Contracts Library

File Maintenance Help for NextGen® Enterprise 8

Contracts Library

Contracts can be set up for payers to indicate: The amount you expect to be reimbursed for procedures. When an authorization is required. When a referral is required. Other contract specific items, for example, the ability to send $0.00 claims such as capitated with contracts, you can: Attach payers to the contract. Create contract subgroupings for reporting purposes. For more information on contract subgrouping, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide for NextGen® Enterprise, and refer to the Contract Subgrouping section. Access Contract Library Maintenance Setup an Exception Through the Contract Library

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

Help Guide for NextGen® Enterprise PM 8

Access Contract Library Maintenance

Access the Contract Library Maintenance window, to create contract defaults, such as co-payments, deductibles, and physician referrals and authorizations. In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Double-click the applicable library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Parent topic: Contracts Library

File Maintenance Help for NextGen® Enterprise 8

Access Contract Library Maintenance

Access the Contract Library Maintenance window, to create contract defaults, such as co-payments, deductibles, and physician referrals and authorizations. In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Double-click the applicable library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Activate and Assign a Payer to a Practice You can limit a practice's access to certain Payers master files. Add or Modify a Contract Set Up a Fee Schedule for Contract Payers Modifier Reimbursement Tab Multiple Procedure Discounting Tab Payer/Provider Tab Contract Exceptions Parent topic: Contracts Library

File Maintenance Help for NextGen® Enterprise 8

Define Contract Subgrouping Categories

Contract subgrouping categories represent different types of contracts, such as Capitated, Government, Non-government, and Medicare. For example, you could create a subgrouping named Medicare for all the Medicare contracts that are set up in your contract library. After you create the subgrouping categories, they display as selections in the Provider master file and the Contract library (on the Practice tab of the Add/Modify Provider Information window and on the General tab of Contract Library Maintenance window) where you can attach the contracts to providers and contract libraries. On the File Maintenance desktop, select Master Lists. The Master Lists List window opens. Select Contract Subgrouping. Do one of the following: To add a new item, select open menu button , and then select New. To modify an existing item, select the item in list, select open menu button , and then select Open. You can also double-click to open the item. The Add/Modify Contract Subgrouping Information windo

File Maintenance Help for NextGen® Enterprise 8

Attach Contract Subgroupings to a Provider

Contract subgroupings that are attached to a provider indicate which contracts the provider participates in because the subgroupings are assigned to the contracts. After you attach the subgroupings, the payers associated with the contracts are updated. Open a provider master file and then select the Practice tab. In the Contract Subgrouping field, select the contract categories to associate with the provider. Note: The Contract Subgrouping field label you see might be named differently. This provider becomes a participating provider for the payer. You can see these providers in the Payer master file. If you open a payer and select the contract on the Payer master file > Libraries tab, these participating providers are automatically selected in the Participating Providers field. Likewise, if you clear a Contract Subgrouping check box, then the providers name is removed from the Payer master file > Libraries tab > Participating Providers field. Parent topic: Setup an Exception Through th

Contracts Library

Recommendations

Contracts Library

Set Up a Fee Schedule for Contract Payers

Access Contract Library Maintenance

Access Contract Library Maintenance

Define Contract Subgrouping Categories

Attach Contract Subgroupings to a Provider

Contracts Library

Set Up a Fee Schedule for Contract Payers

Access Contract Library Maintenance

Access Contract Library Maintenance

Define Contract Subgrouping Categories

Attach Contract Subgroupings to a Provider