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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
.
File Maintenance Help for NextGen® Enterprise 8
To Activate Unbundling
Prevent SIM bundling by doing one of the following: To prevent SIM bundling for all payers: Open Practice Preferences > Claims Preferences, under Billing, and select the Do Not Sum Units for CPT4 Code check box. To prevent SIM bundling for a payer: Open a Payer master file > Payer Defaults - 2 tab and select the Do Not Sum Units for CPT4 Code check box. 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
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
File Maintenance Help for NextGen® Enterprise 8
Set Up an Alternate CPT4 Code
Open a Service Item library. From the Search list on the left, select a service item and then select the Payer tab. Select the applicable main payer from the drop-down list. Enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 column. Note: If there is an alternate payer attached to a main payer in the Payer Master and there are Alternate Payer Alternate CPT4 codes that need to be used on the alternate payer claim, then enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 field for the selected service item and payer that the alternate payer is attached to. Only when the location and service items on the encounter match the location and services set up on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer will Alternate Payer Alternate CPT4 codes populate to the alternate payer claim. Parent topic: Alternate CPT4 Code
NextGen® Enterprise EHR Help
Verify the CPT4 Code in the Service Item Library
Prior to selecting and ordering Immunizations, verify the CPT4® in the SIM Library. Select File Maintenance > Libraries > Service Items. The Service Items List window opens. Double-click the default Service Item Library for your practice. Note: The default Service Item Library is indicated by a green color check mark under the Practice Default column. Enter the CPT4® code in the Search field. If the code exists, it appears in CPT4 Code. To verify if your alternate Medicare Billing code exists, enter the Q code in the Search field. Note: If the CPT4® code or Q code does not exist, you must set up the Service Item Library. For more information about setting up the Service Item Library, go to the NextGen Healthcare Success Community and download the latest System Administrator Guide for NextGen Enterprise. Parent topic: Using Advanced Service Item Library Mode
File Maintenance Help for NextGen® Enterprise 8
Alternate CPT4 Code
You can set up Alternate Payer Alternate CPT4 codes in the Service Item Library for the main payer that the alternate payer is attached to. If these codes are set up, they only populate the alternate payer claim when the following conditions are met: The location and service items on the encounter match the location and service items set up in Location field and Valid Alternate Payer Service Items on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer. There are Alternate Payer Alternate CPT4 ( Alt Payer CPT4) codes set up for the main payer on the Payer tab of the Service Item Library Maintenance window. Set Up an Alternate CPT4 Code Parent topic: Payer Tab - SIM Library
