Attach CPT4 Codes to Field Locator 51

File Maintenance Help for NextGen® Enterprise 8

Set Up CPT4 Codes at the Provider Master Level

To set up CPT4 codes at the provider master level: From the Master Files > System list, select Providers. Select the appropriate provider. Select the Practice tab. Select the drop-down arrow in the ServiceLocation field and select the location where the service is performed. A list of payers displays in the Group Information section. Under Group information, double-click the payer to which you want to add CPT4 codes. The Modify Provider Practice Payer window displays. Select the Open Record button next to the CPT4 Provider Nbrs field. The Valid Provider Numbers for [Payer Name] window displays. Select the Open Menu button and select New. Note: You can open and delete existing records. You can edit existing provider numbers, but you cannot edit the CPT4 code range. The Provider Number for CPT4 Range window displays. In the CPT4 field, enter the CPT4 code at the beginning of the range you want to set up. Use the to display the CPT4 Code Search window to search for a CPT4 code by code or

File Maintenance Help for NextGen® Enterprise 8

Attach a Taxonomy Code for the Provider at the Practice Level

To attach a taxonomy code for the provider at the practice level: From the Master Files list, select System or PM > Providers. Select the provider. Select the Practice tab. Select the Rendering provider at this practice check box. Select a service location from the Service Location field, and then double-click on the applicable payer listed under Group Information. If you select the default location and a specific payer, then the code applies for this payer at all locations. If you select a specific location and the default payer, then the row applies for all payers at that location. If you select a specific location and specific payer, then the code applies only to this payer at this location. The Modify Provider Practice Payer window displays. Select the taxonomy code from the Taxonomy Code field. If you want to set taxonomy codes for specific procedure ranges, select the CPT4 Provider Nbrs button. The Valid Provider Numbers for [Payer Name] window displays. Select the Open Menu butt

File Maintenance Help for NextGen® Enterprise 8

Attaching Taxonomy Codes to Groups

From the Master Files list, select Practice > Groups. Select the group. If you want to select a default taxonomy code for the group, select a code from the Taxonomy Code field. A taxonomy code added to the default location with a specific payer row applies only for that payer across all locations. The code overrides the taxonomy code at the top of the group screen for that payer. If you want to select a taxonomy code for the group at the location level: Select a service location. Then double-click a payer name in the Payer column. And then select the code from the Taxonomy Code field. A taxonomy code added to the default payer row at a specific location applies for all payers at that location. The code can also be payer-specific at a specific location. The most specific setting is always selected above the other settings. If you want to set taxonomy codes for specific procedure ranges, select the CPT4 Group Information button. The CPT4 Group Information for [Group Name] window displays

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Add CPT4 Code Information Parent topic: Setting Up Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code requires specific settings in the Payers master file. Each payer that is to roll-up to a single CPT4 code line on the claim must have the CPT on Rev Code Roll-up option selected so that the CPT4 code appears in Field Locator 44 on UB claims. Also, the Ignore modifiers on roll-up option must be selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Do one of the following: To add a payer, select Open Menu and select New. To modify a payer, select the payer from the list, and then select Open Menu and select Open. The Add/Modify Payer Information window opens. Select the Defaults-2 tab. Select the CPT on Rev Code Roll-up check box. Add Payer Information Select the Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. To

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Enhanced UB Users

In File Maintenance, select Master Files - System > Payers. Right-click the applicable payer and then select Open. The Modify Payer Information window appears. Select the Practice tab and then the UB tab. Modify Payer Information In the Location field, select the practice location, if applicable. This enables all the fields and check boxes on the tab. The location that you select must be the same as the location that is selected on the Create Encounter or Encounter Maintenance window. Enter the applicable information in the Field Locator fields and enable the check boxes to display the information on the UB claim. The following conditions must be met for Enhanced UB users that want to use the automated UB billing process: Field Locator 51 must be populated. The Type of Facility field must be equal to 7 (Clinic). The Bill Classification field must be equal to 4 (Outpatient Rehab Facility). The Bill Frequency field must be blank. Select OK. Parent topic: Setting Up UB Claims for Enhanced

Attach CPT4 Codes to Field Locator 51

Recommendations

Set Up CPT4 Codes at the Provider Master Level

Attach a Taxonomy Code for the Provider at the Practice Level

Attaching Taxonomy Codes to Groups

Set Up CPT4 Codes for Roll-Up Billing

Set Up Payers for Roll-Up Billing by CPT4 Code

Set Up Payers for Enhanced UB Users

Set Up CPT4 Codes at the Provider Master Level

Attach a Taxonomy Code for the Provider at the Practice Level

Attaching Taxonomy Codes to Groups

Set Up CPT4 Codes for Roll-Up Billing

Set Up Payers for Roll-Up Billing by CPT4 Code

Set Up Payers for Enhanced UB Users