To Activate Unbundling

File Maintenance Help for NextGen® Enterprise 8

Unbundling Service Item Codes

Open a Service Item library, and enter the applicable Service Item Code in the Service Item # field. Select the Payer tab. Select the drop-down arrow in the Payer box and select the applicable payer. Select the Do Not Sum Units for CPT4 Code check box. Select OK. Parent topic: Unbundle Service Item Codes by Payer

File Maintenance Help for NextGen® Enterprise 8

Unbundle Service Item Codes by Payer

You can unbundle (not group the same service items together as multiple units) Service Items Codes by payer or by practice. This option is available to accommodate payers who do not want to be billed with multiple units of the same service item; they prefer each service item listed separately, each with a unit of one. When SIMs are set to unbundle, separate charge lines generate. You can prevent SIM bundling: for all payers in a practice. of all SIMs for a specific payer. for a specific SIM and payer combination. When you prevent bundling, multiple identical charge lines are prevented from being combined on one line and summed on the paper claim. The identical charges display on separate lines on the paper HCFA 1500 claim or are entered individually in an electronic send file. When the check box is cleared (the application default), the application sums identical line items and indicates multiple units for billing on a paper HCFA 1500 or in an electronic send file. To Activate Unbundli

Help Guide for NextGen® Enterprise PM 8

Do Not Sum Units for CPT4 Code

With Behavioral Health Billing, multiple charges on a single encounter that have the same CPT4 code, the same modifier(s), the same base minutes and the same unit price will roll-up (bundle) to a single line item on claims. The total units on the claim is calculated using the total time entered on all roll-up charges. The amount on the claim for the roll-up line item is calculated using the total units multiplied by the base price in the SIM Library. Do Not Sum Units for CPT4 Code is an option that will prevent multiple charges on an encounter with the same CPT4 code and modifiers from rolling-up (bundling) to a single line item on claims. The option is available at the Practice level, the Payer level, and the CPT4/Payer level. Note: This option should only be enabled if charge bundling should not occur for a Practice, a specific Payer, or a specific CPT4/payer combination. Practice Preferences > Claims: Select this check box to prevent multiple charges with the same CPT4 code and modi

File Maintenance Help for NextGen® Enterprise 8

Activate a CPT4 Roll Up

Open a Service Item library and then select a SIM. Select the Payer tab. Select the Single Unit CPT4 Roll Up check box. Select this check box if you want the application to roll up charges that are associated with the SIM's CPT4 code and have a quantity of 1 when claim is billed. Parent topic: CPT4 Roll Up

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

To set up a SIM code for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. Do one of the following: To add a SIM code, select Open Menu and select New. To modify a SIM code, search for the code and then select the code from the list on the left. Select the General tab. Each SIM code that is to roll-up to a single line item on the claim must have the following parameters defined. Revenue Code: Select the appropriate revenue code for UB/837I claims. This is the default revenue code for all UB payers. If the roll-up payer requires a different revenue code, the Alt Rev code must be defined on the Payer tab for the roll-up payer. Form: Select 1500. This is the default type of form for all payers. If the roll-up payer requires a different form (e.g. UB), additional se

File Maintenance Help for NextGen® Enterprise 8

Suppress Billing for Individual SIMs

From the File Maintenance desktop, select Libraries > Service Items. The Service Items Libraries window opens. Double-click a service item library. The Service Item Library Maintenance window opens. On the General tab, select the Suppress Billing check box. Parent topic: General Tab

To Activate Unbundling

Recommendations

Unbundling Service Item Codes

Unbundle Service Item Codes by Payer

Do Not Sum Units for CPT4 Code

Activate a CPT4 Roll Up

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

Suppress Billing for Individual SIMs