Encounter Rate SIM Narrative for Claims

Help Guide for NextGen® Enterprise PM 8

Enter an Encounter-Level Narrative for an ER SIM Code

If the Encounter Rate Library for the payer is setup to insert the ER SIM into encounter maintenance, then the ER SIM automatically inserts on the Encounter Rate sub-tab on the Billing & Collections tab of the Encounter Maintenance window when the encounter is billed. An encounter-level narrative can be manually entered for an Encounter SIM either before or after the encounter is billed. Access Patient Chart for the desired patient. Select the Encounters tab. Double-click to open the desired encounter. The Encounter Maintenance window appears. Select the Billing & Collections tab, and then the Encounter Rate sub-tab. In the Narrative field for the primary, secondary or tertiary encounter rate payer, enter a free-text comment for the ER SIM. The maximum is 80 characters. If the encounter is in Unbilled status prior to entering the narrative, select OK to save changes and close the window. If the encounter is in Billed status prior to entering the narrative, you get a prompt asking if yo

Help Guide for NextGen® Enterprise PM 8

Enter a Charge-Level Narrative for an ER SIM Code

If the Encounter Rate Library for the payer is setup to not insert the ER SIM into Encounter Maintenance, then the ER SIM automatically inserts on the Charge Posting window as an additional charge line when the encounter is billed. The Narrative field on the Charge Posting window automatically populates for the ER SIM charge line if a pre-defined narrative is setup for the ER SIM code on the Other tab of the Service Items library. Otherwise the charge-level narrative can be manually entered for the ER SIM after the encounter is billed. Access the Charge Posting window for the desired patient and encounter. Select the charge line for the ER SIM code and then select the Open button. In the Narrative field, enter a free-text comment for the ER SIM. To save changes and close the window, select OK. The following prompt displays: Would you like to flag this charge to be rebilled? Select one of the following: To rebill the ER SIM, select Yes. The ER SIM charge line is flagged to bill with a g

File Maintenance Help for NextGen® Enterprise 8

Other Tab - SIM Library

You can enter additional narrative information in theNarrativefield on theService Item Library Maintenancewindow. The narrative displays: In theNarrativefield on theCharge Postingwindow In box 19 on the paper 1500 claim form As either a 2300 NTE or 2400 NTE record on the electronic claim based on the Submitter Profile settings In FL 84 box for Remarks on a UB92 claim form or in box FL 80 for UB04 claim form, if the appropriate claim print option is activated In the paper HCFA, a line label automatically generates that shows the corresponding charge for the narrative. Note: Alternatively, you can leave this field blank and only add a narrative for each patient as needed on theCharge Postingwindow inNextGen® Enterprise PM. You can also modify the narrative on theClaim Detailtab of theClaim Maintenancewindow. Below the Narrative field is a Create Test Results MEA Segmen t check box. When you select this option for 1500 claims you will have access to the Test Results window in NextGen® Ent

File Maintenance Help for NextGen® Enterprise 8

Encounter Rate Library with Claim Detail Rules Report

The Encounter Rate Library with Claim Detail Rules report includes information from the Encounter Rate Billing library in File Maintenance. Information on the report pulls from the Encounter Rate Billing Library Maintenance window > Claims tab. The report includes the following information: Column Description Data Populates From Description Library Name Encounter Rate Billing Library field ER Claim Detail Rule ER Claim Detail Rules Description Encounter Rate Claim Detail Rules window > Description field Eff Dt Effective Date Encounter Rate Claim Detail Rules window > Effective Date field Exp Dt Expiration Date Encounter Rate Claim Detail Rules window > Expiration Date field Prim Include Copay Ind Include Copay in Primary Electronic Claim Encounter Rate Claim Detail Rules window > Primary Electronic Claims section (Y/N) Prim ER SIM on the Claim Do you send the ER SIM on the Claim? Encounter Rate Claim Detail Rules window > Primary Electronic Claims section (Y/N) Prim Display narr on ER

Help Guide for NextGen® Enterprise PM 8

Set Up the Claims Tab

The Claims tab on the Encounter Rate Billing Library Maintenance window contains a series of questions designed for configuring claims for the ER payer. Primary, secondary and tertiary claims for the payer can be configured separately. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claims tab. Existing Claim Detail Rules sets display as separate rows, with the current active row at the top of the list. Rows can be sorted by selecting on the Eff Date, Exp Date or Description column headings. Do one of the following: To add a Claim Detail Rules set, select open menu button and select New. To modify a Claim Detail Rules set, select the row from the list, and then select open menu button and select Open. To copy a Claim Detail Rules set, select the row from the list, and select open menu button and select Copy. The Encounter Rate Claim Detail Rules window opens. In the Effective Date and Expiration Date fields, enter an effe

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claims Tab

The Claims tab on the Encounter Rate Billing Library Maintenance window contains a series of questions designed for configuring claims for the ER payer. Primary, secondary and tertiary claims for the payer can be configured separately. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claims tab. Existing Claim Detail Rules sets display as separate rows, with the current active row at the top of the list. Rows can be sorted by selecting on the Eff Date, Exp Date or Description column headings. Do one of the following: To add a Claim Detail Rules set, select open menu button and select New. To modify a Claim Detail Rules set, select the row from the list, and then select open menu button and select Open. To copy a Claim Detail Rules set, select the row from the list, and select open menu button and select Copy. The Encounter Rate Claim Detail Rules window opens. In the Effective Date and Expiration Date fields, enter an effe

Encounter Rate SIM Narrative for Claims

Charge-Level Narrative

Encounter-Level Narrative

Recommendations

Enter an Encounter-Level Narrative for an ER SIM Code

Enter a Charge-Level Narrative for an ER SIM Code

Other Tab - SIM Library

Encounter Rate Library with Claim Detail Rules Report

Set Up the Claims Tab

Set Up the Claims Tab

Enter an Encounter-Level Narrative for an ER SIM Code

Enter a Charge-Level Narrative for an ER SIM Code

Other Tab - SIM Library

Encounter Rate Library with Claim Detail Rules Report

Set Up the Claims Tab

Set Up the Claims Tab