Enterprise-Level Co-Pay

Help Guide for NextGen® Enterprise PM 8

Practice-Level Co-Pay

The practice level co-pay amount is the patient’s co-pay for all encounters if a zero ($0.00) or positive amount ($15.00) is found in the Practice Level co-pay amount fields on the Insurance Maintenance window. If the Practice Level co-pay amount fields are blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Practice Level Co-Pay Amount field on the Insurance Maintenance window is available only if the Enable practice payer specific information option is selected in Practice Preferences > Chart. This allows each practice to define a different co-pay amount for the same patient or insurance. Family practice co-pay amount may be different from the specialty practice co-pay amount. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Encounter-Level Co-Pay

If a zero ($0.00) or positive amount ($20.00) is found in the Enc Co-payment field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for that encounter only. If the Enc Co-payment field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Enc Co-Payment field on the Insurance Maintenance window is available only if the Enable encounter payer copay option is selected in Practice Preferences > Chart. This allows an encounter level co-pay amount to be entered that overrides the practice level co-pay amount for all other encounters. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Insurance Override Co-Pay

If a zero ($0.00) or positive amount is found in the Co-Pay for Patient field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for all encounters. If the Co-Pay for Patient field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Co-Pay for Patient override field on the Insurance Maintenance window is available only if the Display override policy number and co-pay option is selected on the Defaults-2 tab of the Payers master file. This allows a patient level co-pay amount to be entered that overrides the subscriber/policy holder level co-pay amount. The policy holder parent may have a co-pay amount that is different from a dependent child that is covered under the policy. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Contract Co-Pay

If both a green check and a zero ($0.00) or positive amount are found for the CPT4 code in the Apply Co-Pay Amount column on the Fee Schedule tab of the Contract Library Maintenance window, the defined amount will be the patient’s co-pay for that service. If no green check is found for the CPT4 code, no patient co-pay will be applied for that service. If a green check is found with a blank Apply Co-Pay Amount for the CPT4 code, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The contract Apply Co-Pay Amount will be applied to a charge only if the contract is linked to the primary insurance on the encounter in the Managed Care Contract field on the Practice > Libraries sub-tab of the Payers master file and only for the providers checked in the Participating Provider field. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Enterprise-Level Co-Pay

The enterprise level co-pay amount is the patient’s co-pay if a zero ($0.00) or positive amount ($30.00) is found in the Co-Pay Type column on the Insurance Maintenance window. The defined amount will be the patient’s co-pay for all encounters and practices. If the enterprise-level Co-Pay Type is blank and no co-pay is applied to any encounter. This is the last step in the hierarchy to derive the co-pay amount. Note: The enterprise-level Co-Pay Type field on the Insurance Maintenance window is available only if the Enable practice payer specific information option is not selected in Practice Preferences > Chart. This allows all practices to use the same co-pay amount for the same patient or insurance. When all practices are the same type of specialty. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Co-Pay Amount Hierarchy

You can derive the co-pay amount using the following hierarchy from highest to lowest. Contract Exception Co-Pay Contract Co-Pay Encounter-Level Co-Pay Insurance Override Co-Pay Practice-Level Co-Pay Enterprise-Level Co-Pay Contract Exception Co-Pay The patient's co-pay for contract exception is derived on the Contract Exception Maintenance Window. Contract Co-Pay The patient's co-pay for contract is derived on the Contract Library Maintenance Window. Encounter-Level Co-Pay The patient's co-pay for encounter level is derived on the Insurance Maintenance Window. Insurance Override Co-Pay The patient's co-pay for insurance override is derived on the Insurance Maintenance Window. Practice-Level Co-Pay The patient's co-pay for practice level is derived on the Insurance Maintenance Window. Enterprise-Level Co-Pay The patient's co-pay for enterprise level is derived on the Insurance Maintenance Window. Parent topic: Co-Pays

Enterprise-Level Co-Pay

Recommendations

Practice-Level Co-Pay

Encounter-Level Co-Pay

Insurance Override Co-Pay

Contract Co-Pay

Enterprise-Level Co-Pay

Co-Pay Amount Hierarchy

Enterprise-Level Co-Pay

Practice-Level Co-Pay

Encounter-Level Co-Pay

Insurance Override Co-Pay

Contract Co-Pay

Enterprise-Level Co-Pay

Co-Pay Amount Hierarchy