Encounter Maintenance

Help Guide for NextGen® Enterprise PM 8

Encounter Maintenance - Clinical Tab

The Clinical tab includes clinical information about the patient’s encounter. The tab is useful for those who do not have NextGen® Enterprise, but would like to capture limited clinical information for each encounter in NextGen® Enterprise PM. All fields on this tab require numeric entries, not text. The information on this tab is not available or viewable in NextGen® Enterprise. The Clinical tab includes the following fields: Field Description Height (In Inches) Enter the patient’s height at the time of the encounter. Weight (In Pounds) Enter the patient’s weight at the time of the encounter. Temperature Enter the patient’s temperature at the time of the encounter. Pulse Enter the patient’s pulse at the time of the encounter. Blood Pressure Enter the patient’s systolic and diastolic pressure at the time of the encounter. User Defined Fields: Clinical UD 1-4 Up to four additional encounter-level custom fields can be created using the User Defined Fields in the Encounters preferences un

Help Guide for NextGen® Enterprise PM 8

UB Value Codes Sub-Tab

Value codes indicate the code and related dollar amounts that identify monetary data required for processing claims. This information is required for benefit determination. Value codes are two character alpha-numeric codes that print in Field Locators 39-41 on UB claims. You can modify the code and the dollar amount when specific codes and amounts are needed on the UB claim for the encounter. You can select one Value Code and associated Dollar Amount in rows 39a - 41d, or up to 12 codes and amounts per encounter. Example: When you select 21 (Catastrophic) in row 31a and enter a dollar amount, the condition code 21 and the amount display in field locator 39a on UB claim forms for the encounter. Note: A default Value Code may have been linked to the Revenue Code that prints in Field Locator #42 on UB claims for the service. The default is defined in File Maintenance > PM System Master Files > Revenue Codes. Parent topic: Encounter Maintenance - UB Tab

Help Guide for NextGen® Enterprise PM 8

UB Occurrence Codes Sub-Tab

Occurrence Codes define specific events relating to a bill that may affect payer processing. This is a two character alpha-numeric code that prints in Field Locators 31 - 34 on the UB claims form. You can select one Occurrence Code and Date for field locators 31a - 34b, or up to eight (8) codes and dates per encounter. Example: When you select 01 (Auto Accident) in row 31a and enter a date, the condition code 01 and the date display in field locator 31 on UB claim forms for the encounter. If the 01 (Auto Accident) occurrence code is linked to revenue code 369 Auto Accident Catastrophic, then 369 prints in the field locator box. Note: When an Occurrence Code is linked to a Revenue Code, the default Revenue Code prints on the UB form in the field locator box. The default is defined in File Maintenance > System Master Files > PM > Revenue Codes. Parent topic: Encounter Maintenance - UB Tab

Help Guide for NextGen® Enterprise PM 8

UB Condition Codes Sub-Tab

Condition codes indicate a set of conditions that apply to a bill that can affect processing and payment of the claim. This two-digit code can indicate many different reasons that will affect claim processing such as: if a claim is employment related, a non-terminal condition for Hospice, or a private room is medically necessary. You can select one Condition Code for field locators 18 - 28, or up to ten (11) codes per encounter. Example: When you select 02 (Condition is Employment Related) in row 18, the condition code 02 displays in field locator 18 on UB claim forms for the encounter. Parent topic: Encounter Maintenance - UB Tab

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounters for UB Claims

The following list outlines the areas of the Encounter Maintenance window that are important to the setup of UB claims: On the General tab, complete the Service Location field. On the UB tab, access the following sub-tabs: Condition Codes, Occurrence Codes, and Value Codes. Encounter Maintenance Note: For Enhanced UB users, the automated UB claims process only applies to payers who are considered primary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes, which are explained in the following sections, only occurs for primary payers who have the required criteria. UB/General Tab UB/Condition Codes Tab UB/Occurrence Codes Tab UB/Value Codes Tab Setting Up Practice Preferences for UB Claims Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

UB General Sub-Tab

The General sub-tab in the UB tab includes the following fields: Field Description Type of Bill This field contains three fields; one for each character of a three-digit code on UB claims. The default digits for all encounter are defined on the Claims tab in Practice Preferences. You can modify them if different digits are needed on the UB claim for the encounter. Hold Date This option puts a hold on the claim. It is used by Medicare but can be used by other providers as well. It stops the creation of a claim until the hold date ends, currently not used. Source of Admission Select from the list the actual source of the admission. For example, a clinical referral or a law enforcement. It prints in Field Locator #15 on UB claims. You can select from: 1 - Clinic Referral 8 - Court/Law Enforcement 7 - Emergency Room 3 - HMO Referral 9 - Information Not Available 1 - Physician Referral 6 - Transfer from Another Facility 4 - Transfer from Hospital A - Transfer from RPCH 5 - Transfer from SNF

Encounter Maintenance - UB Tab

Recommendations

Encounter Maintenance - Clinical Tab

UB Value Codes Sub-Tab

UB Occurrence Codes Sub-Tab

UB Condition Codes Sub-Tab

Setting Up Encounters for UB Claims

UB General Sub-Tab

Encounter Maintenance - UB Tab

Encounter Maintenance - Clinical Tab

UB Value Codes Sub-Tab

UB Occurrence Codes Sub-Tab

UB Condition Codes Sub-Tab

Setting Up Encounters for UB Claims

UB General Sub-Tab