NextGen Knowledge Center

Add or Modify an Encounter Rate Billing Library

The Encounter Rate Billing library enables you to configure the billing process for payers who require a flat encounter rate. This library is used to configure the business rules applicable to a payer. The Encounter Rate Billing library provide the flexibility to set up multiple rate codes to accommodate the different billing requirements of individual payers. The appropriate library can then be attached to the payer.
A SIM with the appropriate CPT4 code must be set up in the SIM library before you set up encounter rate billing.

To add or modify an Encounter Rate Billing library, do the following:

  1. Access File Maintenance.
  2. Select Libraries, and then Encounter Rate Billing.
    The Encounter Rate Billing List window opens.
  3. Do one of the following:
    • To add a library, select Open Menu and select New.
    • To modify a library, select the library from the list, and then select Open Menu and select Open.
    The Encounter Rate Billing Library Maintenance window opens.
    Encounter Rate Billing Library Maintenance

  4. In the Encounter Rate Billing Library field, enter a name for the library. This field is required.
  5. In the Encounter Rate SIM section, do both of the following:
    1. Select Open Folder to set the SIM Configuration Hierarchy.
    2. Right-click to set up Encounter Rate SIM Maintenance.
  6. Complete parameters as needed on the following tabs:
    • General
    • Primary Encounter Rate
    • Secondary and Tertiary Encounter Rate
    • Claims
    • Claim SIM Options
    • COB Claims
  7. To save changes and close the window, select OK.