SIM Exceptions

Help Guide for NextGen® Enterprise PM 8

Contract Exceptions

You can charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider/payer/location level in order to apply the exceptions to charges. Setting Up Exceptions In the Contract Library Parent topic: Contracts Library

File Maintenance Help for NextGen® Enterprise 8

Applying Exceptions to Charges

SIM and contract exceptions can be applied to a charge in the Charge Posting window. When a service item is entered, a search is generated for an exception. If NextGen® Enterprise PM finds a match for the charge rendering, charge location, and primary payer from the encounter for a specific service item or CPT4 code, the exception fields override the charge fields, which otherwise would pull data from the SIM and Contract libraries. Parent topic: SIM Exceptions

File Maintenance Help for NextGen® Enterprise 8

Contract Exceptions

You can charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider/payer/location level in order to apply the exceptions to charges. Parent topic: Access Contract Library Maintenance

File Maintenance Help for NextGen® Enterprise 8

Setting Up an Exception through the SIM Library

In the SIM library, you can create a new SIM exception or modify existing ones. Note: You must set up all SIM Exceptions, Groups, and SIM Exception Groups before you attach them to a provider. For information on attaching the appropriate SIM to a provider, see the section Assigning Exceptions for the Provider, Payer, and Location in the File Maintenance Master Files Guide for NextGen® Enterprise. Set Up a New SIM Exception Modify Existing SIM Exceptions Setting Up More Than One Exception per SIM Set Default SIM Exceptions for Self-Pay Patients at Practice Level Set Default SIM Exceptions for Self-Pay Patients at Location Level Parent topic: SIM Exceptions

File Maintenance Help for NextGen® Enterprise 8

Set Up a New SIM Exception

In File Maintenance, select Libraries menu > Service Items. The Service Item Libraries window opens. Select a Service Item Library. Select Open Menu. Select SIM Exceptions from the shortcut menu. The SIM Exceptions List window opens. Select open menu button , and then select New. The SIM Exception Maintenance window opens. Complete the window by entering the exception information. For descriptions of the fields, see SIM Exception Setup Field Descriptions. Note: The SIM Exception fields in which you enter the exceptions are located in the spreadsheet section of the dialog box. Use the TAB key or arrow keys to move the insertion point to the applicable cell for your entry. Right-click on a cell to display the shortcut menu, then you can delete an entry by the cell or row. If your library has fewer than 50 SIM items, press the TAB key or arrow keys to move to the next SIM item that you want to enter an exception for. If your library has 50 or more SIM items, go back to the Type the first

Help Guide for NextGen® Enterprise PM 8

Cost Estimation Data Sources

The information for cost estimation can be retrieved from: Service Items (SIM) library A library that enables you to add SIM codes with associated CPT®4 code for each practice, along with prices. You can also group service items under one main number or name. SIM exception A library that enables you to charge different fees according to provider, location, and payer. Additional fees are referred to as exceptions, which can be set up and maintained through the SIM Library. Contract library A library that enables you to set up payers for the contract and indicates the reimbursement amount for the procedures. Contract exception A library that enables you to charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider, payer, or location level to apply the exce

SIM Exceptions

Recommendations

Contract Exceptions

Applying Exceptions to Charges

Contract Exceptions

Setting Up an Exception through the SIM Library

Set Up a New SIM Exception

Cost Estimation Data Sources

Contract Exceptions

Applying Exceptions to Charges

Contract Exceptions

Setting Up an Exception through the SIM Library

Set Up a New SIM Exception

Cost Estimation Data Sources