Rules for Claim Population

File Maintenance Help for NextGen® Enterprise 8

Set Up CPT4 Codes at the Provider Master Level

To set up CPT4 codes at the provider master level: From the Master Files > System list, select Providers. Select the appropriate provider. Select the Practice tab. Select the drop-down arrow in the ServiceLocation field and select the location where the service is performed. A list of payers displays in the Group Information section. Under Group information, double-click the payer to which you want to add CPT4 codes. The Modify Provider Practice Payer window displays. Select the Open Record button next to the CPT4 Provider Nbrs field. The Valid Provider Numbers for [Payer Name] window displays. Select the Open Menu button and select New. Note: You can open and delete existing records. You can edit existing provider numbers, but you cannot edit the CPT4 code range. The Provider Number for CPT4 Range window displays. In the CPT4 field, enter the CPT4 code at the beginning of the range you want to set up. Use the to display the CPT4 Code Search window to search for a CPT4 code by code or

File Maintenance Help for NextGen® Enterprise 8

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

You can set up a range of CPT4 codes at the practice/location/provider level. This range allows you to have a different provider number for each CPT4 code. Set Up CPT4 Codes at the Provider Master Level Rules for Claim Population Parent topic: Providers Practice Tab

Help Guide for NextGen® Enterprise PM 8

Set Up a Default Location for Group Provider Numbers

To set up a group that has the same Group Provider number for payers at all or several practice locations, do the following: In File Maintenance, under Master Files, select Practice > Groups. The Groups List window opens. Double-click a group. The Group Information window opens. From the Service Location list, select the <Default> option. Select one of the following options based on the following information: To set up the group on the default payer, double-click the Default row listed under the Payer Name column. The Group Information window opens additional fields. This set up is for the default payer and the Payer Name field is disabled. To set up a specific payer for the group, right-click in the Group Information section, then select New. The Group Information window opens additional fields. Because this setup is for a specific payer, the Payer Name field is available. From the Payer Name list, select a payer. In the Group Number field, enter the group number. In the Opt Group Val

File Maintenance Help for NextGen® Enterprise 8

Attach a Taxonomy Code for the Provider at the Practice Level

To attach a taxonomy code for the provider at the practice level: From the Master Files list, select System or PM > Providers. Select the provider. Select the Practice tab. Select the Rendering provider at this practice check box. Select a service location from the Service Location field, and then double-click on the applicable payer listed under Group Information. If you select the default location and a specific payer, then the code applies for this payer at all locations. If you select a specific location and the default payer, then the row applies for all payers at that location. If you select a specific location and specific payer, then the code applies only to this payer at this location. The Modify Provider Practice Payer window displays. Select the taxonomy code from the Taxonomy Code field. If you want to set taxonomy codes for specific procedure ranges, select the CPT4 Provider Nbrs button. The Valid Provider Numbers for [Payer Name] window displays. Select the Open Menu butt

File Maintenance Help for NextGen® Enterprise 8

Providers Demographics Tab

The Demographics tab contains the provider name, address, and other profile information. Field Description Last/ First/ Middle Names Enter the name of the provider. It is very important that you only enter the provider's middle initial in the Middle Name field. If you enter an entire name in the Middle Name field (even though the field is labeled Middle Name instead Middle Initial), the application will take the last letter of the name you entered and enter it as the middle initial in box 17 of the HFCA 1500 form. Business/ Home/ Other1/ Other2 Select the type of address information you want to enter for the provider. Address/ City/ State/ Zip/ Country/ County The first space is for street number and name. The second space is for other address details such as suite number. If the ZIP code table is set up, you can enter the ZIP code, and the city, state, county, and country automatically display. Country Select the drop-down arrow and select the applicable country. County Select the dro

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

Rules for Claim Population

Recommendations

Set Up CPT4 Codes at the Provider Master Level

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

Set Up a Default Location for Group Provider Numbers

Attach a Taxonomy Code for the Provider at the Practice Level

Providers Demographics Tab

Add Payer-Specific Facility IDs

Set Up CPT4 Codes at the Provider Master Level

Assign a Provider Number at a Practice/Location/Provider/CPT4 Code Level

Set Up a Default Location for Group Provider Numbers

Attach a Taxonomy Code for the Provider at the Practice Level

Providers Demographics Tab

Add Payer-Specific Facility IDs