Additional Billing Provider Information

Field	Description
Taxonomy Code	The taxonomy code you select on the Alt Payer Carve Out Criteria window overrides the taxonomy code you selected in the Groups master file.
Provider Number	This is the facility location provider number.
National Provider ID	This setting overrides the group-level NPI for alternate payer claims. If this field is blank, then the group NPI is used. Note: NPI is a standard unique identifier for health care providers and is used in filing and processing healthcare claims and other transactions.
In-Line Edits Payer ID	The in-line edits payer ID identifies the client and payer that represents a set of edits done from the NextGen In-line Edits engine. Note: The in-line edits payer ID supports 13 characters. The first 6 characters denote the client ID and the last 7 characters denote the payer ID. The in-line edits payer ID overrides the enterprise-level, practice-level, payer/system-level, payer/practice-level, and payer/practice/UB-level IDs.

Help Guide for NextGen® Enterprise PM 8

Create an Alternate Payer Carve-Out Criteria

In File maintenance, select Master Files > System > PM and then select Payers. The Payers List window opens. Double-click a payer. The Modify Payer Information window opens. Select the Alt Payer tab. To create an alternate payer carve-out criteria, select open menu and then select New. The Add Alt Payer Carve Out Criteria window opens. In the Alt Payer Criteria section, do the following: Select an alternate payer from the list. You can also create a new alternate payer by selecting the open menu in the Alt Payer Criteria section. Select the effective and expiration date. Enter the description for the alternate payer carve-out criteria. Note: The alternate payer carve-out criteria details are practice specific. Select the required location. Note: When you select a location, the fields in the Billing Provider Information section are enabled. To enter the SIM range, select open menu and then select New. The Alt Payer Number SIM Range window opens. Enter the SIM range. Select the Populate

File Maintenance Help for NextGen® Enterprise 8

Additional Billing Provider Information

The following table provides additional information on billing providers for an alternate payer. Field Description Taxonomy Code The taxonomy code you select on the Alt Payer Carve Out Criteria window overrides the taxonomy code you selected in the Groups master file. Provider Number This is the facility location provider number. National Provider ID This setting overrides the group-level NPI for alternate payer claims. If this field is blank, then the group NPI is used. Note: NPI is a standard unique identifier for health care providers and is used in filing and processing healthcare claims and other transactions. In-Line Edits Payer ID The in-line edits payer ID identifies the client and payer that represents a set of edits done from the NextGen In-line Edits engine. Note: The in-line edits payer ID supports 13 characters. The first 6 characters denote the client ID and the last 7 characters denote the payer ID. The in-line edits payer ID overrides the enterprise-level, practice-leve

File Maintenance Help for NextGen® Enterprise 8

Alternate Payer Configuration Report Columns

You can choose the following columns to appear on the Alt Payer Configuration report. Column Description Data Populates From Payer Name The name of the payer. Payer Name field on the Payer Defaults-1 tab. Alt Payer Name The name of the alternate payer. Alt Payer field on the Alt Payer Carve Out Criteria window Eff Date The effective date of the alternate payer. Eff Date field on the Alt Payer Carve Out Criteria window Exp Date The expiration date of the alternate payer. Exp Date field on the Alt Payer Carve Out Criteria window Desc The description of the alternate payer carve-out criteria. Description field on the Alt Payer Carve Out Criteria window Locations The valid service locations for the alternate payer. Valid Locations field on the Alt Payer Carve Out Criteria window SIM Ranges The service code ranges for the alternate payer. SIM Ranges section on the Alt Payer Carve Out Criteria window Diag Ranges The diagnosis code ranges for the alternate payer. ICD Ranges section on the Alt

File Maintenance Help for NextGen® Enterprise 8

Create an Alternate Payer Carve-Out Criteria

In File maintenance, select Master Files > System > PM and then select Payers. The Payers List window opens. Double-click a payer. The Modify Payer Information window opens. Select the Alt Payer tab. To create an alternate payer carve-out criteria, select open menu and then select New. The Add Alt Payer Carve Out Criteria window opens. In the Alt Payer Criteria section, do the following: Select an alternate payer from the list. You can also create a new alternate payer by selecting the open menu in the Alt Payer Criteria section. Select the effective and expiration date. Enter the description for the alternate payer carve-out criteria. Note: The alternate payer carve-out criteria details are practice specific. Select the required location. Note: When you select a location, the fields in the Billing Provider Information section are enabled. To enter the SIM range, select open menu and then select New. The Alt Payer Number SIM Range window opens. Enter the SIM range. Select the Populate

Help Guide for NextGen® Enterprise PM 8

Setting Up Claims

Before you can generate claims, you must set up options to define the following: The type of information you want to display in the various claim form fields The way you want the claim forms to print The location, payer, and provider information for a valid claim creation Specialty Billing For more information about the setup and functionality of the types of billing based on speciality, go toNextGen Healthcare Success Communityand download the following user guides: Anesthesia Billing User Guide forNextGen® Enterprise PM Behavioral Health Billing User Guide forNextGen® Enterprise PM Community Health Centers User Guide forNextGen® Enterprise PM Community Health Centers include the following types of billing: Encounter Rate Billing Roll-Up Billing Dental Billing Claim Printing Library The Claim Printing library enables you to specify options that define which information prints on claim forms. Claim Modifiers Library EDI Claim Profile Library The EDI Claim Profile library enables you to

File Maintenance Help for NextGen® Enterprise 8

Providers System Tab

On the System tab, you can add a provider or modify provider details using the following field descriptions. Field Description Provider Payers This field lists payers and payer numbers added to the provider. After you add a provider, you should add values in the Provider Payers list. Taxonomy Code This field displays a default taxonomy code to classify providers according to type or specialty. Specialty Code1/ Specialty Code2 This field displays the provider's specialty codes. You can modify specialties in the Specialties master file. Provider Subgrouping 1/ Provider Subgrouping 2 (User-defined fields) This field displays provider subgrouping category types that you can use as reporting filters. To modify the information, you can refer to the Provider Subgrouping 1 and Provider Subgrouping 2 fields on the General tab of the Enterprise Preferences window. Employer This field displays the provider's employer. The employers listed are maintained in the Employers master file. Primary Locat

Additional Billing Provider Information

Recommendations

Create an Alternate Payer Carve-Out Criteria

Additional Billing Provider Information

Alternate Payer Configuration Report Columns

Create an Alternate Payer Carve-Out Criteria

Setting Up Claims

Providers System Tab

Create an Alternate Payer Carve-Out Criteria

Additional Billing Provider Information

Alternate Payer Configuration Report Columns

Create an Alternate Payer Carve-Out Criteria

Setting Up Claims

Providers System Tab