Setup the Define TOB by Rev Code

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claim Rules by TOB Tab

The Claim Rules by TOB tab on the Institutional Billing Maintenance window allows the Type of Bill (TOB) to control whether specific fields are populated on claims for the selected payers. From the Institutional Billing Maintenance window, select the Claim Rules by TOB tab. In the Claim Rules by Type of Bill section, do one of the following: To add a new claim rule by TOB, select open menu button and select New. To modify an existing claim rule by TOB, select the row for the rule in the list, select the open menu button and select Open. The Claim Rules by Type of Bill Range window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates cannot overlap between rules for the same TOB range. If dates overlap, the following prompt displays when the OK button is selected: Effective/Expiration dates overlap with [Claim Rules by TOB Name]. In the Description field, enter a descriptive name for the ru

File Maintenance Help for NextGen® Enterprise 8

Setup the Payer Exception Claim Rules Tab

The Payer Exception Claim Rules tab on the Institutional Billing Maintenance window allows the Revenue Code to control specific claim override options for the selected payers. From the Institutional Billing Maintenance window, select the Payer Exception Claim Rules tab. In the Payer Exception Claim Rules section, do one of the following: To add a new payer exception claim rule, select open menu button and select New. To modify an existing payer exception claim rule, select the row for the rule in the list, select the open menu button and select Open. The Payer Exception Claim Rules window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates cannot overlap between rules for the same payer revenue code or category. If dates overlap, the following prompt displays when OK is selected: Effective/Expiration dates overlap with [Payer Exception Claim Rules Name]. In the Description field, enter a

File Maintenance Help for NextGen® Enterprise 8

Add or Modify an Institutional Billing Library

Open File Maintenance. Select Libraries, and then Institutional Billing. The Institutional Billing List window opens. Do one of the following: To add a new library, select open menu button and select New. To modify an existing library, select the row for the library in the list, select open menu button and select Open. Institutional Billing Library Maintenance window opens. In the Institutional Billing Library Name field, enter a descriptive name for the library. This field is required. In the Payer Rules for Institutional Billing section, existing payer configurations display as separate rows in descending date order. This section is required. Do one of the following: To add new payer rules, select open menu button and select New. To modify existing payer rules, select the row for the rule set in the list, select open menu button and select Open. To copy existing payer rules, select the row for the rule set in the list, select open menu button and select Copy. The Institutional Billin

File Maintenance Help for NextGen® Enterprise

Add or Modify an Institutional Billing Library

Open File Maintenance and then select Libraries > Institutional Billing. The Institutional Billing List window opens. Select the open menu button to add, open, or copy a payer rule. Institutional Billing Library Maintenance window opens. In the Institutional Billing Library Name field, enter a descriptive name for the library. In the Payer Rules for Institutional Billing section, use the open menu button create, open, or copy an existing rule. The Institutional Billing Maintenance window opens. Enter values in all fields. Note: In order for the payer rules to apply to an encounter, the Billable Date on the Encounter Maintenance window must fall within the Effective/Expiration Dates defined in the Institutional Billing Maintenance window. Add or modify the values in the following tabs by selecting the open menu button: Define TOB by Rev Code: Allows the Type of Bill (TOB) for claims to be defined by revenue code for the selected payers. The system creates a claim break based on TOB. The

Help Guide for NextGen® Enterprise PM 8

IB Library with TOB by Rev Code Report

The Institutional Billing Library with TOB by Rev Code report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window > Define TOB by Rev Code tab. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Desc Description Description field Default Default Use as default billing rules for Institutional Claims check box Y or N Type of Bill Rules Type of Bill Rules Define Type of Bill by Revenue Code Category window > Description field Payer Name Payer Name Valid Payers section Eff Dt Effective Date Define Type of Bill by Revenue Code Category window > Effective Date field Exp Dt Expiration Date Define Type of Bill by Revenue Code Category window > Expiration Date field Rev Cd Cat Revenue Code Category Define Type of Bill by Revenue Code Category window > Revenue Code Category field Fac Type F

File Maintenance Help for NextGen® Enterprise 8

IB Library with TOB by Rev Code Report

The Institutional Billing Library with TOB by Rev Code report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window > Define TOB by Rev Code tab. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Desc Description Description field Default Default Use as default billing rules for Institutional Claims check box Y or N Type of Bill Rules Type of Bill Rules Define Type of Bill by Revenue Code Category window > Description field Payer Name Payer Name Valid Payers section Eff Dt Effective Date Define Type of Bill by Revenue Code Category window > Effective Date field Exp Dt Expiration Date Define Type of Bill by Revenue Code Category window > Expiration Date field Rev Cd Cat Revenue Code Category Define Type of Bill by Revenue Code Category window > Revenue Code Category field Fac Type F

Setup the Define TOB by Rev Code

Recommendations

Set Up the Claim Rules by TOB Tab

Setup the Payer Exception Claim Rules Tab

Add or Modify an Institutional Billing Library

Add or Modify an Institutional Billing Library

IB Library with TOB by Rev Code Report

IB Library with TOB by Rev Code Report

Setup the Define TOB by Rev Code

Set Up the Claim Rules by TOB Tab

Setup the Payer Exception Claim Rules Tab

Add or Modify an Institutional Billing Library

Add or Modify an Institutional Billing Library

IB Library with TOB by Rev Code Report

IB Library with TOB by Rev Code Report