Determining Patient Co-Pays
The following diagram describes how the application determines patient co-pay amounts:
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Insurance Override Co-Pay
If a zero ($0.00) or positive amount is found in the Co-Pay for Patient field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for all encounters. If the Co-Pay for Patient field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Co-Pay for Patient override field on the Insurance Maintenance window is available only if the Display override policy number and co-pay option is selected on the Defaults-2 tab of the Payers master file. This allows a patient level co-pay amount to be entered that overrides the subscriber/policy holder level co-pay amount. The policy holder parent may have a co-pay amount that is different from a dependent child that is covered under the policy. Parent topic: Co-Pay Amount Hierarchy
Help Guide for NextGen® Enterprise PM 8
Co-Pays
When entering charges, a portion of the original charge amount breaks off into the Pat Amt column on the Charge Posting window. This amount is the patient’s co-pay for the service and it is the amount designated as the patient's responsibility in the Patient Responsibility master file. If you have a co-pay defined in a contract or in a patient's insurance maintenance record, you can see a portion of the original charge amount break off into the patient amount. Co-Pay Amount Hierarchy Co-pay amount hierarchy decides from where to derive the patient's co-pay. Co-Pays on Charges with Calculated Amounts Calculated co-pays on charges is derived on the Charge Posting window. Parent topic: Billing
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Help Guide for NextGen® Enterprise PM 8
Enter a Co-Pay Amount
On the Detail tab in the Insurance Maintenance window , there are several fields available for co-pay amounts. The amount entered indicates the patient's co-pay for the insurance, and the patient is responsible to pay that amount on encounters the insurance is linked to. Access the Insurance Maintenance window for the patient's insurance. Select the Detail tab. In the lower-right section of the window, enter a co-pay amount in the appropriate fields, as indicated below. Enterprise-Level Co-Pay In the Co-Pay Amount field, enter a dollar amount, or select a pre-defined co-pay amount from the drop-down list. This will be the patient's default co-pay for all encounters in all practices in the enterprise. Note: The enterprise-level Co-Pay Amount field is available only if the Enable practice payer specific information option is not selected in Practice Preferences > Chart. This allows all practices to use the same co-pay amount for the same patient/insurance. For example, all practices are
