Other Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

General Tab

The Service Items Library > General tab includes general information for each SIM code that affects charge posting, billing, claims and reporting in NextGen® Enterprise PM. The General tab includes the following fields: Field Description Place of Service You can select a default Place of Service. This default displays on the Charge Posting window. Notes: A place of service selected at the SIM level overrides a place of service at the location level. You can select <none> as the place of service if the service can be performed at different kinds of places. However, if you select <none>, the charge does not create. Component Select the component type for this service item: Global (both the technical and professional), Professional (physician supervision and interpretation), or Technical (equipment or technology). The Component field appears only if the SIM fields: Show dept, modality and component check box is selected in the Libraries Practice Preferences. This field is required. Note:

File Maintenance Help for NextGen® Enterprise 8

Payer Tab - SIM Library

On the Payer tab in the Service Item library, all of the billing information displays that is needed to correctly set up the service item with a specific payer so that the claims are promptly paid. Field Description Payer If a payer requires an alternate CPT4 or Revenue code for the service item, then select that payer name. If you need to set multiple payers, fill out the information for the first payer, then select a new payer. The window will clear, but the first payer's information is saved. Suppress Rendering/ Attending Loop You can select the option to determine whether the Attending (2310A) and Rendering (2310B) loops should be suppressed. Do Not Sum Units for CPT4 Code You can select this check box to indicate that for a specific payer and SIM combination, multiple identical charge lines are prevented from being combined on one line and summed on the paper claim. The identical charges display on separate lines on the paper HCFA 1500 claim or are entered individually in an elect

Help Guide for NextGen® Enterprise PM 8

Encounter Rate SIM Narrative for Claims

The Narrative field on the Charge Posting window, or on the Encounter Rate sub-tab on the Billing & Collections tab of the Encounter Maintenance window, can be used to enter a free-text narrative, or comment, for the ER SIM code on the encounter. This populates the narrative segment for the ER SIM on claims for the primary, secondary or tertiary encounter rate payer. Charge-Level Narrative To include a charge-level narrative for an ER SIM on claims, the Encounter Rate Billing library for the payer must include the following settings on the Claims tab: Display narrative on ER SIM charge Line? = Yes From what field should the narrative data pull from? = Charge Entry If a narrative exists on the Charge Posting window for the ER SIM charge line, then it is used on the claim. If the narrative for the ER SIM charge line is blank, then the narrative for the first charge line is used on the claim. Charge Posting Encounter-Level Narrative To include an encounter-level narrative for an ER SIM on

Help Guide for NextGen® Enterprise PM 8

Enter Test Results for a Charge

When you enter a charge on the Charge Posting window for a SIM code that is set up in the Service Items library to create MEA test result segments, the system allows you to enter a test Qualifier, Date, and Result. A confirmation message appears stating that the charge is saved. Note: If test results are received from an HL7 interface, all the fields for charge test results fill automatically. Open NextGen® Enterprise PM. Select Charges. The Charge Posting window opens. Select the desired patient and encounter. Do the following for the SIM code that is set up to create MEA test result segments. Enter a new charge, and then select Save or Next. Select an existing charge, and then select the Test Results button on the charge toolbar. The Test Data for this Charge window opens. Note: You can enter up to five test qualifiers and results. In the Qualifier field, select one of the following: HT(Height) R1(Hemoglobin) R2(Hematocrit) R3(Epoetin Starting Dosage) R4(Creatinine) A qualifier canno

Help Guide for NextGen® Enterprise PM 8

Claim Hierarchy to Determine Type of Claim

NextGen® Enterprise PM follows a hierarchy that determines what type of claim form (1500 or UB) is created for each payer. The system moves from the highest to the lowest level in the hierarchy to make the claim determination. It is important to understand the claim hierarchy to properly troubleshoot claim related issues. Claim Hierarchy (from highest to lowest): Payer > Alternate Payer > Location/SIM: The first place the system looks in determining the type of claim to be created is the Modify Payer Information window in the Alt Payer tab for the payer attached to the encounter. If the Alt Payer tab is completed for the Location on the encounter, and one or more SIM codes have been defined, then encounters for that location having one or more of the specified SIM codes entered as charges create the type of claim defined on the Alt Payer tab. Payer > Practice > UB > Location/Provider: The second place the system looks in determining the type of claim to be created is the Modify Payer I

File Maintenance Help for NextGen® Enterprise 8

Claims Tab

The Payer Master file provides information for setting up processing criteria for 1500 Claims, UB Claims, and ADA Claims. Field Description Form Template If you have used a form template to replace your HCFA or UB paper claims, then select the drop-down arrow and select the appropriate form template for the payer. Real Time Edits Payer ID Enter the Payer ID for Real Time Edits at the Payer/Practice level. The Payer ID identifies the client and payer - which in turn represents a set of edits that launch from the NextGen In-line Edits engine. The ID is 13 characters long. The first six characters are interpreted as the client ID and the last seven characters are interpreted as the payer ID. This payer ID overrides the enterprise-level, practice-level, and payer/system-level IDs. Fields in the Claims Tab of Modify Payer Information You can find the descriptions of the fields in the Practice > Claims tab of Modify Payer Information window. UB Claims Tab on Claims ADA Claims Tab on Claims P

Other Tab - SIM Library

Recommendations

General Tab

Payer Tab - SIM Library

Encounter Rate SIM Narrative for Claims

Enter Test Results for a Charge

Claim Hierarchy to Determine Type of Claim

Claims Tab

General Tab

Payer Tab - SIM Library

Encounter Rate SIM Narrative for Claims

Enter Test Results for a Charge

Claim Hierarchy to Determine Type of Claim

Claims Tab