Set Up a Dental and Medical SIM

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

Set Up a SIM Used as an Anesthesia and a Dental SIM

Service items can be set up and billed as anesthesia or dental SIM. They must be set up at the Payer level in the Service Item Library. Open a SIM in a Service Item Library. Select the General tab. Ensure that 1500 or UB is selected in the Form drop-down list. Enter the applicable base units, up to four digits, in the Base Unit field. Note: One base unit is equal to either 10 or 15 minutes depending on the Anesthesia Minutes Per Unit setting on the Payer Defaults - 2 tab of the Payer master file. Check the Anesthesia SIM check box and then select the Payer tab. Select the applicable dental payer from the Payer drop-down list. You must designate this payer as a dental payer on the Payer tab of the Service Item Library Maintenance window. See Payer tab for more information. Enter the applicable effective and expiration dates in the Eff and Exp fields. Select ADA from the Form drop-down list. Enter any additional information that is applicable. Select OK. Parent topic: Dental SIMs

File Maintenance Help for NextGen® Enterprise 8

Set Up ADA SIMs

Service items that are only used as Dental SIMs are designated as a Dental SIM by selecting ADA from the Form drop-down list on the General tab of the Service Item Library Maintenance window for that SIM. Service items designated as Dental SIMs can only be billed on an ADA Dental claim or as patient responsibility; they do not populate an 1500/837 Professional or UB/837 Institutional form. Open a SIM in a Service Item Library. In the File Maintenance window, select the General tab. Select ADA from the Form drop-down list. Select OK. Parent topic: Dental SIMs

File Maintenance Help for NextGen® Enterprise 8

Dental SIMs

To accurately use the Dental billing feature, the service items that are used for billing dental charges need to be designated Dental SIMs in the Service Item Library. A service item is designated a Dental SIM three different ways depending on the following ways it is used: SIMs only used as a Dental SIM SIMs used as a Medical and a Dental SIM SIMs used as an Anesthesia SIM and a Dental SIM Set Up ADA SIMs Set Up a Dental and Medical SIM Set Up a SIM Used as an Anesthesia and a Dental SIM Parent topic: Add a New Service Item

Help Guide for NextGen® Enterprise PM 8

Set Up Payer-Specific Requirements

Not all payers require an ADA claim form. Some payers may require a 1500 form. To set up a SIM code to use 1500 forms for a payer, do the following: From the Service Item Library Maintenance window, select the applicable service item. Select the Payer tab. Payer In the Payer field, select the payer. In the Eff and Exp columns, enter the effective and expiration dates for the SIM code/payer. In the Form column, select 1500. To save changes and close the window, select OK. Parent topic: Service Items Library for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Service Items Library for Dental Billing

When setting up SIM codes for dental, set the Form field on the Service Item Library Maintenance window to ADA. Service Library Maintenance Set Up Payer-Specific Requirements Parent topic: Dental Billing

Set Up a Dental and Medical SIM

Recommendations

Payer Tab - SIM Library

Set Up a SIM Used as an Anesthesia and a Dental SIM

Set Up ADA SIMs

Dental SIMs

Set Up Payer-Specific Requirements

Service Items Library for Dental Billing

Payer Tab - SIM Library

Set Up a SIM Used as an Anesthesia and a Dental SIM

Set Up ADA SIMs

Dental SIMs

Set Up Payer-Specific Requirements

Service Items Library for Dental Billing