Primary Credential Conflicts and Messages

File Maintenance Help for NextGen® Enterprise 8

Add or Modify Primary Credentials

Access the Modify Provider Information window for a provider. Select the Credentialing tab. Credentials for the provider are listed in the top section of the tab and Primary Credentials are listed in the bottom section of the tab. Hover over the Information icon on the right to view tool tip information for this section. Note: The Primary Credentials section appears only when the Enable Provider Credential Billing options is enabled in Enterprise Preferences > General. In the Primary Credentials section, do one of the following: To add a primary credential, select Open Menu and select New. To modify a primary credential, select the item from the list, and then select Open Menu and select Open. The Primary Credentials window opens. In the Effective Date field, enter the date the primary credential becomes effective. This field is required, and the date must be earlier than the expiration date. In the Expiration Date field, enter the date the primary credential expires. This field is req

Help Guide for NextGen® Enterprise PM 8

Primary Credential Conflicts and Messages

You can enter multiple Primary Credentials for a provider on the Credentialing tab. However, there can only be one primary credential in effect at a time. When you enter a primary credential with an effective or expiration date that overlaps with another, the following prompt displays: Effective/Expiration dates overlap with another Primary Credential. Primary Credential Conflict/Message 1 A provider's Primary Credential, in combination with another credential, can be used in the configuration of the Claim Modifiers Library to add a charge-level modifier to claims during the billing process in NextGen® Enterprise PM. The Claim Modifiers Library adds the modifier only if the primary credential is defined in both the Credentialing and Primary Credentials sections of the Credentialing tab. When you enter a primary credential for a provider that is not listed as one of their credentials, the following prompt displays: The Credential does not exist in the Credentialing table above. The Clai

File Maintenance Help for NextGen® Enterprise 8

Primary Credentials

Payers may require charge-level modifiers on claims that identify the rendering provider's credentials. For example, in the state of Ohio, a Registered Nurse (RN) that provides services as a Licensed Professional Clinical Counselor (LPCC) requires a UH modifier on claims that reflects under what license they were operating. In cases where a provider has multiple credentials, a Primary Credential can be identified on the Credentialing tab. Their primary credential, in combination with another credential, can then be used in the configuration of the Claim Modifiers Library to add the appropriate charge-level modifier to claims during the billing process in NextGen® Enterprise PM. Note: To set up Primary Credentials for providers, the Enable Provider Credential Billing check box must be enabled in Enterprise Preferences > General. Add or Modify Primary Credentials Primary Credential Conflicts and Messages Hide Primary Credentials Parent topic: Providers Credentialing Tab

Help Guide for NextGen® Enterprise PM 8

Primary Credentials

Payers may require charge-level modifiers on claims that identify the rendering provider's credentials. For example, in the state of Ohio, a Registered Nurse (RN) that provides services as a Licensed Professional Clinical Counselor (LPCC) requires a UH modifier on claims that reflects under what license they were operating. In cases where a provider has multiple credentials, a Primary Credential can be identified on the Credentialing tab. Their primary credential, in combination with another credential, can then be used in the configuration of the Claim Modifiers Library to add the appropriate charge-level modifier to claims during the billing process in NextGen® Enterprise PM. Note: To set up Primary Credentials for providers, the Enable Provider Credential Billing check box must be enabled in Enterprise Preferences > General. Add or Modify Primary Credentials Primary Credential Conflicts and Messages Hide Primary Credentials Parent topic: Providers Credentialing Tab

Help Guide for NextGen® Enterprise PM 8

Add or Modify Primary Credentials

Access the Modify Provider Information window for a provider. Select the Credentialing tab. Credentials for the provider are listed in the top section of the tab and Primary Credentials are listed in the bottom section of the tab. Hover over the Information icon on the right to view tool tip information for this section. Note: The Primary Credentials section appears only when the Enable Provider Credential Billing options is enabled in Enterprise Preferences > General. Modify Provider Information window; Credentialing tab In the Primary Credentials section, do one of the following: To add a primary credential, select Open Menu and select New. To modify a primary credential, select the item from the list, and then select Open Menu and select Open. The Primary Credentials window opens. In the Effective Date field, enter the date the primary credential becomes effective. This field is required, and the date must be earlier than the expiration date. In the Expiration Date field, enter the

Help Guide for NextGen® Enterprise PM 8

Provider Credentials with Overlapping Dates

When Enable Provider Credential Billing is not enabled in Enterprise Preferences > General, a provider can have multiple entries for the same credential type with overlapping dates. For example: Dr. Smith obtained a State License on 11/01/2016. The license is effective from 11/01/2016 - 12/31/2017. Dr. Smith renewed the State License on 10/15/2017. The renewed license is effective from 11/01/2017 - 12/31/2018. In the above example, two entries can be made on the Modify Provider Information > Credentialing tab for State License, even though the effective date for the renewed license falls within the date range on the original license. When Enable Provider Credential Billing is enabled in Enterprise Preferences > General, a provider cannot have multiple entries for the same credential type with overlapping dates. Using the same example above, the following prompt displays when a second entry is made on the Modify Provider Information > Credentialing tab for State License with an effectiv

Primary Credential Conflicts and Messages

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