Entering a Courtesy Charge for a Claim

Help Guide for NextGen® Enterprise PM 8

Set Up the Payer Master

In the Payer Master file, on the Practice Parameters/Other tab, select the following options: Default Non-Participating Providers Accept Assignment to No Transfer Non-Par Charges to patient Select Managed Care Contract. When a contract is selected, the check boxes required for setting up a courtesy claim are displayed. Select only providers who are participating providers. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Set Up the Contract Library for Courtesy Claims

Select the Contract Library that is associated with the payer. On the General tab of the Contract Library Maintenance window, enable the following check boxes: Prorate Insurance Balance Create Zero Dollar Claim Ensure that there is a detail record set up for the CPT4 for participating providers. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Set Up Contract Exceptions for Courtesy Claims

To generate courtesy claims for a payer, access the Contract library list and right-click on the applicable payer and then select Contract Exceptions. The Contract Exception Maintenance window opens. Enter the name of the type of extension in the Contract Exception Name (required) field. In the exception, select the CPT4 code for generating a courtesy claim. Enter the full charge in the Allowed column. Enter the full charge in the Co-Pay Amount column. Note: For more information about setting up contract exceptions, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide forNextGen® Enterprise. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Run Claim Edits after Entering Charges

You must run claim edits on charges immediately after you enter charges. The edits identify errors that may need to be corrected before the encounter goes through the billing process to create a claim for the payer. Open the Patient Chart for the desired patient. On the Encounters tab, select the encounter to run the claim edits. From the main toolbar, select Edits and do one of the following: You can run edits from the Appointment Book using Edits on the appointment toolbar. You can run edits from an open claim. You can add edits to the autoflow process. When the claim edits run successfully, the Claim Production Status window opens displaying the following: Build, Critical, Custom, Required, Error, Warning, and Informational labels under the Severity column. Errors for encounters appearing in red that result in bad claims and prevent reimbursement. Warnings for encounters appearing in blue do not prevent a clean claim, but might be contractual, and should be addressed. Informational

Help Guide for NextGen® Enterprise PM 8

Exempt Patient Co-Payments

You can configure an encounter to exempt the patient from having to make a co-payment. When you make a patient's co-payment exempt, the application does not apply the co-payment amount to the patient amount due. When a patient is exempt from making a co-payment, the Charge Entry window still displays the patient co-pay responsibility that would have applied, but the co-pay amount is not included in the patient amount. Open Chart Lookup, access the patient chart, select Encounters > Insurance tab, and double-click on the payer in the Encounter Insurance list. The Insurance Maintenance window opens. Enable the Co-pay Exempt check box. Note: If the Co-pay Exempt field does not display on the Insurance Maintenance window, use the following procedure to activate it. To display the Co-pay Exempt field on Insurance Maintenance window, open the Chart Practice Preferences, and then enable the Enable encounter payer co-pay check box. Parent topic: Generating Secondary Electronic Claims

File Maintenance Help for NextGen® Enterprise 8

Charges and Contracts

Note: After the charges have been generated, the Balance Control window reflects the charges set up in the Contract Library Maintenance window. The amount from the Co-Pay Amount field is automatically entered into the patient's bucket. The system checks to see which payer is associated with the encounter. The system checks payer maintenance to see which contract is attached and whether the provider is participating or non-participating. The contract is searched to see if anything has been entered for the specific CPT4 code that was charged in the encounter. If it has, then it uses the specified information. If not, it uses the default information from the top of the contract dialog box. Parent topic: Setup an Exception Through the Contract Library

Entering a Courtesy Charge for a Claim

Recommendations

Set Up the Payer Master

Set Up the Contract Library for Courtesy Claims

Set Up Contract Exceptions for Courtesy Claims

Run Claim Edits after Entering Charges

Exempt Patient Co-Payments

Charges and Contracts

Entering a Courtesy Charge for a Claim

Set Up the Payer Master

Set Up the Contract Library for Courtesy Claims

Set Up Contract Exceptions for Courtesy Claims

Run Claim Edits after Entering Charges

Exempt Patient Co-Payments

Charges and Contracts