Entering Reason Codes during Payment Entry
During the payment entry process, you have the ability to apply reason codes at the:
Recommendations
Help Guide for NextGen® Enterprise PM 8
You can enter multiple reason codes at the line-item level, and each line-item can have a different reason code. Line-item reason codes are selected from the Line Item Reasons column at the bottom of the Payment Entry window. Open NextGen® Enterprise PM. On the main toolbar, select Posting . The Batch Posting window opens. Double-click the desired batch header record. The Payment Entry window opens. Type the encounter number in Enc/Clm#, and select Enter. The account guarantor, patient, medical record number, and the billed account displays in the Payment Entry window. In Line Item Reasons, select the codes that match the payer's reason code on the remittance advice. Enter the required fields and select Recalc. Select Save. Parent topic: Entering Reason Codes during Payment EntryAdd a Line-item Reason Code during Payment Entry
Help Guide for NextGen® Enterprise PM 8
Transaction level reason codes are selected in the Payment Entry window in the Clm Reasons field. You can enter multiple reason codes at the transaction level. Transaction codes are set up for the practice in the Reason Code Maintenance window in File Maintenance. Open NextGen® Enterprise PM. On the main toolbar, select Posting . The Batch Posting window opens. Double-click the desired batch header record. The Payment Entry window opens. Type the encounter number in Enc/Clm#, and press Enter. The account guarantor, patient, medical record number, and the billed account displays in the Payment Entry window. In the Clm Reasons list, select the codes that match the payer's reason code on the remittance advice. Select Save. Parent topic: Entering Reason Codes during Payment EntryAdd a Transaction Level Reason Code during Payment Entry
Help Guide for NextGen® Enterprise PM 8
You can print on-demand encounter and account level receipts from the following windows after a payment is entered and saved: Payment Entry Account Summary Enter an Encounter Payment Enter a Transaction for an Account You can use the Payment Entry window to enter transactions details for an account. Enter an Invoice Payment You can enter an invoice payment in to the system using the Payment Entry window. Receive a Secondary Payer Payment before the Primary Payer You can use the Use Settled up status option for posting the payment to a secondary payer. Parent topic: Posting TransactionsPosting Encounter and Account Level Payments
Help Guide for NextGen® Enterprise PM 8
There are four types of reason codes as described below. The type of code that is used is determined by the payer. Different payers may return the same code as either a Line Item code or a Claim Level code. If this occurs, it is possible to have the same code in the Reason Code Library with two different code types to ensure that the ERA 835 file processes correctly. Adjudication codes are always claim level codes. Remark codes are always line item level codes. Reason codes that are imported “on-the-fly” are automatically flagged as either Line Item or Claim Level, depending on how they are returned by the payer in the ERA file. Line Item: Line Item reason codes are returned by the payer at the charge, or CPT® 4 code, level. They are available for selection in the Line Item Reasons column at the bottom of the Payment Entry window. They display in the Reason column in the Patient Chart > Encounters > Transactions sub-tab. Claim Level: Claim Level reason codes are returned by the payer aReason Code Types
File Maintenance Help for NextGen® Enterprise 8
Use the following table to enter reason codes into the library. Field Description Reason Code Library Enter the name for the library. Hide Library Select this check box to hide the library in the Reason Code List. Search Method: Description Select this option to run a search by reason code description. Search Method: Code Select this option to run a search by reason code. Search for keyphrase anywhere in the item Select this check box to search for a string of letters anywhere in the reason code description instead of searching based on the letters at the beginning of the description. This check box is available when you are modifying an existing reason code library. Type the first letter(s) of the Reason Code to locate Enter the first few letters of the reason code description to display the reason code you are searching for. If you selected the Search for keyphrase anywhere in the item check box, enter letters that occur within the description. Reason Codes List Lists the reason codeReason Code Library Maintenance Field Descriptions
Help Guide for NextGen® Enterprise PM 8
The following table lists each option available in the Reason Codes Library with a description of how it works and how it may be used. Reason Code Option How it Works How it is Used Force Item Rebill Select this check box to flag line items with the reason code to "Rebill" to the current payer. Note: This option applies to Line Item reason codes only. When trends are identified for a reason code that always require rebilling. Write Off Remaining Balance Select this check box to adjust the remaining balance to $0.00 for line items with the reason code. The adjustment occurs when the transaction batch is posted. Note: This option applies to Line Item reason codes only. Sometimes used with payers of last resort, such as Medicaid. Note: ERA uses the Adjustment Code selected below to make the adjustment. Manual payment entry uses the Write Off Remaining Payer Balance adjustment code selected in Practice Preferences > Transactions to make the adjustment. Display on Patient Statements Select