Payer/Provider Tab

File Maintenance Help for NextGen® Enterprise 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

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

Activate and Assign a Payer to a Practice

When you select Practice access for payer master file, the payers can be defined at the practice level, and you can restrict which practices have access to them. After all the practices have been set up with or without access to the selected payer, specific areas in the application where that practice, depending on their access, will or will not see the payer: File Maintenance The Group Information window in File Maintenance NextGen® Enterprise PM The Payer Lookup window The Eligibility Referral Lookup window The Claim Request Lookup window The Add/Modify Provider Information window The following areas of the application show all the payers in the enterprise regardless of the practice's access settings: Reports Service Item Library Maintenance Parent topic: Access Contract Library Maintenance Parent topic: Enterprise Preferences - General Tab

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

File Maintenance Help for NextGen® Enterprise 8

Attach Contract Subgroupings to a Provider

Contract subgroupings that are attached to a provider indicate which contracts the provider participates in because the subgroupings are assigned to the contracts. After you attach the subgroupings, the payers associated with the contracts are updated. Open a provider master file and then select the Practice tab. In the Contract Subgrouping field, select the contract categories to associate with the provider. Note: The Contract Subgrouping field label you see might be named differently. This provider becomes a participating provider for the payer. You can see these providers in the Payer master file. If you open a payer and select the contract on the Payer master file > Libraries tab, these participating providers are automatically selected in the Participating Providers field. Likewise, if you clear a Contract Subgrouping check box, then the providers name is removed from the Payer master file > Libraries tab > Participating Providers field. Parent topic: Setup an Exception Through th

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

Payer/Provider Tab

Recommendations

General Tab of Contract Library Maintenance

Modifier Reimbursement Tab

Activate and Assign a Payer to a Practice

Access Contract Library Maintenance

Attach Contract Subgroupings to a Provider

Access Contract Library Maintenance