SIM Pricing Regions Library

File Maintenance Help for NextGen® Enterprise 8

Select a Default SIM Pricing Region Library for an Enterprise

The system uses a pricing region associated with the enterprise only when there is no pricing region associated with the payer or if the encounter is self pay. Access the Enterprise Preferences > Libraries tab. Select a default region in the following fields: Pricing Region Library for Self Pay field – The system uses this pricing region if an encounter is self-pay and, therefore, has no payer. Default Pricing Region Library field – The system uses this pricing region if the encounter has a payer but no pricing region is selected for the payer (the Pricing Regions Library field in the Payer master file > Payer Defaults-1 tab is blank). This pricing region is also used when the Pricing Region Library for Self Pay field is blank. Select OK. Parent topic: SIM Pricing Regions Library

File Maintenance Help for NextGen® Enterprise 8

Libraries Tab - Enterprise Preferences Descriptions

The following table provides descriptions of the fields located in the Libraries Enterprise Preferences. Field Description Enable Advanced Service Item Library Mode Caution: Once you enable this feature, you cannot disable it. This check box turns on all features that enable you to set prices by configuring locations into payer-centric groupings. For example, Medicare might have different regional groupings than Aetna, and pricing would be determined accordingly. Default Pricing Region Library for Self Pay Select the appropriate SIM Pricing Regions library that defines the pricing when an encounter is self-pay. For more information, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide for NextGen Enterprise. Default Pricing Region Library Select the appropriate SIM Pricing Regions library that defines the pricing for payers of this enterprise. For more information, go to NextGen Healthcare Success Community and download the latest File Mai

File Maintenance Help for NextGen® Enterprise 8

Preventing Use of Default SIM Library to Determine Charges

When your practice uses Advanced Service Item Library Mode, you will require an effective location to be selected in the pricing regions before the application can determine which Service Items library to use. When Default Pricing Region Library for Self Pay and Default Pricing Region Library are defined in the Enterprise Preferences, but no effective location exists, then when a user enters a procedure, the Service Item library selected in the Libraries Practice Preferences is used, by default. You can prevent the practice-level Service Item library from being used by selecting Require Effective Location in Pricing Region check box in the Enterprise Preferences Libraries tab. Requiring an effective location provides more control over which payer a user can attach to a charge or procedure. For example, users will be unable to select a payer that is not affiliated with a location. When a user enters a procedure, a message displays that a location is not selected in the pricing region. T

NextGen® Enterprise EHR Help

Using Advanced Service Item Library Mode

The Advanced Service Item Library Mode feature provides the ability to set pricing for tests and services based on how various payers divide the country into geographical regions. If you need to set up test pricing for your practice that is based on regions, the Advanced Service Item Library Mode is the way to accomplish this. You can set prices by configuring locations into payer centric groupings. As an example, Medicare may have different regional groupings than Aetna, and pricing is determined accordingly. In addition, the concept of SIM Pricing Templates was introduced to support the management of prices using parent/child relationships between libraries.If you do not need to set up payment based on pricing regions, do not use this parameter. Advanced Service Item Library Mode implementation in the Orders module uses File Maintenance, master files and libraries to assign a SIM code to a lab order test specimen charge. It does not allow you to assign the library at the same time be

NextGen® Enterprise EHR Help

Assign Default SIM Pricing Region Libraries to Payers

If Advanced Service Item Mode is enabled and SIM Pricing Region libraries are defined, you can assign the libraries to payers. Select File Maintenance > System > Payers. Double-click a payer. The Modify Payer Information window opens. Under Payer-Defaults-1 tab, in the Pricing Regions Library field, select a SIM Pricing Region Library. Select OK. Parent topic: SIMs Groups in the Orders Tests Master File

File Maintenance Help for NextGen® Enterprise 8

Advanced Service Item Library Mode

When you need to maintain pricing for several locations that are grouped into different regions, the Enable Advanced Service Item Library Mode allows you to set pricing based on how various payers divide the country into geographical regions. For example, Medicare has different regional groupings than Aetna, and pricing would be determined accordingly. With Enable Advanced Service Item Library Mode, you can also use SIM Pricing Templates to manage prices in the Service Item libraries. Note: Once you enable Advanced Service Item Library Mode, you cannot disable it. You can create a SIM Pricing Regions Library to support setting prices based on geographical regions that may vary by payer. For more information on SIM Pricing Regions Library see, File Maintenance Libraries Guide for NextGen® Enterprise. You can assign default pricing regions for the enterprise and payers by setting up additional pricing in the Service Items library for claim printing. You can assign permissions in the Syst

SIM Pricing Regions Library

Recommendations

Select a Default SIM Pricing Region Library for an Enterprise

Libraries Tab - Enterprise Preferences Descriptions

Preventing Use of Default SIM Library to Determine Charges

Using Advanced Service Item Library Mode

Assign Default SIM Pricing Region Libraries to Payers

Advanced Service Item Library Mode

Select a Default SIM Pricing Region Library for an Enterprise

Libraries Tab - Enterprise Preferences Descriptions

Preventing Use of Default SIM Library to Determine Charges

Using Advanced Service Item Library Mode

Assign Default SIM Pricing Region Libraries to Payers

Advanced Service Item Library Mode