Dental Billing

Help Guide for NextGen® Enterprise PM 8

Dental Billing

This section provides information on dental billing for Health Centers that perform dental services. Specific setup in File Maintenance is required so that dental charges can be entered on encounters and then billed to dental payers on either 1500, ADA or UB claim forms. The type of claim form generated is determined by the setup for each dental payer. The following claim formats are supported in NextGen® Enterprise PM: 1500: Electronic 837PPaper CMS 1500 Form (2012) ADA: Electronic 837D Paper ADA Form (2024) UB: Electronic 837IPaper UB04 Form (2004) Dental billing in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Code Tables CPT4 Codes SIM library Claim Edits library Claim Printing library Transaction Codes Payers Set Up Practice Preferences for Dental Billing View Code Tables for Dental Billing Service Items Library for Dental Billing Claim Edits for Dental Billing Claim Printing Library for ADA Claims Payers Master File for Dental Billi

Help Guide for NextGen® Enterprise PM 8

Sliding Fee Schedules

Sliding Fee Schedules are typically used by Health Centers. They are linked to a patient or to a specific patient encounter inNextGen® Enterprise PM. When it is linked and you enter the percentage or charge amount on an encounter, it is automatically adjusted. The percentage of the automatic adjustment is based on householdfamily sizeandannual income. Sliding Fee Schedule adjustments are reported on the UDS Report. You can create multiple sliding fee schedules, if needed. If the percentage discounts vary for medical, dental, vision and/or behavioral health services, separate schedules can be created for each. To use Sliding Fee Schedules inNextGen® Enterprise PM, the following set up must be completed. CreateTransaction Codesin File Maintenance to be used for sliding fee adjustments. CreateSliding Fee Schedulesin File Maintenance. Configure options inPractice Preferences > Sliding Feeto determine how sliding fee adjustments should function within the practice. When Sliding Fee Schedule

Help Guide for NextGen® Enterprise PM 8

View Code Tables for Dental Billing

The Tooth, Surface, and Quadrant code tables in File Maintenance are preloaded with standardized codes and descriptions that are used to identify teeth, surfaces, and quadrants for dental services entered on the Charge Posting window in NextGen® Enterprise PM. Access File Maintenance. Select Code Tables. The Code Tables List window opens. In the Code Table field, select a code table. Items within the selected code table are displayed. The following list describes the code tables used for dental billing. Quadrants: Corresponds to the quadrant or area of the mouth for specific dental procedures on the Charge Posting window. The quadrant prints in box 25 on both the ADA 2019 form and the ADA 2024 form. Surface: Corresponds to the surface on the tooth for specific dental procedures on the Charge Posting window. You can select one or more codes if the Allow multiple tooth surfaces check box is selected in Practice Preferences > Charge Entry. The surface prints in box 28 on both the ADA 2019

Help Guide for NextGen® Enterprise PM 8

Setting Up Claims

Before you can generate claims, you must set up options to define the following: The type of information you want to display in the various claim form fields The way you want the claim forms to print The location, payer, and provider information for a valid claim creation Specialty Billing For more information about the setup and functionality of the types of billing based on speciality, go toNextGen Healthcare Success Communityand download the following user guides: Anesthesia Billing User Guide forNextGen® Enterprise PM Behavioral Health Billing User Guide forNextGen® Enterprise PM Community Health Centers User Guide forNextGen® Enterprise PM Community Health Centers include the following types of billing: Encounter Rate Billing Roll-Up Billing Dental Billing Claim Printing Library The Claim Printing library enables you to specify options that define which information prints on claim forms. Claim Modifiers Library EDI Claim Profile Library The EDI Claim Profile library enables you to

File Maintenance Help for NextGen® Enterprise 8

Printing Preferences for Document Types

You can set up printing preferences for the following document types in NextGen® Enterprise PM. Account Receipt Anesthesia Gantt Report Appointment Reminder Letters Appointment Multi Resource Report Budget Letters Claim Images Note: You can select Claim Images to select a ADA, 1500, or UB claim type. Claims Note: You can select Claims to select a ADA, 1500, or UB claim type. Collection Letters Cost Estimate Credit Card Processing Day Timer Encounter Bills EOB Images Fee Tickets Forms Note: You can select Forms to select a specific form template. Forms Enhanced Note: You can select Forms Enhanced to select a specific enhanced form. Invoices Label Templates Note: You can select Label Templates to select a specific label. Patient Data Sheets Patient Detail Data Sheets Recall Letters Reports Statements Parent topic: Printing Practice Preferences

Help Guide for NextGen® Enterprise PM 8

Billing

Billing is the process of collecting payments for a service rendered. The patient or the patient's insurance company is billed and the respective payment is received from them. Billing and Collections NextGen® Enterprise PM billing and collections set up and processes. Enter Charges You can enter charges on the Charge Posting window. Configuring Session Settings Session settings is a feature in NextGen® Enterprise PM that enables you to select specific parameters that are used as defaults during your current login session. Co-Pays When the original charge amount breaks off into the patient amount, it is called the patient's co-pay. Charge Test Results on Electronic Claims You can charge test results on electronic claims for reimbursement. Charge Discounts You can apply discounts to the charges for an encounter from the Charge Posting window. Processing Pending NextGen Enterprise EHR Charges You can process pending NextGen® Enterprise EHR charges. National Drug Code (NDC) Information fo

Dental Billing

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Dental Billing

Sliding Fee Schedules

View Code Tables for Dental Billing

Setting Up Claims

Printing Preferences for Document Types

Billing

Dental Billing

Dental Billing

Sliding Fee Schedules

View Code Tables for Dental Billing

Setting Up Claims

Printing Preferences for Document Types

Billing