Force Claims to Paper by ICD Code

Help Guide for NextGen® Enterprise PM 8

Force the Secondary Claim to Bill to the Primary Claim Provider

When you are using Supervisor Billing for a provider and the patient has two payers, you can set the application to force the secondary claim to bill the payer for the same provider (the supervisor) that the primary claim bills for. You can set the option to force the secondary claim to bill the primary claim provider in the master file for the payer. In File Maintenance, select Master Files > Payers > Practice > Other. Enable the Force rendering provider from primary claim as rendering on secondary claim check box. Parent topic: Generating Secondary Electronic Claims

File Maintenance Help for NextGen® Enterprise 8

Force Service Items to Paper at the Payer Level

When you force a service item to paper at the payer level, a paper claim generates for that service item, even when the payer is set for electronic transmission. Open the Service Item library. The Service Item Library Maintenance window opens. In the Search list on the left, select the service item. The matching results are listed. Note: You can enter an asterisk (*) to see all the records. Select the applicable service item from the Search list. Select the Payer tab. In the Payer field, select the payer from the drop-down list, then select the Force to Paper check box. Parent topic: Forcing Service Items to a Paper Claim

File Maintenance Help for NextGen® Enterprise 8

Force Service Items to Paper at the Practice Level

When you force a service item to paper at the practice level, a paper claim generates for that service item, even when the payer is set for electronic transmission. Open the Service Item library. The Service Item Library Maintenance window opens. In the Search list on the left, begin typing the service item you want to search for. The matching results are listed. Note: You can enter an asterisk (*) to see all the records. Select on the applicable service item from the Search list. On the General tab, select the Force to Paper check box. Parent topic: Forcing Service Items to a Paper Claim

File Maintenance Help for NextGen® Enterprise 8

Forcing Service Items to a Paper Claim

In the Service Item Library Maintenance window, you can force specific service items to a paper claim when claims generate at the practice and payer levels. In addition, forcing specific service items to paper at either level overrides the claim Media Type set on the Add/Modify Payer Information window. Force Service Items to Paper at the Practice Level Force Service Items to Paper at the Payer Level Parent topic: General Tab

File Maintenance Help for NextGen® Enterprise 8

Add a New Service Item

On the Service Item Library Maintenance window, select open menu button , then select New. Enter a CPT code or select on the to search for the CPT code. If you search for the code, the CPT4 Code Search window opens. Under Search Method, select either Code or Description to determine how you want the search results to list, then enter the search data either by code or description. Select the appropriate code, and then select OK. The service item number and default description automatically populate. The default description for the SIM is the same as the CPT4 code description. You can change the description if necessary. For example, if the description Office/outpatient visit, new, problem focused is not meaningful to the staff, you could change it to simply Office Visit New Patient. Enter the information on the General tab, including effective date range and price. Required fields display with red labels. If there are payers that use alternate codes for the SIM, then enter that informat

Help Guide for NextGen® Enterprise PM 8

Set Up Behavioral Health SIM Codes

Behavioral Health SIM codes are set up by selecting the appropriate SIM Type and the default Behavioral Health Base Minutes for each code. Open File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the Service Items list, double-click to open the library. The Service Item Library Maintenance window opens. Service Item Library Maintenance window If you want to modify an existing SIM code, enter the code in the Search field, and then select the code from the list. Displays existing parameters defined for the SIM code. If you want to create a SIM code, select Open Menu next to the Service Item # field, and the select New. In the CPT4 Code field, do one of the following. This field is required. Enter the CPT4 code to be used on claims. Select the Search button to search and select the CPT4 code to be used on claims. Note: The code must exist in the CPT4 Codes master file. The Service Item # field defaults to the selected CPT4 code and can be

Force Claims to Paper by ICD Code

Recommendations

Force the Secondary Claim to Bill to the Primary Claim Provider

Force Service Items to Paper at the Payer Level

Force Service Items to Paper at the Practice Level

Forcing Service Items to a Paper Claim

Add a New Service Item

Set Up Behavioral Health SIM Codes

Force the Secondary Claim to Bill to the Primary Claim Provider

Force Service Items to Paper at the Payer Level

Force Service Items to Paper at the Practice Level

Forcing Service Items to a Paper Claim

Add a New Service Item

Set Up Behavioral Health SIM Codes