Set Up an Alternate Type of Service Codes Library

File Maintenance Help for NextGen® Enterprise 8

Types of Service Library

The Types of Service library enables you to enter Alternate Type of Service codes that meet specific payer requirements. Alternate Type of Service codes can also be set up for specific CPT4 codes or CPT4 code ranges. In addition, Alternate Type of Service Codes can be specific, based on payer requirements, for the claim media type: either paper or electronic. After a Type of Service Library has been set up, it can be attached to a payer at the Payer Master level. When you view or print paper claims, any Alternate Type of Service codes that are set up and attached to the payer print in box 24c on the 1500 form. Set Up an Alternate Type of Service Codes Library Attach an Alternate Type of Service Library to a Payer

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate CPT4 Code

Open a Service Item library. From the Search list on the left, select a service item and then select the Payer tab. Select the applicable main payer from the drop-down list. Enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 column. Note: If there is an alternate payer attached to a main payer in the Payer Master and there are Alternate Payer Alternate CPT4 codes that need to be used on the alternate payer claim, then enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 field for the selected service item and payer that the alternate payer is attached to. Only when the location and service items on the encounter match the location and services set up on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer will Alternate Payer Alternate CPT4 codes populate to the alternate payer claim. Parent topic: Alternate CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

Alternate Type of Service Codes

You can use alternate type of service codes in the place of standard type of service codes for each payer by creating a library of alternate type of service codes, and then attaching the library to the payer. State Payer If the Standard Code is... Then the Alternate Code is... CT, AR, NY, PA, MD, OR, WI, SC All Types of Service codes Blank WA Medicare All Types of Service codes Blank SC Medicaid All Types of Service codes Blank PA Blue Cross Blue Shield All Types of Service codes Blank MD Blue Cross Blue Shield All Types of Service codes Blank TX WorkComp All Types of Service codes Blank WA Medicaid and WorkComp All Types of Service codes 3 AL Medicare when there is no Secondary or Tertiary Payer All Types of Service codes Blank Note: The table outlines the alternate type of service codes for paper claims. The alternate type of service codes for electronic claims are not mentioned here. Parent topic: Appendix A: Alternate Type of Service Codes

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

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

Attaching Taxonomy Codes to Groups

From the Master Files list, select Practice > Groups. Select the group. If you want to select a default taxonomy code for the group, select a code from the Taxonomy Code field. A taxonomy code added to the default location with a specific payer row applies only for that payer across all locations. The code overrides the taxonomy code at the top of the group screen for that payer. If you want to select a taxonomy code for the group at the location level: Select a service location. Then double-click a payer name in the Payer column. And then select the code from the Taxonomy Code field. A taxonomy code added to the default payer row at a specific location applies for all payers at that location. The code can also be payer-specific at a specific location. The most specific setting is always selected above the other settings. If you want to set taxonomy codes for specific procedure ranges, select the CPT4 Group Information button. The CPT4 Group Information for [Group Name] window displays

Set Up an Alternate Type of Service Codes Library

Recommendations

Types of Service Library

Set Up an Alternate CPT4 Code

Alternate Type of Service Codes

Adding a New UB92 Service Item

Alternate CPT4 Code

Attaching Taxonomy Codes to Groups

Types of Service Library

Set Up an Alternate CPT4 Code

Alternate Type of Service Codes

Adding a New UB92 Service Item

Alternate CPT4 Code

Attaching Taxonomy Codes to Groups