Set Up Charge Options

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Claim Options tab. Complete the fields to set up Claim Options. For more information on each field, see Claim Options Field Descriptions. To save changes and close the window, select OK. Claim Options Field Descriptions Parent topic: Behavioral Health Billing Libra

File Maintenance Help for NextGen® Enterprise 8

Set Up Billing Options

The Billing Options tab is used to specify which Place of Service code and ICD codes should be used on claims when multiple Behavioral Health charges on an encounter each have different codes. It also allows selection of an adjustment reason code for auto-balancing a variance amount on COB claims. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. From the list, double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Billing Options tab. Complete the fields to set up Billing Options. For more information on each field, see Billing Options Field Descriptions. To save changes and close the window, select OK. Billing Options Field Descriptions Parent topic: Behavioral Health Billing Library

Help Guide for NextGen® Enterprise PM 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

File Maintenance Help for NextGen® Enterprise 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

File Maintenance Help for NextGen® Enterprise 8

Behavioral Health Billing Library

The Behavioral Health Billing library defines parameters for “variance” charges which can be calculated and added to encounters during the billing process for specific payers. The library also defines other claim and billing parameters that may be needed when billing Behavioral Health services to specific payers. A single library can be created and linked to the practice to be used for all payers. Or payer-specific libraries can be created and linked only to those payers. You can generate the Behavioral Health Billing report from the Behavioral Health Billing library , go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Add or Modify a Behavioral Health Billing Library Set Up Charge Options Set Up Claim Options Set Up Billing Options

Help Guide for NextGen® Enterprise PM 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

Set Up Charge Options

Recommendations

Set Up Claim Options

Set Up Billing Options

Set Up Charge Options

Charge Options Field Descriptions

Behavioral Health Billing Library

Charge Options Field Descriptions

Set Up Claim Options

Set Up Billing Options

Set Up Charge Options

Charge Options Field Descriptions

Behavioral Health Billing Library

Charge Options Field Descriptions