Payer Name and Number

Field	Description
Payer Name	Select a payer to whom to assign a number.
Payer Number	Enter the provider's number for that payer. This number shows in box 17 of the HCFA 1500.

File Maintenance Help for NextGen® Enterprise 8

Delete a UPIN

Existing default UPINs can be deleted to avoid claims rejections by those payers who do not recognize Medicare UPINs. To delete a default UPIN or other payer/provider number from an existing Provider master file: Open the System Master Files. Select Providers. The Provider List window displays. Select a provider from the list, select the Open Menu icon, and then select Open. The Modify Provider Information window displays. On the System tab, select the entry in the Payer Name/Payer Nbr list that you want to delete. Double-click the highlighted entry or right-click it to bring up the shortcut menu and select Open. The Payer Number for Provider window displays. Highlight the number in the Payer Number field and then select the Delete key on your keyboard. The field is now blank. Select OK. Parent topic: Payer Name and Number

File Maintenance Help for NextGen® Enterprise 8

Group Information Setup for a Provider

Group information is set up for the rendering provider for each service location. Each provider has a default group information record that is automatically included for generic use. However, you can set up specific information for a payer. If you have group information set up for a specific payer, then it becomes the default information for box 33 of the HCFA 1500. Note: If you do not have group information set up for the payer or the default level, then the provider information in the top half of the window is printed in box 33 of the HCFA 1500. To set up group information: On the Add/Modify Provider Information window, select the Practice tab. Under Service Location, select a location. A list of payers for that location displays in the Group Information section. If you want to copy the information for one payer to other locations in the Service Locations list, right-click the payer and then select one of the following: Copy to All Locations to copy the payer to all other locations.

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

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

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

File Maintenance Help for NextGen® Enterprise 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

Payer Name and Number

Recommendations

Delete a UPIN

Group Information Setup for a Provider

Add Payer-Specific Facility IDs

Payer Tab - SIM Library

Payer Defaults - 1 Tab

Payer Defaults - 1 Tab

Delete a UPIN

Group Information Setup for a Provider

Add Payer-Specific Facility IDs

Payer Tab - SIM Library

Payer Defaults - 1 Tab

Payer Defaults - 1 Tab