Alternate Payers

Help Guide for NextGen® Enterprise PM 8

Payers Master File

Payers are the third-party entities, other than guarantors or employers, that you expect to receive reimbursement from. Some examples of payers are commercial insurance companies, Medicaid, and Medicare. In the Payers master file, you can specify the contract associated with the payer, the participating providers, how to submit claims, and other general payer information. You can generate Payers Master File reports from the Payers master file. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Auditing Payers Master File Add or Modify a Payer Payer Defaults - 1 Tab Defaults - 2 Tab System Tab Practice Tab Configuring Alternate Payers You an use the Alternate Payer Simultaneous Billing feature to associate an alternate payer to a payer. External Tab for Payer Information Co-Pays Tab Changing the Payer Address and Associated Patient Records Activate and Assign a Payer to a Practice You can limit a practi

File Maintenance Help for NextGen® Enterprise 8

Alternate Payers

The Payers-Alt Payers master file allows you to create an alternate payer and associate the alternate payer to a payer in the Payers master file. You can associate the same alternate payer to multiple payers or associate multiple alternate payers to a payer. When you bill an encounter with a payer having alternate payers, separate claims can be generated simultaneously. For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. You can also hide or show an alternate payer by selecting open menu and then selecting Hide or Un-hide. You can generate Alternate Payer Listing report from the Payers-Alt Payers master file. For more information, go to Ne

Help Guide for NextGen® Enterprise PM 8

Configuring Alternate Payers

The Alternate Payer Simultaneous Billing feature enables you to associate an alternate payer to a payer set up in the Payers master file. When you bill an encounter with a payer having multiple alternate payers, separate claims are generated simultaneously. The Alt Payer tab lists the alternate payer configurations for a payer. You can use the Alternate Payer Simultaneous Billing feature when the charges for an encounter should be billed to different payers (payer carve-out), usually on a different claim form type (1500 and UB). For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. Note: When you use the Alternate Payer Simultaneous Billing

File Maintenance Help for NextGen® Enterprise 8

Configuring Alternate Payers

The Alternate Payer Simultaneous Billing feature enables you to associate an alternate payer to a payer set up in the Payers master file. When you bill an encounter with a payer having multiple alternate payers, separate claims are generated simultaneously. The Alt Payer tab lists the alternate payer configurations for a payer. You can use the Alternate Payer Simultaneous Billing feature when the charges for an encounter should be billed to different payers (payer carve-out), usually on a different claim form type (1500 and UB). For example, you set up a payer to bill medical services such as an office visit (99213). Now, when you bill a behavioral health service for substance abuse therapy, the claim may go to a trading partner where the diagnosis is F11.10. But when the same substance abuse therapy is rendered for a patient with a mental health disorder, such as depression, the claim goes to the Department of Mental Health. Note: When you use the Alternate Payer Simultaneous Billing

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

Help Guide for NextGen® Enterprise PM 8

Add an Alternate Payer

In File Maintenance, select Master Files > System > PM, and then select Payers-Alt Payers. The Payers-Alt Payers List window opens. To add an alternate payer, select open menu and then select New. The Add Alt Payer Information window opens. In the Alt Payer Details section, do the following: Enter the alternate payer name. Enter the NEIC/Payer Number, if applicable. You can enter the number for a specific clearing house and/or a specific payer. Enter the alternate payer alias name, if applicable. Enter the in-line edits payer ID, if applicable. Note: You must have a NextGen® In-Line Edits license to use this option. Note: The alternate payer details are system specific. In the Main Address section, enter the address of the alternate payer. To define the billing options for an alternate payer, do the following on the Alt Payer Billing Option tab: Select the applicable values for the fields in the Libraries section. In the Claim Details section, select the applicable media type (electron

Alternate Payers

Recommendations

Payers Master File

Alternate Payers

Configuring Alternate Payers

Configuring Alternate Payers

Setting Up Claims

Add an Alternate Payer