Charge Options Field Descriptions

Field	Description
Disable Variance Calculation	This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings.
Insert SIM with Variance Amount on Roll-up Charges Service Item #	Select the SIM code to be added to encounters as an additional charge during the billing process when there is a “variance” in units for timed behavioral health charges that roll-up. This is a required entry. Note: The SIM code must first be created in the SIM Library with a $0.00 price.
Variance Calculation When Secondary	Select one of the following options for calculating the variance charge amount when billing the secondary payer on the encounter: Note: This setting applies when the primary payer on the encounter is not using a Behavioral Health Billing Library and therefore a variance charge was not already added to the encounter when the primary payer was billed. Sum of roll-up less prior payer transactions (default): Select this option to calculate a variance charge amount for the secondary payer that is based on the sum of the roll-up charges minus any payment/adjustment transaction amounts already posted from the primary payer. Sum of roll-up: Select this option to calculate a variance charge amount for the secondary payer that is based on the sum of the roll-up charges.
Variance Calculation When Tertiary	Select one of the following options for calculating the variance charge amount when billing the tertiary payer on the encounter: Note: This setting applies when the primary and secondary payers on the encounter are not using a Behavioral Health Billing Library and therefore a variance charge was not already added to the encounter when the primary/secondary payers were billed. Sum of roll-up less prior payer transactions (default): Select this option to calculate a variance charge amount for the tertiary payer that is based on the sum of the roll-up charges minus any payment/adjustment transaction amounts already posted from the primary and secondary payers. Sum of roll-up: Select this option to calculate a variance charge amount for the tertiary payer that is based on the sum of the roll-up charges.
Adjustment Transaction Code for Variance	Select the third-party adjustment transaction code to be used with negative variance charges. This field is required. Note: The adjustment transaction code must have the Allow sign over ride check box selected. The code will be used as a Negative to reduce the balance on the original charges and used as a Positive to reverse the amount of the negative variance charge.

File Maintenance Help for NextGen® Enterprise 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

Help Guide for NextGen® Enterprise PM 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

File Maintenance Help for NextGen® Enterprise 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

File Maintenance Help for NextGen® Enterprise 8

Columns in Behavioral Health Billing Library Report

The Behavioral Health Billing Library report includes information from the Behavioral Health Billing library in File Maintenance. Information on the report pulls from the Behavioral Health Billing Library Maintenance window. The report includes the following information: Column Description Data Populates From Library Description Library Description Behavioral Health Billing Library field Variance SIM Variance SIM Charge Options tab > Variance SIM section > Service Item # field Variance SIM Desc Variance SIM Description Charge Options tab > Variance SIM section > Description field Variance Calc Secondary Variance Calculation when Secondary Charge Options tab > Variance Calculations section > Variance Calculation When Secondary field Variance Calc Tertiary Variance Calculation when Tertiary Charge Options tab > Variance Calculations section > Variance Calculation When Tertiary field Variance Adj Trans Code Variance Adjustment Transaction Code Charge Options tab > Variance Adjustment sect

Help Guide for NextGen® Enterprise PM 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

File Maintenance Help for NextGen® Enterprise 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

Charge Options Field Descriptions

Recommendations

Charge Options Field Descriptions

Set Up Charge Options

Set Up Charge Options

Columns in Behavioral Health Billing Library Report

Claim Options Field Descriptions

Claim Options Field Descriptions

Charge Options Field Descriptions

Set Up Charge Options

Set Up Charge Options

Columns in Behavioral Health Billing Library Report

Claim Options Field Descriptions

Claim Options Field Descriptions