Formats

File Maintenance Help for NextGen® Enterprise

Formats

You define specific formats used for payers with the Formats master file. This master file defines specific formats of character types that can be entered for group and policy numbers on patient records. Only entries that correspond to the specified format are acceptable or valid for the Group and Policy Numbers fields. You can attach a format to a payer and also require policy and group numbers on the Insurance Maintenance window in NextGen® Enterprise PM. When a group or policy number format is selected on the Payer Defaults - 2 tab, only character types defined in that format from the Formats List can be entered in the Health Insurance Claim (HIC)/Policy Number and Group Number fields for that payer on the Insurance Maintenance window. Access the Formats Master File Add or Modify Format Sets Delete Formats Attach Formats to a Payer Parent topic: Master Files - System

File Maintenance Help for NextGen® Enterprise 8

Payers Master File

Payers are the third-party entities, other than guarantors or employers, that you expect to receive reimbursement from. Some examples of payers are commercial insurance companies, Medicaid, and Medicare. In the Payers master file, you can specify the contract associated with the payer, the participating providers, how to submit claims, and other general payer information. You can generate Payers Master File reports from the Payers master file. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Auditing Payers Master File Add or Modify a Payer Search for Payers Using Payer Number or NEIC Number You can search for a payer using NEIC number or payer number. Add Duplicate NEIC Number to Existing Payers You can add an NEIC number for a payer, that exists for other payers. Hide a Payer Payer Defaults - 1 Tab Real-time Address Validation for a Payer Practice Tab Configuring Alternate Payers You an use the Alt

File Maintenance Help for NextGen® Enterprise 8

Attach Formats to a Payer

From the Master Files - System list, select Payers, and then double-click the appropriate payer. The Modify Payer Information window opens. Select the Payer Defaults - 2 tab. Select the Require Policy Number check box if you want to require a policy number. Select the drop-down arrow in the Policy Number Format field and select one from the list if you want to use a specific format for the policy number. Select the Require Group Number check box if you want to require a group number. Select the drop-down arrow in the Group Number Format field and select one from the list if you want to use a specific format for the group number. Note: The Group Number field on the Insurance Maintenance window has a maximum field length of 19 characters. The Format Name for any format that exceeds this limit does not display in the Group Number Format list. Select OK. Note: You can require a policy number and a group number with or without using a format. You can also enter a format with or without requ

File Maintenance Help for NextGen® Enterprise

Attach Formats to a Payer

From the Master Files - System list, select Payers, and then double-click the appropriate payer.The Modify Payer Information window opens. Select the Payer Defaults - 2 tab. Select the Require Policy Number check box if you want to require a policy number. Select the drop-down arrow in the Policy Number Format field and select one from the list if you want to use a specific format for the policy number. Select the Require Group Number check box if you want to require a group number. Select the drop-down arrow in the Group Number Format field and select one from the list if you want to use a specific format for the group number. Note: The Group Number field on the Insurance Maintenance window has a maximum field length of 19 characters. The Format Name for any format that exceeds this limit does not display in the Group Number Format list. Select OK. Note: You can require a policy number and a group number with or without using a format. You can also enter a format with or without requi

Help Guide for NextGen® Enterprise PM 8

Payers Master File

Payers are the third-party entities, other than guarantors or employers, that you expect to receive reimbursement from. Some examples of payers are commercial insurance companies, Medicaid, and Medicare. In the Payers master file, you can specify the contract associated with the payer, the participating providers, how to submit claims, and other general payer information. You can generate Payers Master File reports from the Payers master file. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Auditing Payers Master File Add or Modify a Payer Payer Defaults - 1 Tab Defaults - 2 Tab System Tab Practice Tab Configuring Alternate Payers You an use the Alternate Payer Simultaneous Billing feature to associate an alternate payer to a payer. External Tab for Payer Information Co-Pays Tab Changing the Payer Address and Associated Patient Records Activate and Assign a Payer to a Practice You can limit a practi

Help Guide for NextGen® Enterprise PM 8

Payer Defaults - 1 Tab

Field Description Payer Name Enter the name of the payer. When entering data into this field, the following three rules must be met: The first character must be alphabetic. The name must be at least two characters long. Valid characters of the name include: 0123456789 ABCDEFGHIJKLMNOPQRSTUVWXYZ & (ampersand) . (period) , (comma) - (dash) <space> When you modify the payer name, a message appears indicating the number of person or patient records associated with the payer. The message provides the following options: Yes: To update the payer master record in File Maintenance and on the associated person/patient records in NextGen® Enterprise PM. No: To update the payer master record in File Maintenance only. Cancel: To return to the payer record. Note: Define generic payer names for less frequently used plans to avoid creating an excessive payer file. For example, define Commercial Insurance COB1, COB2, and COB3 with blank addresses that may be added at the time of assignment. You can def

Formats

Recommendations

Formats

Payers Master File

Attach Formats to a Payer

Attach Formats to a Payer

Payers Master File

Payer Defaults - 1 Tab

Formats

Formats

Payers Master File

Attach Formats to a Payer

Attach Formats to a Payer

Payers Master File

Payer Defaults - 1 Tab