Contract Automatic Adjustment
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Help Guide for NextGen® Enterprise PM 8
Charge Posting Window
The alerts message shows a $50.00 automatic adjustment, which is the difference between the charge amount and the allowed amount specified in the contract for this CPT4 code. Select . The Charge Posting window opens with the automatic adjustment. Parent topic: Example of an Auto Adjustment for a Non-Participating Provider
Help Guide for NextGen® Enterprise PM 8
Example of an Auto Adjustment for a Non-Participating Provider
This example shows the contract set up to automatically adjust the charge to 70% for the primary insurance and 30% for the guarantor. Contract Automatic Adjustment Charge Posting Window Parent topic: Set Up Auto Charge Adjustments for Non-Participating Providers
Help Guide for NextGen® Enterprise PM 8
Set Up Auto Charge Adjustments for Non-Participating Providers
Before you begin For the Contract's auto-charge adjustment to work properly, you must populate the following fields on the General tab of the Contract Library Maintenance window: Add a value to the % of Allowed Amount for NonParticipants field Select the Automatically adjust charges check box The application enables you to set up auto-adjustments for non-participating providers based on the terms of their contract. When charges are entered, they are adjusted according to the terms of the contract for the non-participating providers. In File Maintenance, access the Payers Master File. The Payer List window appears. Select the open menu button and select New to set up a new payer or select Open to modify an existing payer. The Add/Modify Payer Information window appears. Select the Practice tab and then select the Libraries tab. Select the drop-down arrow in the Managed Care Contract field and select the contract that meets the contract terms of the payer. When you select a contract, the
File Maintenance Help for NextGen® Enterprise 8
Set Up Auto Charge Adjustments for Non-Participating Providers
Before you begin For the Contract's auto-charge adjustment to work properly, you must populate the following fields on the General tab of the Contract Library Maintenance window: Add a value to the % of Allowed Amount for NonParticipants field Select the Automatically adjust charges check box The application enables you to set up auto-adjustments for non-participating providers based on the terms of their contract. When charges are entered, they are adjusted according to the terms of the contract for the non-participating providers. In File Maintenance, access the Payers Master File. The Payer List window appears. Select the open menu button and select New to set up a new payer or select Open to modify an existing payer. The Add/Modify Payer Information window appears. Select the Practice tab and then select the Libraries tab. Select the drop-down arrow in the Managed Care Contract field and select the contract that meets the contract terms of the payer. When you select a contract, the
Help Guide for NextGen® Enterprise PM 8
Contract Automatic Adjustment
When you enter a charge for SIM code with a price for a patient and primary insurance, the contract linked to the insurance specifies that the allowed amount is for the CPT4 code. You can create an automatic adjustment when the Automatically adjust charges option is enabled for the contract. Charge Amount - Allowed Amount = Adjustment Amount The automatic adjustment displays in the Adjustment column in the charge ledger section of the Charge Posting window. You can view the summary information for the adjustment transaction on the Transactions sub-tab of the Patient Chart > Encounters tab. You can view the transaction details on the Payment Entry window. Parent topic: Automatic Adjustments Overview
Help Guide for NextGen® Enterprise PM 8
Automatic Adjustments Overview
You can apply automatic adjustments at the time of charge posting to adjust the difference between the charge amount for a procedure and the allowed amount for the payer. Charge Amount - Allowed Amount = Adjustment Amount When you enter and save a charge on the Charge Posting window, the Contract can be linked to the payer (insurance) on the charge. If there is a contract linked to the payer, the CPT4 code for the charge is included in the Fee Schedule set up within the contract and the Automatically adjust charges option is enabled in the setup of the contract, then the automatic adjustment is applied to the charge. Automatic Adjustments - Additional Information You can use some additional information while working with automatic adjustments. Contract Automatic Adjustment Contract Adjustments on Charges with Calculated Amounts Reversing Automatic Adjustments You can reverse automatic adjustments on the Reverse Automatic Adjustments window. Reverse and Correct Auto-Adjustments after a
