Eligible Number of Patient Days Billing

Help Guide for NextGen® Enterprise PM 8

Add Claim Consolidation Rules to a CSC Library

To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list. Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure. After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules. From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following: Right-click the library and select Open. Select the open menu button and select Open. The CSC Timespan Rules window opens for the library you selected. Complete the timespan rules. Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not require

File Maintenance Help for NextGen® Enterprise 8

Eligible Number of Patient Days Billing

Community Mental Health Organizations can submit consolidated monthly claims for patient services that combine interdisciplinary treatments for patients with mental illness and/or substance abuse. Services can be performed outside of a professional medical setting such as a patient’s home, a senior center, or a community services center. You can now bill these services for the number of days the patient is authorized to receive these services from your practice. For example, a patient is enrolled in your program for the month of January or 31 days. The patient has a crisis and is admitted to an inpatient facility for 10 days. Therefore, the patient is only authorized to receive these services from you for 21 days. Formula for Billing Example Days in the Month = 31 Days Eligible for Billing = 21 (eligible patient days minus non-eligible patient days) Billed Amount = (21 Days X Daily Rate) Set Up for Eligible Number of Patient Days Billing Parent topic: Claim Header Rules and Claim Conso

Help Guide for NextGen® Enterprise PM 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

Help Guide for NextGen® Enterprise PM 8

Claim Header Rules and Claim Consolidation Rules

Use the Claim Header Rules tab to establish a provider hierarchy and identify the attending provider for consolidated service claims (CSC). The physician with the highest-ranking specialty is automatically listed as the attending provider in the header data of the CSC claim. All CSC claims are sent to the payer as EDI files. These hierarchy rules will apply to all of the payers in the Valid Payers list. Establishing a Provider Hierarchy When a Provider Hierarchy is NOT Established Add Claim Consolidation Rules to a CSC Library Add Claim Header Rules to a CSC Library Eligible Number of Patient Days Billing Parent topic: Consolidated Service Claims

File Maintenance Help for NextGen® Enterprise 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

File Maintenance Help for NextGen® Enterprise 8

Claim Header Rules and Claim Consolidation Rules

Use the Claim Header Rules tab to establish a provider hierarchy and identify the attending provider for consolidated service claims (CSC). The physician with the highest-ranking specialty is automatically listed as the attending provider in the header data of the CSC claim. All CSC claims are sent to the payer as EDI files. These hierarchy rules will apply to all of the payers in the Valid Payers list. Establishing a Provider Hierarchy When a Provider Hierarchy is NOT Established Add Claim Consolidation Rules to a CSC Library Add Claim Header Rules to a CSC Library Eligible Number of Patient Days Billing Parent topic: Consolidated Services Claim Library

Eligible Number of Patient Days Billing

Recommendations

Add Claim Consolidation Rules to a CSC Library

Eligible Number of Patient Days Billing

Set Up for Eligible Number of Patient Days Billing

Claim Header Rules and Claim Consolidation Rules

Set Up for Eligible Number of Patient Days Billing

Claim Header Rules and Claim Consolidation Rules

Eligible Number of Patient Days Billing

Add Claim Consolidation Rules to a CSC Library

Eligible Number of Patient Days Billing

Set Up for Eligible Number of Patient Days Billing

Claim Header Rules and Claim Consolidation Rules

Set Up for Eligible Number of Patient Days Billing

Claim Header Rules and Claim Consolidation Rules