Purchased Service Indicators

File Maintenance Help for NextGen® Enterprise 8

Designating a SIM as a Purchased Service Indicator for Specific Payers

You can designate a SIM as a Purchased Service Indicator for specific payers when the Purchased Service check box is selected on the Service Item Library Maintenance window > Payer tab. The following list outlines billing conditions and rules for Purchased Service Indicators. When a SIM is designated as a Purchased Service Indicator, only one Purchased Service Indicator line item per claim is allowed during billing. Therefore, if there are multiple Purchased Service Indicators entered on the Charge Posting window, then multiple claims are created. When this option is selected, a facility must be entered in the Facility field on the Encounter Maintenance window. If a facility is not entered, then the Claim Production Status report displays the following error when the encounter is billed: The Laboratory/Facility Number is Required When a claim has a Purchased Service Indicator, then, on the HCFA 1500 claim form, the "Yes" check box is selected for Box "20. Outside Lab?" and the total ch

File Maintenance Help for NextGen® Enterprise 8

Unbundle Service Item Codes by Payer

You can unbundle (not group the same service items together as multiple units) Service Items Codes by payer or by practice. This option is available to accommodate payers who do not want to be billed with multiple units of the same service item; they prefer each service item listed separately, each with a unit of one. When SIMs are set to unbundle, separate charge lines generate. You can prevent SIM bundling: for all payers in a practice. of all SIMs for a specific payer. for a specific SIM and payer combination. When you prevent bundling, 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 electronic send file. When the check box is cleared (the application default), the application sums identical line items and indicates multiple units for billing on a paper HCFA 1500 or in an electronic send file. To Activate Unbundli

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

File Maintenance Help for NextGen® Enterprise 8

Adding a New UB92 Service Item

Field Description Payer Select a payer that requires an alternate CPT4 code for the service item. This payer name prints in box 50 of the UB form. If you need to set multiple payers, fill out the information for the first payer, then select a new payer. The fields clear, but the first payer's information is saved. Note: After a payer has been saved on the Payer tab, you cannot remove that payer if, for example, the payer is no longer valid. Instead, you must expire the payer by changing the expiration date in the Exp field. Eff Enter the date that the alternate code becomes effective. Exp Enter the date that the alternate code for the payer ends. Form Select either the HCFA 1500 or UB form. For more information on adding UB information, refer to the next section. Alt CPT4 Enter the alternate CPT4 code to be used. This must be a valid CPT4 code. If an alternate code is assigned, the Service Item displays on the charge window, but the ALT code prints on the claim. Alt Payer CPT4 Enter th

File Maintenance Help for NextGen® Enterprise 8

Set Up Qualifying SIMs

For an encounter to be marked as a qualifying encounter, at least one of the line items in the encounter must be marked as a qualifying SIM. In Practice Preferences > Claims select the Enable Qualifying Encounter Billing check box. In File Maintenance > Libraries > Service Items open the applicable library. Select an existing SIM or select the Open Menu and select New. Select the General tab. Select the qualifying-related check boxes from the Qualifying Encounter field. For more information, see Service Item Library Maintenance Qualifying Encounter Descriptions. Note: These check boxes are used primarily by CHC clients. If the code is on an encounter by itself or with other codes at the time the encounter is billed, the Qualifying Encounter check box is automatically selected on the Claims tab of the Encounter Maintenance window. This flag is used for reporting purposes primarily for grants as well as state and federal reports. Select the Payer tab, then select the Qualifying Encounter

File Maintenance Help for NextGen® Enterprise 8

Configurations in Claim Practice Preferences

The following table provides descriptions for the fields located in Claims Practice Preferences. Field Description Enable Qualifying Encounter Billing Activates qualifying encounter billing for all encounters with line items marked as a qualifying SIM Note: To complete the setup for qualifying encounter billing, you must configure one or more SIMs to be a qualifying SIM. Suppress zero balance claims Suppresses claims with a $0 (zero) balance during batch billing. Suppress CLIA ID from mammography claims Makes mammography certification codes and Clinical Laboratory Improvement Amendments (CLIA) IDs mutually exclusive on electronic claims. When you select this option, NextGen® Enterprise PM identifies a mammography code on a claim and prints the mammography code, and not the CLIA ID for Medicare claims. When you clear this option, both the mammography code and the CLIA codes are printed on the claim. Note: To suppress CLIA ID from mammography claims, you must set a SIM as mammography cod

Purchased Service Indicators

Recommendations

Designating a SIM as a Purchased Service Indicator for Specific Payers

Unbundle Service Item Codes by Payer

Payer Tab - SIM Library

Adding a New UB92 Service Item

Set Up Qualifying SIMs

Configurations in Claim Practice Preferences

Designating a SIM as a Purchased Service Indicator for Specific Payers

Unbundle Service Item Codes by Payer

Payer Tab - SIM Library

Adding a New UB92 Service Item

Set Up Qualifying SIMs

Configurations in Claim Practice Preferences