Claim Modifiers Library

File Maintenance Help for NextGen® Enterprise 8

Claim Modifiers Library

The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl

Help Guide for NextGen® Enterprise PM 8

Add or Modify a Claim Modifiers Library

Access File Maintenance. Select Libraries, and then Claims Modifiers. The Claims Modifiers List window opens. To add a claim modifier, select the open menu button, and then select New. The Add Claim Modifiers window opens. Enter a value in the Claim Modifiers Library field. Select the open menu button and then select New. The Add/Modify Claim Modifiers window opens. Enter the desired values in the mandatory fields and then select OK. Note: You must select a value for Modifier Charge for Claims, otherwise the modifier will not get added. The new claim modifier appears in the Claim Modifiers area of the Add Claim Modifiers window. In the SIM Exception Mode section, select one of the following: None (default): Select this button if the criteria defined for the modifier applies to all SIM codes. Include: Select this button if the criteria defined for the modifier applies to specific SIM codes only. Exclude: Select this button if the criteria defined for the modifier applies to all SIM code

File Maintenance Help for NextGen® Enterprise 8

Add or Modify a Claim Modifiers Library

Access File Maintenance. Select Libraries, and then Claims Modifiers. The Claims Modifiers List window opens. To add a claim modifier, select the open menu button, and then select New. The Add Claim Modifiers window opens. Enter a value in the Claim Modifiers Library field. Select the open menu button and then select New. The Add/Modify Claim Modifiers window opens. Enter the desired values in the mandatory fields and then select OK. Note: You must select a value for Modifier Charge for Claims, otherwise the modifier will not get added. The new claim modifier appears in the Claim Modifiers area of the Add Claim Modifiers window. In the SIM Exception Mode section, select one of the following: None (default): Select this button if the criteria defined for the modifier applies to all SIM codes. Include: Select this button if the criteria defined for the modifier applies to specific SIM codes only. Exclude: Select this button if the criteria defined for the modifier applies to all SIM code

Help Guide for NextGen® Enterprise PM 8

Select a Default Claim Modifiers Library

A Claim Modifiers library can be selected at the practice-level to be used for all payers, or at the payer-level to be used for specific payers only. A payer-level library overrides the default practice-level library for that payer. To select a default library for a practice, do the following: Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. In the Preferences List, select Libraries. In the Claim Modifiers Library field, select the default library to be used for the practice. To save changes and close the window, select OK. To select a default library for a payer, Access File Maintenance Select System Master Files, then PM, and then Payers. The Payer List window opens. From the list, double-click to open a payer. The Modify Payer Information window opens. Select the Practice tab, and then the Libraries sub-tab. In the Modifiers Library field, select the Claim Modifiers library to be used for the payer. To

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Anesthesia Billing

Use the following procedure to set up a claim modifier for Anesthesia SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character anesthesia modifier. This field is required and cannot be modified after the modifier is saved. For example: P1 - Normal healthy patient P2 - Patient with mild systemic disease P3 - Patient with severe systemic disease P4 - Patient with severe systemic disease that is a constant threat to life P5 - Patient who is not expected to survive without the procedure P6 - Declared brain-dead patient whose organs are being removed for donor purposes In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Modifiers for Anesthesia Billing

Use the following procedure to set up a claim modifier for Anesthesia SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character anesthesia modifier. This field is required and cannot be modified after the modifier is saved. For example: P1 - Normal healthy patient P2 - Patient with mild systemic disease P3 - Patient with severe systemic disease P4 - Patient with severe systemic disease that is a constant threat to life P5 - Patient who is not expected to survive without the procedure P6 - Declared brain-dead patient whose organs are being removed for donor purposes In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier

Claim Modifiers Library

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