NextGen Knowledge Center

Create an Alternate Payer Carve-Out Criteria

  1. In File maintenance, select Master Files > System > PM and then select Payers.
    The Payers List window opens.
  2. Double-click a payer.
    The Modify Payer Information window opens.
  3. Select the Alt Payer tab.
  4. To create an alternate payer carve-out criteria, select open menu and then select New.
    The Add Alt Payer Carve Out Criteria window opens.
  5. In the Alt Payer Criteria section, do the following:
    • Select an alternate payer from the list.

      You can also create a new alternate payer by selecting the open menu in the Alt Payer Criteria section.

    • Select the effective and expiration date.
    • Enter the description for the alternate payer carve-out criteria.
  6. Select the required location.
  7. To enter the SIM range, select open menu and then select New.
    The Alt Payer Number SIM Range window opens.
    • Enter the SIM range.
    • Select the Populate ordering Phys 2420E loop (professional only) check box to identify SIMs when a payer wants the ordering physician to be reported on the claim for specific procedures.
    • The Default Ordering from field is enabled once you select the Populate ordering Phys 2420E loop (professional only) check box. Select either Rendering or Referring, or keep the field blank.
    • Select OK.
  8. To enter the ICD range, select open menu and then select New.
    The ICD Code Ranges window opens.

    Enter the ICD range and select OK.

  9. Select the rendering provider.
  10. In the Billing Provider Information section, do the following:
    • Select the taxonomy code.
    • Enter the provide number, national provider ID, and In-Line Edits payer ID.

    When you add the billing provider details, the claim generates with these details for the carve-out criteria. If you use two carve-out criteria while creating a claim for an alternate payer, the claim considers billing provider details from the criteria that was entered first.

  11. Select Next to create another alternate payer carve-out criteria.
  12. To save the changes and close the window, select OK.