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

Generating Courtesy Claims

A courtesy claim is a claim that you, the provider, does not submit to a payer (because you are non-par with the patient’s contract) for charges related to services you have rendered on the patient. It is a claim that you generate, but do not send. Instead, you give it to the patient so they can submit it. The example in this section shows how a courtesy claim can be generated. This example assumes that some providers in your office are par with the contract and the services are to be billed. Set Up the Payer Master Set Up the Contract Library for Courtesy Claims Set Up Contract Exceptions for Courtesy Claims Entering a Courtesy Charge for a Claim Parent topic: Generating and Submitting 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

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

Generating Courtesy Claims

Run Claim Edits after Entering Charges

Exempt Patient Co-Payments

Set Up the Payer Master

Set Up the Contract Library for Courtesy Claims

Set Up Contract Exceptions for Courtesy Claims

Generating Courtesy Claims

Run Claim Edits after Entering Charges

Exempt Patient Co-Payments