Set Up an Alternate CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

Alternate CPT4 Code

You can set up Alternate Payer Alternate CPT4 codes in the Service Item Library for the main payer that the alternate payer is attached to. If these codes are set up, they only populate the alternate payer claim when the following conditions are met: The location and service items on the encounter match the location and service items set up in Location field and Valid Alternate Payer Service Items on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer. There are Alternate Payer Alternate CPT4 ( Alt Payer CPT4) codes set up for the main payer on the Payer tab of the Service Item Library Maintenance window. Set Up an Alternate CPT4 Code Parent topic: Payer Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate Type of Service Codes Library

From the File Maintenance window, select Libraries > Type of Service. Select open menu button , and then select New. Enter the name of the new library in the Service Name field. Select open menu button , and then select New. The Add Type of Service Alternate window opens. In the Type of Service list, select the applicable standard Type of Service. The Code field is automatically populated with the standard code and the field is disabled and cannot be changed. Enter the applicable Alternate Type of Service code for: paper claims in the Alt Paper field. electronic claims in the Alt Electronic field. Note: When entering alternate type of service codes for paper or electronic claim types, you must fill in both of these fields. For example, if a payer requires an alternate type of service code for paper claims, but they want the standard type of service code for electronic claims, then you must enter the alternate code in the ALT Paper field and the standard code in the ALT Electronic field

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

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Add CPT4 Code Information Parent topic: Setting Up Roll-Up Billing by CPT4 Code

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

Help Guide for NextGen® Enterprise PM 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

Set Up an Alternate CPT4 Code

Recommendations

Alternate CPT4 Code

Set Up an Alternate Type of Service Codes Library

Set Up CPT4 Codes at the Provider Master Level

Set Up CPT4 Codes for Roll-Up Billing

Post a Payment to an Alternate Payer

Post a Payment to an Alternate Payer

Alternate CPT4 Code

Set Up an Alternate Type of Service Codes Library

Set Up CPT4 Codes at the Provider Master Level

Set Up CPT4 Codes for Roll-Up Billing

Post a Payment to an Alternate Payer

Post a Payment to an Alternate Payer