Claim Options Field Descriptions

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 will be created for the encounter, each with 1 line item.
Secondary Claims Roll-up lines view	Select one of the following billing options for the roll-up charge amount on secondary claims: Sum of roll-up less prior payer transactions (default): Select this option to send the charge amount on claims for the secondary payer as 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 send the charge amount on claims for the secondary payer as the sum of the roll-up charges.
Secondary Claims Always bill as primary when prior payer is	Select Open Folder to select one or more payers, if applicable. If one of the selected payers is primary on the encounter, the claim for the secondary payer will appear as if it’s a primary claim.
Tertiary Claims Roll-up lines view	Select one of the following billing options for the roll-up charge amount on tertiary claims: Sum of roll-up less prior payer transactions (default): Select this option to send the charge amount on claims for the tertiary payer as 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 send the charge amount on claims for the tertiary payer as the sum of the roll-up charges.
Tertiary Claims Always bill as primary when prior payer is	Select Open Folder to select one or more payers, if applicable. If one of the selected payers is secondary on the encounter, the claim for the tertiary payer will appear as if it’s a primary claim.

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. 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 Claim Options tab. Behavioral Health Billing Library Maintenance window; Claim Options tab Complete the fields to set up Claim Options. For more information on each field, see Claim Options Field Descriptions. To save changes and close the window, select OK. Claim

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

Help Guide for NextGen® Enterprise PM 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

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

Do Not Sum Units for CPT4 Code

With Behavioral Health Billing, multiple charges on a single encounter that have the same CPT4 code, the same modifier(s), the same base minutes and the same unit price will roll-up (bundle) to a single line item on claims. The total units on the claim is calculated using the total time entered on all roll-up charges. The amount on the claim for the roll-up line item is calculated using the total units multiplied by the base price in the SIM Library. Do Not Sum Units for CPT4 Code is an option that will prevent multiple charges on an encounter with the same CPT4 code and modifiers from rolling-up (bundling) to a single line item on claims. The option is available at the Practice level, the Payer level, and the CPT4/Payer level. Note: This option should only be enabled if charge bundling should not occur for a Practice, a specific Payer, or a specific CPT4/payer combination. Practice Preferences > Claims: Select this check box to prevent multiple charges with the same CPT4 code and modi

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

Claim Options Field Descriptions

Recommendations

Set Up Claim Options

Claim Options Field Descriptions

Charge Options Field Descriptions

Charge Options Field Descriptions

Do Not Sum Units for CPT4 Code

Columns in Behavioral Health Billing Library Report

Set Up Claim Options

Claim Options Field Descriptions

Charge Options Field Descriptions

Charge Options Field Descriptions

Do Not Sum Units for CPT4 Code

Columns in Behavioral Health Billing Library Report