Allow Encounter Payers to Differ on a Case

Help Guide for NextGen® Enterprise PM 8

Require Case Management for a Payer

You can indicate that a payer requires case management in NextGen® Enterprise PM. The payer can then only be used on encounters that are part of a case. When case management is required, the following occurs: The Case Management Required field displays on the Patient Chart > Encounters tab > Case Management tab. If a user selects insurance for an encounter and a case is not attached to the encounter, then a warning alert displays when a user saves the encounter insurance. To generate a claim edit when the payer is attached and the encounter is not linked to a case, activate claim edit 217. In File Maintenance, select Master Files > System > Payers. Double-click a payer. The Modify Payer Information window opens. Select Practice tab > Other tab. Select Require Case Management, and then select OK. Select Require Case Management, and then select OK. If you want to generate a claim edit when the payer is attached but the encounter is not linked to a case, activate claim edit 217. Parent to

Help Guide for NextGen® Enterprise PM 8

View Alternate Payer Details for an Encounter

If an alternate payer is associated with an encounter insurance, then the alternate payer details appear in the Alternate Payer Details section. Open a patient chart. Select the Encounter tab and then select the Insurance sub-tab. In the Encounters list, select an encounter having an alternate payer associated with a payer. Select an encounter insurance in the Encounter Insurance section. The alternate payer details appear in the Alternate Payer Details section. Parent topic: Encounters in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

Enable Qualifying Encounter Billing

The Encounter Rate Billing functionality in NextGen® Enterprise PM includes logic that identifies multiple encounters for a patient on the same date of service at the same location with the same encounter rate payer. Qualifying Encounter Billing must be enabled for the practice. When enabled, the Encounter Rate Billing Status fields display on the Billing & Collections tab of the Encounter Maintenance window. These fields are used to determine which encounter to bill when a patient has multiple same-day encounters with more than one provider at the same location with the same encounter rate payer attached. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Parent topic: Practice Preferences for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Add Insurance Verification Information to an Encounter

You can enter additional information for an insurance linked to an encounter in the Patient Insurance - Encounter window. This applies to primary, secondary, and tertiary payers. Open NextGen® Enterprise PM. On the main toolbar, select Chart or Chart Lookup.. The Patient Lookup window opens. In the Search Criteria section, enter the patient's information, and select Find. Patient records that match the search criteria, appear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select the Encounters tab. From the Encounters list, select an encounter with a payer attached. Select the Insurance tab. In the Encounter Insurance section, select the payer. In the Verification section, select open record . The Patient Insurance - Encounter window opens. Patient Insurance Encounter Window Make the desired changes, and select OK. Parent topic: Viewing Insurance Information in Encounters

Help Guide for NextGen® Enterprise PM 8

Create an Encounter from an Appointment

Create an Encounter from an Appointment Create an Encounter from an Appointment If a patient has appointment and services performed by a provider in the practice, you must create an encounter from the appointment during the check-in process. Open NextGen® Enterprise PM. From Appointment Book, select the appointment. Right-click an appointment and select Checkin/Create Encounter. The Add Patient Information window opens. If the patient does not have a chart, update necessary information in the Add Patient Information window, and then select Chart to create the patient's chart. The Create Encounter window opens. Select a program for the encounter. Enter all the mandatory information marked in red to complete the patient's encounter. Note: In Practice Preferences > Case Management, if the Allow encounter payers to differ when case is attached preference is selected, you can link a case to an appointment even if the insurance on the appointment differs from the insurance on the case. Note:

Help Guide for NextGen® Enterprise PM 8

Set Up Enterprise Preferences for Encounter Rate Billing

You must enable encounter rate billing for the enterprise. When enabled, further setup can be completed for practices within the enterprise that use encounter rate billing functionality. This also enables an Encounter Rate Billing library to be attached to the appropriate payers later in the setup. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Enterprise. The Enterprise Preferences window appears. Select the General tab. Select the Encounter rate billing check box. Enterprise Preferences To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Allow Encounter Payers to Differ on a Case

Recommendations

Require Case Management for a Payer

View Alternate Payer Details for an Encounter

Enable Qualifying Encounter Billing

Add Insurance Verification Information to an Encounter

Create an Encounter from an Appointment

Set Up Enterprise Preferences for Encounter Rate Billing

Require Case Management for a Payer

View Alternate Payer Details for an Encounter

Enable Qualifying Encounter Billing

Add Insurance Verification Information to an Encounter

Create an Encounter from an Appointment

Set Up Enterprise Preferences for Encounter Rate Billing