Location. If the Taxonomy Code is blank on Enhanced UB Tab on Payer use the Taxonomy Code from the Group master. Parent topic: Taxonomy Codes to Payers

File Maintenance Help for NextGen® Enterprise 8

Attaching a Taxonomy Code to the Alternate Payer

From the Master Files list, select System or PM > Payers. Select the payer. Select the Alt Payer tab. In the Location Specific Information section, select the taxonomy code from the Taxonomy Code field. Parent topic: Taxonomy Codes to Payers

File Maintenance Help for NextGen® Enterprise 8

Taxonomy Codes to Payers

You can attach taxonomy codes for group billing in the Payer master file. These codes override the Group master file taxonomy code. You can attach these codes to: Payers at the practice level for specific locations. This setting is only for UB claims. Alternate payers for a specific location. Attaching Taxonomy Codes to Payers Attaching a Taxonomy Code to the Alternate Payer Priority for Taxonomy Code Usage for Claims Examples of Payer Taxonomy Setup Parent topic: Taxonomy Codes

Help Guide for NextGen® Enterprise PM 8

UB/General Tab

All the fields on the UB > General sub-tab can be automatically populated. The information on this tab can be overridden, but it is not recommended, especially if you are an Enhanced UB user and you want to use the automated UB claims process. Regular UB users should not use the fields on this window, except to change the Source of Admission field. Regular UB users should continue to use the Billing & Collections tab on the Encounter Maintenance window to review or change the values that display on the UB claim form. Encounter Maintenance Field Description Type of Bill This field is divided into three positions. The values for each position are described separately. First Position After the UB claim is billed, this position is populated automatically with the value that is in the Type of Facility field located on Modify Payer Information > Practice > UB sub-tab. If this field does not contain a value, this position is populated from the Type of Facility field in Practice Preferences >

Help Guide for NextGen® Enterprise PM 8

UB Sub-Tab

The following conditions apply to the UB tab that displays on the Practice tab of the Add/Modify Payer Information window: Regular UB users do not use this tab. Set up on this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all of the fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaul

File Maintenance Help for NextGen® Enterprise 8

UB Sub-Tab

The following conditions apply to the UB tab that displays on the Practice tab of the Add/Modify Payer Information window: Regular UB users do not use this tab. Set up on this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all of the fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaul

Examples of Payer Taxonomy Setup

Recommendations

Priority for Taxonomy Code Usage for Claims

Attaching a Taxonomy Code to the Alternate Payer

Taxonomy Codes to Payers

UB/General Tab

UB Sub-Tab

UB Sub-Tab

Priority for Taxonomy Code Usage for Claims

Attaching a Taxonomy Code to the Alternate Payer

Taxonomy Codes to Payers

UB/General Tab

UB Sub-Tab

UB Sub-Tab