Group Information Setup for a Provider

File Maintenance Help for NextGen® Enterprise 8

Assigning Exceptions for the Provider, Payer, and Location

A provider can have exceptions to how charges are normally paid. To be able to apply these exceptions to a charge, you must assign them to the provider for each service location/payer combination. For each combination, you can assign one contract exception and one SIM exception. You can attach a SIM and a contract exception to the provider at a specific location for all payers or for specific payers. A SIM or contract exception for a specific payer overrides the default exception. To assign exceptions to the provider, payer, and location: From the Master Files - System list, select Providers. Double-click on a provider from the list or highlight the provider and select the Open Menu button. The Modify Provider Information dialog box displays. Select the Practice tab. Under Service Location, select the applicable location. A list of payers displays in the Group Information section. If you want to set the default for all payers, double-click the Default row in the Group Information secti

File Maintenance Help for NextGen® Enterprise 8

Assign a Submitter Group to a Payer at the Provider Level

Before you can use a Submitter Group with a Submitter Profile, you must associate the Submitter Group with a payer at the provider level. In the File Maintenance window, select Master Files - System > Providers. Double-click a provider. On the Modify Provider Information window, select the Practice tab. Select the Rendering provider at this practice check box. Select a location from the Service Location field. Do one of the following: Double-click a payer listed in the Payer Name column. Right-click anywhere in the Group Information list, then select New. The Add/Modify Provider Practice Payer window opens. In the Submitter Group field, select the Submitter Group that you want to associate with the payer displayed in the Payer Name field. Select OK. Parent topic: Using Submitter Groups Parent topic: Providers Practice Tab

File Maintenance Help for NextGen® Enterprise 8

Set Up the Groups Master File

Set up the Groups master file if a group needs to have specific information printed in box 33 of the HCFA 1500. The group must be selected in the Provider master file to be used. For more information on how the group works with the Provider master file to be displayed in the HCFA 1500, refer to Providers. Access the list of Practice master files. In the Master Files field, select Groups. The Groups List window opens. Select the open menu button, and then select New. The Group Information window opens. Enter information in the Group Information window as applicable. Select OK. Fields in the Group Information Window The following table describes the fields available in the Group Information window: Set Up a Default Location for Group Provider Numbers Add Multiple Default Rows for Billing Group You can add multiple default rows for a location and default payer of the billing group. Tax ID Number for Billing Group You can enter multiple tax IDs for a location and default or non-default pay

File Maintenance Help for NextGen® Enterprise 8

Add Payer-Specific Facility IDs

Open a location master file. Do one of the following: To create facility IDs at the system level, select the Location Defaults tab. To create facility IDs at the practice level, select the Practice tab, and then select the Use practice level claims data check box. Note: Facility IDs on the Practice tab override the ones on the Location Defaults tab. Select Payer Specific subtab to create payer-specific facility IDs. On the Payer Specific subtab, right-click in a row and then select New. To modify an existing ID, right-click on the row and then select Open. The Add/Modify Payer Facility ID window displays. Select the payer name, and then enter the facility ID. Do not use a specific payer name more than once. Note: If the Use practice level claims data check box is selected on the Practice tab, the payer-specific facility ID on the Practice tab overrides any claim-type specific IDs. If no pertinent facility exists on the Practice tab and the check box is selected, the facility for HCFA 1

Help Guide for NextGen® Enterprise PM 8

Set Up the Groups Master File

Set up the Groups master file if a group needs to have specific information printed in box 33 of the HCFA 1500. The group must be selected in the Provider master file to be used. For more information on how the group works with the Provider master file to be displayed in the HCFA 1500, refer to Providers. Access the list of Practice master files. In the Master Files field, select Groups. The Groups List window opens. Select the open menu button, and then select New. The Group Information window opens. Enter information in the Group Information window as applicable. Select OK. Fields in the Group Information Window The following table describes the fields available in the Group Information window: Set Up a Default Location for Group Provider Numbers Add Multiple Default Rows for Billing Group You can add multiple default rows for a location and default payer of the billing group. Tax ID Number for Billing Group You can enter multiple tax IDs for a location and default or non-default pay

File Maintenance Help for NextGen® Enterprise 8

Set Up a Default Location for Provider Numbers

To set up a provider that has the same individual Provider number for payers at all or several practice locations: From the Master Files - System list, select Providers. Double-click a provider name. The Modify Provider Information dialog box displays. Select the Practice tab. In the Service Location field, select <Default>. Select one of the following options based on the information below: To set up the provider on the default payer, double-click on the Default row in the Group Information section. Because this is the setup for the default payer, the Payer Name field is disabled. To set up a specific payer for the provider, right-click in the Group Information section, then select New. Because this is the setup for a specific payer, a payer must be selected in the Payer Name field. If this is a new payer, select the arrow in the Payer Name field and select the payer. If this is the default payer, you cannot select a new payer. Enter the provider's number in the Provider Number field.

Group Information Setup for a Provider

Recommendations

Assigning Exceptions for the Provider, Payer, and Location

Assign a Submitter Group to a Payer at the Provider Level

Set Up the Groups Master File

Add Payer-Specific Facility IDs

Set Up the Groups Master File

Set Up a Default Location for Provider Numbers

Assigning Exceptions for the Provider, Payer, and Location

Assign a Submitter Group to a Payer at the Provider Level

Set Up the Groups Master File

Add Payer-Specific Facility IDs

Set Up the Groups Master File

Set Up a Default Location for Provider Numbers