Contract Defaults

Field	Contract Defaults - Contractor and Co-Pay Options Descriptions
Co-Payment on Office Encounters	To require a co-payment, select this check box. When you attach insurance to an encounter, an alert reminds you that the contract requires a co-pay for all encounters.
Default Co-Pay Amount	Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when you attach the insurance to the encounter, you will be given another warning.
Co-Pay Origin	Select either Allowed or Reimbursed to determine whether the co-pay percent will be multiplied by the allowed or the reimbursed amount. The Co-Pay Origin can be set to use either an allowed amount or a reimbursed amount to calculate a co-pay that is due. This option is used with the Co-Pay % that is set at the payer-level. In addition, the percentage co-pay will only be calculated for individual CPT4 codes designated on the Fee Schedule tab.
Deductible in Effect	If the contract requires a deductible amount, select this check box. When entering insurance information for the patient, an alert warns you that a deductible is required.
Multiply Fee Schedule Co-Pay by Quantity	Select this check box so that the fee schedule co-pay multiplies by the charge line item quantity. For example, if based on the fee schedule, there is a $100 charge where $50 is allowed, 80% (or $40) is reimbursed for participating, and the copay is 20% (or $10). When you enter that charge with a quantity of 5, the amount for the one-time 20% copay is multiplied by 5. The result is $10 x 5 = $50.
Apply Co-Pay to First Line Item (default)	Select this check box to apply a co-pay to the first charge line item only. The co-pay amount pulls from the contract's Fee Schedule tab, if set up. Otherwise, the co-pay amount pulls from Insurance Maintenance.
Apply Co-Pay to All Line Items	Select this check box to apply a co-pay to all charge line items, including those that are not listed on the contract's Fee Schedule tab. The co-pay amount pulls from the Fee Schedule tab, if set up. Otherwise, the co-pay amount pulls from Insurance Maintenance.
Apply Co-Pay to All Line Items in the Fee Schedule	Select this check box to apply a co-pay to all charge line items that are listed on the contract's Fee Schedule tab that have an entry in the Co-Pay Amount field and a green check mark. Otherwise, a co-pay amount is not applied.
Contract Subgrouping 1 & 2	Select the contract subgroup that indicates what kind of contract this is. Note: The field names you see may be different because they come from the names entered in the Contract Subgrouping fields on the General tab under the Enterprise Preferences.
Note	Enter any additional information about the contract library. This note is visible only within the current library.

Help Guide for NextGen® Enterprise PM 8

Automatic Adjustments

The Automatic Adjustments section enables you to automatically adjust charges to the expected allowed amount at the time they are entered. This section is used in conjunction with the Fee Schedule tab. Field Automatic Adjustments Descriptions Automatically adjust charges Select this check box so that adjustments are automatically made for the items at the time charges are entered on the Charge Posting window. This check box enables the remaining fields in the section. Adjustable Allowed Amount Select this check box to determine the write off (auto adjustment) based on the patient co-pay plus the contract reimbursement amount. If you select this option, the Co-Pay Origin field changes to Reimbursed and, on the Fee Schedule tab, the Allowed column becomes disabled. Default Auto-Adj Transaction Select the transaction code to associate with the automatic transactions. Note: The codes listed are set up in the Transaction Codes master file as an Adjustment type and have the source as Third p

Help Guide for NextGen® Enterprise PM 8

Allowed and FFS/Balance Distribution

Field Allowed and FFS/Balance Distribution Descriptions Fee for Service Enter the percentage of the full fee that you expect to get for participating and non-participating physicians. % of Allowed Amount for Participants Enter the percentage of the allowed amount a participating provider expects to be reimbursed. A provider is a participant when the contract is selected for it in the Providers master file. % of Allowed Amount for Non-Participants Enter the percentage of the allowed amount a non-participating provider expects to be reimbursed. Prorate Insurance Balance If this option is selected and it is also selected on Other tab (of Practice in the Add/Modify Payer Information window) then: The patient's charges will be prorated between the Primary Insurance and the Secondary or Patient bucket. The proration is based on the Fee for Service percentages. The prorated balances can be viewed in the patient's Balance Control window. Note: If you prorate the patient's charges, you can get

File Maintenance Help for NextGen® Enterprise 8

Contract Defaults

The Contract Defaults section contains options that enable you to set informational alerts, information about co-payments, co-pay amounts, and a default percentage for expected reimbursement, among other options. Field Contract Defaults - Contractor and Co-Pay Options Descriptions Co-Payment on Office Encounters To require a co-payment, select this check box. When you attach insurance to an encounter, an alert reminds you that the contract requires a co-pay for all encounters. Default Co-Pay Amount Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when you attach the insurance to the encounter, you will be given another warning. Co-Pay Origin Select either Allowed or Reimbursed to determine whether the co-pay perce

Help Guide for NextGen® Enterprise PM 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

File Maintenance Help for NextGen® Enterprise 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

File Maintenance Help for NextGen® Enterprise 8

Automatic Adjustments

The Automatic Adjustments section enables you to automatically adjust charges to the expected allowed amount at the time they are entered. This section is used in conjunction with the Fee Schedule tab. Field Automatic Adjustments Descriptions Automatically adjust charges Select this check box so that adjustments are automatically made for the items at the time charges are entered on the Charge Posting window. This check box enables the remaining fields in the section. Adjustable Allowed Amount Select this check box to determine the write off (auto adjustment) based on the patient co-pay plus the contract reimbursement amount. If you select this option, the Co-Pay Origin field changes to Reimbursed and, on the Fee Schedule tab, the Allowed column becomes disabled. Default Auto-Adj Transaction Select the transaction code to associate with the automatic transactions. Note: The codes listed are set up in the Transaction Codes master file as an Adjustment type and have the source as Third p

Contract Defaults

Recommendations

Automatic Adjustments

Allowed and FFS/Balance Distribution

Contract Defaults

Set Up a Fee Schedule for Contract Payers

Set Up a Fee Schedule for Contract Payers

Automatic Adjustments

Automatic Adjustments

Allowed and FFS/Balance Distribution

Contract Defaults

Set Up a Fee Schedule for Contract Payers

Set Up a Fee Schedule for Contract Payers

Automatic Adjustments