General Tab of Contract Library Maintenance

File Maintenance Help for NextGen® Enterprise 8

Payer/Provider Tab

The Payer/Providers tab lists all payers attached to the contract library. When a payer is selected, all participating and non Participating providers for the target payer display on the tab. You can add and remove participating and non-participating providers by using the blue arrows. Selections are saved when you highlight the provider name and then select an arrow. Parent topic: Access Contract Library Maintenance

File Maintenance Help for NextGen® Enterprise 8

Modifier Reimbursement Tab

You can determine surgical reimbursement based on a percentage of the charge amount. The Modifier Reimbursement tab enables you to create a series of modifiers and modifier combinations that are associated with a percentage reduction of allowed amount. If the system cannot find the exact CPT4 code and modifier combination on the Fee Schedule tab, it uses the percentage on the Modifier Reimbursement tab. For example, the scenario under which this tab would be referenced is as follows: You enter a charge and specify a two-digit modifier. The system attempts to find the row in the Contracts library Fee Schedule tab, but the CPT4 code and modifier combination that was entered does not exist in the contract. The system attempts to find the row in the Fee Schedule tab by using only the CPT4 code without the modifier and succeeds. The system attempts to find the row in the Contract Modifier Reimbursement tab using only the modifier that was specified on the charge entry screen and succeeds. T

File Maintenance Help for NextGen® Enterprise 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

Help Guide for NextGen® Enterprise PM 8

General Tab of Contract Library Maintenance

The General tab of Contract Library Maintenance window consists of the following sections: Contract Information Contract Defaults Alerts and Edits Allowed and FFS/Balance Distribution Automatic Adjustments Contract Information Contract Defaults Alerts and Edits Allowed and FFS/Balance Distribution Automatic Adjustments Parent topic: Access Contract Library Maintenance

File Maintenance Help for NextGen® Enterprise 8

Access Contract Library Maintenance

Access the Contract Library Maintenance window, to create contract defaults, such as co-payments, deductibles, and physician referrals and authorizations. In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Double-click the applicable library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Activate and Assign a Payer to a Practice You can limit a practice's access to certain Payers master files. Add or Modify a Contract Set Up a Fee Schedule for Contract Payers Modifier Reimbursement Tab Multiple Procedure Discounting Tab Payer/Provider Tab Contract Exceptions Parent topic: Contracts Library

Help Guide for NextGen® Enterprise PM 8

Access Contract Library Maintenance

Access the Contract Library Maintenance window, to create contract defaults, such as co-payments, deductibles, and physician referrals and authorizations. In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Double-click the applicable library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Parent topic: Contracts Library

General Tab of Contract Library Maintenance

Recommendations

Payer/Provider Tab

Modifier Reimbursement Tab

Set Up a Fee Schedule for Contract Payers

General Tab of Contract Library Maintenance

Access Contract Library Maintenance

Access Contract Library Maintenance

Payer/Provider Tab

Modifier Reimbursement Tab

Set Up a Fee Schedule for Contract Payers

General Tab of Contract Library Maintenance

Access Contract Library Maintenance

Access Contract Library Maintenance