Threshold Rules Conflicts and Messages

File Maintenance Help for NextGen® Enterprise 8

Set Up Threshold Rules for a Program

On the Add/Modify Program Information window, the Threshold Rules sub-tab under the Practice tab enables you to configure payer-specific threshold rules for the program. For example, in a Behavioral Health practice, a payer may require that patients in a specific program have a minimum number of addiction counseling hours per week, or a minimum number of therapy units per month before billing the payer for those services. Access File Maintenance. Select System Master Files, then PM, and then Programs. The Program List window opens. From the list, select a program and then do one of the following: Select Open Menu and then select Open. Right-click and then select Open. Double-click to open the program. The Modify Program Information window opens. Select the Practice tab, and then Threshold Rules on the left. Existing rules are listed in descending order by effective date with the following information: Effective Date Expiration Date Threshold Description Do one of the following: To crea

Help Guide for NextGen® Enterprise PM 8

Threshold Rules Conflicts and Messages

You can create multiple threshold rules for a program with the same effective and expiration dates. However, the descriptions cannot be the same. When you add or modify a threshold rule with an Effective Date and Expiration Date range that overlaps with another rule, and the Description also matches the other rule, the following prompt displays: Effective/Expiration dates overlap with: [Threshold Rule Description]. Threshold Rules Conflict/Message 1 You can create multiple threshold rules for a program with the same effective and expiration dates and payer. However, the SIM codes cannot be the same or left blank. When you add or modify a threshold rule with an Effective Date and Expiration Date range that overlaps with another rule, and the Valid Payer and a Program SIM also match the other rule, the following prompt displays: Please select Valid SIMs from available Program SIMs. Threshold SIMs must be unique per payer row. You cannot have a row with identified SIMs and a blank row at

File Maintenance Help for NextGen® Enterprise 8

Program with Threshold Rules Report Columns

The Program with Threshold Rules report includes information from the Programs master file in File Maintenance. Information on the report pulls from the Threshold Rules sub-tab of the Practice tab on the Modify Program Information window. The report includes the following information: Column Description Data Populates From Prog Name Program Name Name field on the System. Prog Desc Program Description Description field on the System. Thresh Desc Threshold Description Threshold Rules > Description field on the Practice tab. Eff Dt Effective Date Threshold Rules > Effective Date field on the Practice tab. Exp Dt Expiration Date Threshold Rules > Expiration Date field on the Practice tab. Thresh Payer Threshold Payer Threshold Rules > Valid Payers section of the Practice tab. Note: Multiple payers are separated by commas. Thresh SIM Threshold SIM Threshold Rules > Program SIM section of the Practice tab. Note: Multiple SIM codes are separated by commas. Thresh Min Threshold Minimum Minimum

Help Guide for NextGen® Enterprise PM 8

Set Up Threshold Rules for a Program

On the Add/Modify Program Information window, the Threshold Rules sub-tab under the Practice tab enables you to configure payer-specific threshold rules for the program. For example, in a Behavioral Health practice, a payer may require that patients in a specific program have a minimum number of addiction counseling hours per week, or a minimum number of therapy units per month before billing the payer for those services. Access File Maintenance. Select System Master Files, then PM, and then Programs. The Program List window opens. From the list, select a program and then do one of the following: Select Open Menu and then select Open. Right-click and then select Open. Double-click to open the program. The Modify Program Information window opens. Select the Practice tab, and then Threshold Rules on the left. Existing rules are listed in descending order by effective date with the following information: Effective Date Expiration Date Threshold Description Modify Program Information windo

Help Guide for NextGen® Enterprise PM 8

Set Up the Claims Tab

The Claims tab on the Encounter Rate Billing Library Maintenance window contains a series of questions designed for configuring claims for the ER payer. Primary, secondary and tertiary claims for the payer can be configured separately. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claims tab. Existing Claim Detail Rules sets display as separate rows, with the current active row at the top of the list. Rows can be sorted by selecting on the Eff Date, Exp Date or Description column headings. Do one of the following: To add a Claim Detail Rules set, select open menu button and select New. To modify a Claim Detail Rules set, select the row from the list, and then select open menu button and select Open. To copy a Claim Detail Rules set, select the row from the list, and select open menu button and select Copy. The Encounter Rate Claim Detail Rules window opens. In the Effective Date and Expiration Date fields, enter an effe

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claims Tab

The Claims tab on the Encounter Rate Billing Library Maintenance window contains a series of questions designed for configuring claims for the ER payer. Primary, secondary and tertiary claims for the payer can be configured separately. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claims tab. Existing Claim Detail Rules sets display as separate rows, with the current active row at the top of the list. Rows can be sorted by selecting on the Eff Date, Exp Date or Description column headings. Do one of the following: To add a Claim Detail Rules set, select open menu button and select New. To modify a Claim Detail Rules set, select the row from the list, and then select open menu button and select Open. To copy a Claim Detail Rules set, select the row from the list, and select open menu button and select Copy. The Encounter Rate Claim Detail Rules window opens. In the Effective Date and Expiration Date fields, enter an effe

Threshold Rules Conflicts and Messages

Recommendations

Set Up Threshold Rules for a Program

Threshold Rules Conflicts and Messages

Program with Threshold Rules Report Columns

Set Up Threshold Rules for a Program

Set Up the Claims Tab

Set Up the Claims Tab

Set Up Threshold Rules for a Program

Threshold Rules Conflicts and Messages

Program with Threshold Rules Report Columns

Set Up Threshold Rules for a Program

Set Up the Claims Tab

Set Up the Claims Tab