Add or Modify a Claim Modifiers Library

Help Guide for NextGen® Enterprise PM 8

Hide a Claim Modifier

You can hide a claim modifier, if needed. A hidden modifier is no longer applied to claims in NextGen® Enterprise PM, even if the modifier is still in effect and not expired. For example, a charge meets all criteria defined for a hidden modifier, and the date of service on the charge falls within the modifier's effective date range. When the encounter is billed, the modifier change is not applied to the claim for the charge because the modifier is hidden. Access File Maintenance. Select Libraries, and then Claim Modifiers. The Claims Modifiers List window opens. Select a library from the list, and then select the open menu button . Select Open. The Claim Modifiers Library Maintenance window opens. From the Claim Modifiers list, select a modifier to hide and then do one of the following: Select Open Menu and then select Hide. Right-click and then select Hide. Double-click to open the modifier, then select the Hide check box, and then select OK. A prompt appears asking you to confirm hid

File Maintenance Help for NextGen® Enterprise 8

Add or Modify a Claim Modifiers Library

Access File Maintenance. Select Libraries, and then Claims Modifiers. The Claims Modifiers List window opens. To add a claim modifier, select the open menu button, and then select New. The Add Claim Modifiers window opens. Enter a value in the Claim Modifiers Library field. Select the open menu button and then select New. The Add/Modify Claim Modifiers window opens. Enter the desired values in the mandatory fields and then select OK. Note: You must select a value for Modifier Charge for Claims, otherwise the modifier will not get added. The new claim modifier appears in the Claim Modifiers area of the Add Claim Modifiers window. In the SIM Exception Mode section, select one of the following: None (default): Select this button if the criteria defined for the modifier applies to all SIM codes. Include: Select this button if the criteria defined for the modifier applies to specific SIM codes only. Exclude: Select this button if the criteria defined for the modifier applies to all SIM code

Help Guide for NextGen® Enterprise PM 8

Claim Modifiers Library

The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Anesthesia Billing

Use the following procedure to set up a claim modifier for Anesthesia SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character anesthesia modifier. This field is required and cannot be modified after the modifier is saved. For example: P1 - Normal healthy patient P2 - Patient with mild systemic disease P3 - Patient with severe systemic disease P4 - Patient with severe systemic disease that is a constant threat to life P5 - Patient who is not expected to survive without the procedure P6 - Declared brain-dead patient whose organs are being removed for donor purposes In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Rental Billing

Use the following procedure to set up a claim modifier for Rental SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character recurring rental modifier. This field is required and cannot be modified after the modifier is saved. For example: KH: Initial claim, purchase or first month rental KI: Second or third monthly rental KJ: Capped rental months four to fourteen KR: Partial month In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier Change for Claims field, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when the claim is created during the billing process

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Behavioral Health Billing

Use the following procedure to set up a claim modifier for Behavioral Health SIM codes. Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character behavioral health modifier. This field is required and cannot be modified after the modifier is saved. For example: AF: Services provided by a Psychiatrist AH: Services provided by a Psychologist AJ: Services provided by a Licensed Clinical Social Worker HQ: Services provided in a group setting In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier Change for Claims field, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when t

Add or Modify a Claim Modifiers Library

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