Payers Master File

File Maintenance Help for NextGen® Enterprise 8

Alternate Payers

The Payers-Alt Payers master file allows you to create an alternate payer and associate the alternate payer to a payer in the Payers master file. You can associate the same alternate payer to multiple payers or associate multiple alternate payers to a payer. When you bill an encounter with a payer having alternate payers, separate claims can be generated simultaneously. For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. You can also hide or show an alternate payer by selecting open menu and then selecting Hide or Un-hide. You can generate Alternate Payer Listing report from the Payers-Alt Payers master file. For more information, go to Ne

Help Guide for NextGen® Enterprise PM 8

Payers Master File

Payers are the third-party entities, other than guarantors or employers, that you expect to receive reimbursement from. Some examples of payers are commercial insurance companies, Medicaid, and Medicare. In the Payers master file, you can specify the contract associated with the payer, the participating providers, how to submit claims, and other general payer information. You can generate Payers Master File reports from the Payers master file. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Auditing Payers Master File Add or Modify a Payer Payer Defaults - 1 Tab Defaults - 2 Tab System Tab Practice Tab Configuring Alternate Payers You an use the Alternate Payer Simultaneous Billing feature to associate an alternate payer to a payer. External Tab for Payer Information Co-Pays Tab Changing the Payer Address and Associated Patient Records Activate and Assign a Payer to a Practice You can limit a practi

Help Guide for NextGen® Enterprise PM 8

Alternate Payers

The Payers-Alt Payers master file allows you to create an alternate payer and associate the alternate payer to a payer in the Payers master file. You can associate the same alternate payer to multiple payers or associate multiple alternate payers to a payer. When you bill an encounter with a payer having alternate payers, separate claims can be generated simultaneously. For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. You can also hide or show an alternate payer by selecting open menu and then selecting Hide or Un-hide. You can generate Alternate Payer Listing report from the Payers-Alt Payers master file. For more information, go to Ne

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

File Maintenance Help for NextGen® Enterprise 8

Post a Payment to an Alternate Payer

When you post a payment for an encounter having multiple alternate payers associated with a payer, all the payers are listed in the Payer field. Note: You can apply a payment to the alternate payer even if the alternate payer was not billed during the billing process. In NextGen® Enterprise PM, selec the Posting icon. The Batch Posting window opens. Double-click an existing batch. The Payment Entry window opens. Select the applicable patient or encounter number. In the Payer field, select an alternate payer associated with a payer. Enter the payment amount and adjustment amount. Select the payment code and adjustment code. Note: If you have set up the default payment and default adjustment code in the Payers-Alt Payers master file for the alternate payer, then the payment code and adjustment code automatically appears when you enter the payment and adjustment amount. If you have not set up the default payment and default adjustment code in the Payers-Alt Payers master file, then the al

Payers Master File

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Alternate Payers

Payers Master File

Alternate Payers

Payer Defaults - 1 Tab

Payer Defaults - 1 Tab

Post a Payment to an Alternate Payer

Payers Master File

Alternate Payers

Payers Master File

Alternate Payers

Payer Defaults - 1 Tab

Payer Defaults - 1 Tab

Post a Payment to an Alternate Payer