Exempt Patient Co-Payments

Help Guide for NextGen® Enterprise PM 8

Enter a Co-Pay Amount

On the Detail tab in the Insurance Maintenance window , there are several fields available for co-pay amounts. The amount entered indicates the patient's co-pay for the insurance, and the patient is responsible to pay that amount on encounters the insurance is linked to. Access the Insurance Maintenance window for the patient's insurance. Select the Detail tab. In the lower-right section of the window, enter a co-pay amount in the appropriate fields, as indicated below. Enterprise-Level Co-Pay In the Co-Pay Amount field, enter a dollar amount, or select a pre-defined co-pay amount from the drop-down list. This will be the patient's default co-pay for all encounters in all practices in the enterprise. Note: The enterprise-level Co-Pay Amount field 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/insurance. For example, all practices are

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

Viewing Insurance Information in Encounters

You can view a patient's insurance information in the Insurance tab You can view insurance information for an encounter in the Insurance tab under Encounters. The Encounters section displays the list of patient encounters. The Insurance Information section displays information for the selected insurance based on the setup for the payer in the payers master file in File Maintenance. For more information on setting up payers, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise PM. You can do the following on the Insurance tab under Encounters: Open the Encounter Insurance Selection window for the selected encounter. Open the Insurance Maintenance window for the encounter. Remove the selected insurance from the encounter. Open the Balance Control window for the selected encounter. Open the Authorization Listing window for the selected insurance. Open the Referral Listing window for the selected insurance. Open the

Help Guide for NextGen® Enterprise PM 8

Retrieving Co-pay for Cost Estimation

If the practice is running in a real-time system, the system fetches the co-pay amount in the real-time eligibility (271) transaction file. If multiple co-pay amounts are found in the eligibility verification response, they are listed in the Estimate Patient Cost window. If your practice is running in a non-real-time system, the co-pay amount is obtained from the Insurance Maintenance window, Contract Exception Maintenance window, or Contract Library Maintenance window, based on a particular hierarchy system. Co-Pay from Insurance Information Based on the co-pay settings in the Payers master file in File Maintenance, co-pay amounts appear on the Insurance Maintenance window in NextGen® Enterprise PM. Your administrator must enable multiple co-pays by opening the Enterprise Preferences window, the General tab, and selecting the Enable multiple co-pays check box. On the Insurance Maintenance window, the co-pay amounts for cost estimation are as follows: Speciality co-pay information, suc

Help Guide for NextGen® Enterprise PM 8

Create a Pre-Defined Co-Pay by Specialty

From the Insurance Maintenance window and Detail tab, pre-defined co-pays can be created for a patient's insurance that are based on provider specialty. For example: Family Practice/Internal Medicine = $20.00 Cardiology = $40.00 Once created, a pre-defined co-pay can be selected from the list in any of the co-pay amount fields on the Detail tab. If the rendering provider on the encounter has a specialty that is the same as the specialty defined within a pre-defined co-pay, then the co-pay amount automatically defaults to the Enc Co-payment field on the Detail tab. Note: A new pre-defined co-pay can be created at the same time a new insurance is being added for the patient. However, all required fields on the Detail tab must be completed before the co-pay can be added. Access the Insurance Maintenance window for the patient's insurance. Select the Detail tab. In the lower-right section of the window, select the Open Menu button and then select New. If any required fields on the Detail t

File Maintenance Help for NextGen® Enterprise 8

Co-Pays Tab

Because co-payments can vary among different departments and services, you can create multiple co-payments. When you enable multiple co-pays, co-pay settings display in the Payers master file in File Maintenance and in Insurance Maintenance in NextGen® Enterprise PM. The co-pay information created in the payers master file becomes the default for all insurance. However, you can change the co-pay settings when you modify insurance in NextGen® Enterprise PM. To enable multiple co-pays: On the General tab of the Enterprise Preferences window, select the Enable Multiple Co-Pays check box. Note: If you enable this option but no co-pays exist in the Payers master file, users can still add specialty co-pays in Insurance Maintenance. To create multiple co-pay information: Select Co-Pays tab on Modify Payer Information window in the Payers master file . Note: The tab displays only when multiple co-pays is enabled in Enterprise Preferences. The tab displays co-pay information that is used in Ins

Exempt Patient Co-Payments

Recommendations

Enter a Co-Pay Amount

Encounter-Level Co-Pay

Viewing Insurance Information in Encounters

Retrieving Co-pay for Cost Estimation

Create a Pre-Defined Co-Pay by Specialty

Co-Pays Tab

Enter a Co-Pay Amount

Encounter-Level Co-Pay

Viewing Insurance Information in Encounters

Retrieving Co-pay for Cost Estimation

Create a Pre-Defined Co-Pay by Specialty

Co-Pays Tab