Default Library Selection

Help Guide for NextGen® Enterprise PM 8

Claim Modifiers Library

The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Billing Library

The Behavioral Health Billing library defines parameters for “variance” charges which can be calculated and added to encounters during the billing process for specific payers. The library also defines other claim and billing parameters that may be needed when billing Behavioral Health services to specific payers. A single library can be created and linked to the practice to be used for all payers. Or payer-specific libraries can be created and linked only to those payers. You can generate the Behavioral Health Billing report from the Behavioral Health Billing library , go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Add or Modify a Behavioral Health Billing Library Parent topic: Behavioral Health Billing

Help Guide for NextGen® Enterprise PM 8

Non-Coordinated SIM Library

The Non-Coordinated SIM library enables you to set up billing rules for payer-specific service items. This includes service items that are only reimbursed by specific payers such as a state plan, special grant program, or Medicaid, that would not be reimbursed if billed to other payers. Example: A range of behavioral health SIM codes can be billed to Medicaid but not to any other payer. That range of SIM codes can be set up in this library with Medicaid selected as the only valid payer, therefore making the SIM codes “non-coordinated” for all other payers. The library also defines other parameters that affect how non-coordinated SIM codes are handled during charge posting and billing. These parameters include options and settings for Balance Control, auto-adjustments, and claims. A single library can be created and used by the practice. The library may include multiple detail rows, each with different parameters and requirements for a specific payer. Note: This is a practice level libr

Help Guide for NextGen® Enterprise PM 8

Select a Default Library for a Practice

A default library selected at the practice-level is used for all payers in the practice. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. In the Preference List on the left, select Libraries. Practice Preferences window > Libraries tab In the Behavioral Health Billing Library field, select the default library to be used for the practice. In the Non-Coordinated SIM Library field, select the default library to be used for the practice. Note: To utilize the Non-Coordinated SIM functionality, a library must be selected for the practice. In the Claim Modifiers Library field, select the default library to be used for the practice. In the Claim Edits Library field, select the default library to be used for the practice. To save changes and close the window, select OK. Parent topic: Default Library Selection

Help Guide for NextGen® Enterprise PM 8

Select a Default Library for a Payer

A library selected at the payer-level overrides the default library selected at the practice-level. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payer List window opens. Double-click to open the desired payer. The Modify Payer Information window opens. Select the Practice tab, and then the Libraries sub-tab. Modify Payer Information window; Practice tab; Libraries sub-tab In the Behavioral Health Billing Library field, select the library to be used for the payer. In the Modifiers Library field, select the library to be used for the payer. In the Claim Edit Library field, select the library to be used for the payer. To save changes and close the window, select OK. Parent topic: Default Library Selection

File Maintenance Help for NextGen® Enterprise 8

Libraries Practice Preferences

The Libraries Practices Preferences enable you to select default libraries used by the practice. The selected libraries apply to all payers that do not have a different library assigned at the payer level. You can override these practice-level default libraries by selecting different libraries for specific payers. Note: The following libraries are available at the practice-level only, and you do not have the option of selecting an override library at the payer-level: Anesthesia, Consolidated Services Claim, Institutional Billing, NDC, Non-Coordinated SIM and Service Package. Libraries Practice Preferences Descriptions Parent topic: Practice Preferences

Default Library Selection

Recommendations

Claim Modifiers Library

Behavioral Health Billing Library

Non-Coordinated SIM Library

Select a Default Library for a Practice

Select a Default Library for a Payer

Libraries Practice Preferences

Claim Modifiers Library

Behavioral Health Billing Library

Non-Coordinated SIM Library

Select a Default Library for a Practice

Select a Default Library for a Payer

Libraries Practice Preferences