Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Enterprise-Level Co-Pay

The enterprise level co-pay amount is the patient’s co-pay if a zero ($0.00) or positive amount ($30.00) is found in the Co-Pay Type column on the Insurance Maintenance window. The defined amount will be the patient’s co-pay for all encounters and practices. If the enterprise-level Co-Pay Type is blank and no co-pay is applied to any encounter. This is the last step in the hierarchy to derive the co-pay amount. Note: The enterprise-level Co-Pay Type field on the Insurance Maintenance window is available only if the Enable practice payer specific information option is not selected in Practice Preferences > Chart. This allows all practices to use the same co-pay amount for the same patient or insurance. When all practices are the same type of specialty. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Contract Exception Co-Pay

If zero ($0.00) or a positive amount is found for the CPT4 code in the Co-Pay Amount column on the Contract Exception Maintenance window, the defined amount will be the patient’s co-pay for that service. If there is zero amount for the CPT4 code, the system continues with the next step in the hierarchy to derive the co-pay amount. Note: The contract must be linked to the primary insurance on the encounter in the Managed Care Contract field on the Practice > Libraries sub-tab of the Payers master file. The contract exception must be linked to the rendering provider in the Service Location > Group Information > Payer > Contract Exception field on the Practice tab of the Providers master file. The providers must be selected in the Participating Providers field below the Contract field or the contract is not used for those providers. The contract exception Co-Pay Amount is applied to a charge only if the rendering, location, and payer on the charge matches the rendering, location, payer, a

Help Guide for NextGen® Enterprise PM 8

Encounter-Level Co-Pay

If a zero ($0.00) or positive amount ($20.00) is found in the Enc Co-payment field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for that encounter only. If the Enc Co-payment field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Enc Co-Payment field on the Insurance Maintenance window is available only if the Enable encounter payer copay option is selected in Practice Preferences > Chart. This allows an encounter level co-pay amount to be entered that overrides the practice level co-pay amount for all other encounters. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Insurance Override Co-Pay

If a zero ($0.00) or positive amount is found in the Co-Pay for Patient field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for all encounters. If the Co-Pay for Patient field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Co-Pay for Patient override field on the Insurance Maintenance window is available only if the Display override policy number and co-pay option is selected on the Defaults-2 tab of the Payers master file. This allows a patient level co-pay amount to be entered that overrides the subscriber/policy holder level co-pay amount. The policy holder parent may have a co-pay amount that is different from a dependent child that is covered under the policy. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Practice-Level Co-Pay

The practice level co-pay amount is the patient’s co-pay for all encounters if a zero ($0.00) or positive amount ($15.00) is found in the Practice Level co-pay amount fields on the Insurance Maintenance window. If the Practice Level co-pay amount fields are blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Practice Level Co-Pay Amount field on the Insurance Maintenance window is available only if the Enable practice payer specific information option is selected in Practice Preferences > Chart. This allows each practice to define a different co-pay amount for the same patient or insurance. Family practice co-pay amount may be different from the specialty practice co-pay amount. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Contract Co-Pay

If both a green check and a zero ($0.00) or positive amount are found for the CPT4 code in the Apply Co-Pay Amount column on the Fee Schedule tab of the Contract Library Maintenance window, the defined amount will be the patient’s co-pay for that service. If no green check is found for the CPT4 code, no patient co-pay will be applied for that service. If a green check is found with a blank Apply Co-Pay Amount for the CPT4 code, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The contract Apply Co-Pay Amount will be applied to a charge only if the contract is linked to the primary insurance on the encounter in the Managed Care Contract field on the Practice > Libraries sub-tab of the Payers master file and only for the providers checked in the Participating Provider field. Parent topic: Co-Pay Amount Hierarchy

Co-Pay Amount Hierarchy

Recommendations

Enterprise-Level Co-Pay

Contract Exception Co-Pay

Encounter-Level Co-Pay

Insurance Override Co-Pay

Practice-Level Co-Pay

Contract Co-Pay

Enterprise-Level Co-Pay

Contract Exception Co-Pay

Encounter-Level Co-Pay

Insurance Override Co-Pay

Practice-Level Co-Pay

Contract Co-Pay