Force the Secondary Claim to Bill to the Primary Claim Provider

Help Guide for NextGen® Enterprise PM 8

Force Claims to Paper by ICD Code

You can select diagnoses that force the claim to paper for specific payers when associated with a SIM code. To force claims to paper for specific ICD codes for a payer, perform the following steps: From File Maintenance, access Libraries > Service Items. The Service Item Library Maintenance window opens. Enter the CPT4 code and then select Payer. On the Payer tab, do the following: Select a payer in the Payer field. Enable the Force to Paper check box. Select the Open Record/Force to Paper ICDs button. The Diagnosis Codes window opens. On the Diagnosis Codes window do the following: Search for the ICD codes that you want to force to paper. Use the blue arrow to move the codes from the Available list to the Included list. When a payer, with an ICD code set to force to paper, is included in a Service Item, a paper claim is generated for the charge that includes the SIM. Parent topic: Generating Secondary Electronic Claims

File Maintenance Help for NextGen® Enterprise 8

Enable Supervisor Billing at the Provider/Practice Level

When you enable Supervisor Billing for a provider: A supervisor is always required for the provider at the current practice. If no additional Supervisor Billing settings are enabled, all claims for encounters where this provider is rendering use the supervising provider’s name when they are created. You can add specific payer rows on the Practice tab of the Provider master for any location, including the Default location, and the claims will still bill under the Supervisor's name. SIM exceptions and contract exceptions can then be attached to these specific payer rows and still allow the claim to bill under the Supervisor's name. From the Master Files > System list, select Providers. Double-click the provider requiring supervisor billing and then select the Practice tab. Enable the Enable Supervisor Billing check box. Parent topic: Supervisor Billing

Help Guide for NextGen® Enterprise PM 8

Enable Supervisor Billing at the Provider/Practice Level

When you enable Supervisor Billing for a provider: A supervisor is always required for the provider at the current practice. If no additional Supervisor Billing settings are enabled, all claims for encounters where this provider is rendering use the supervising provider’s name when they are created. You can add specific payer rows on the Practice tab of the Provider master for any location, including the Default location, and the claims will still bill under the Supervisor's name. SIM exceptions and contract exceptions can then be attached to these specific payer rows and still allow the claim to bill under the Supervisor's name. From the Master Files > System list, select Providers. Double-click the provider requiring supervisor billing and then select the Practice tab. Enable the Enable Supervisor Billing check box. Parent topic: Supervisor Billing

Help Guide for NextGen® Enterprise PM 8

Supervisor Billing

You can create encounters that require that a supervisor is billed instead of a mid-level rendering provider. To set up this type of billing, you must do the following: Supervisor Billing is enabled by default for all payers, but you can disable it for payers that do not need it. Enable supervisor billing so that a supervisor is always required for a specific provider at the current practice. If necessary, enable or disable supervisor billing in the specific payer rows in the provider master file. The payer row setting overrides the practice-level setting on the Practice tab for just that provider/payer combination. The payer-level settings are available for payer rows at either the Default location (which will apply to all locations) or a specific location (which will only apply for that location). Make the Supervisor field available on the Encounter Maintenance window in NextGen® Enterprise PM. Disable Supervisor Billing for a Payer Enable Supervisor Billing at the Provider/Practice

Help Guide for NextGen® Enterprise PM 8

Option for Billing Provider Secondary Reference Qualifiers

This billing option only applies to professional claims (1500/CMS1500). The Bill SSN with SY secondary reference option on the Modify Provider Practice Payer window in the Provider master file enables you to set up the Billing Provider Secondary Reference Qualifier to be an SY for SSN or an EI for Tax ID based on how the provider is credentialed with Medicare. When this option is selected, the 2010AA Billing Provider Secondary Reference Qualifier REF01 is set to SY (Social Security Number). Data for this option is pulled from the Tax ID Number/SSN field on the Practice tab in the Provider master file into the REF02 segment. If the SSN for a provider is not in the system, the Tax ID number is pulled into the REF02 segment. If the option is not selected, the 2010AA Billing Provider Secondary Reference Qualifier REF01 is set to EI (Tax ID Number) and the Tax ID number is pulled into the REF02 segment. Parent topic: Supervisor Billing

File Maintenance Help for NextGen® Enterprise 8

Fields in the Claims Tab of Modify Payer Information

Field Description Submitter Profile Select the submitter profile that you want to apply to 1500 or form template claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. If there are multiple payers with the same transmitter ID, then a message displays stating there is more than one payer with the same ID. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the Payers master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type accepted by the clearing house as being electronic or paper. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable this check box if you want the claim being s

Force the Secondary Claim to Bill to the Primary Claim Provider

Recommendations

Force Claims to Paper by ICD Code

Enable Supervisor Billing at the Provider/Practice Level

Enable Supervisor Billing at the Provider/Practice Level

Supervisor Billing

Option for Billing Provider Secondary Reference Qualifiers

Fields in the Claims Tab of Modify Payer Information

Force Claims to Paper by ICD Code

Enable Supervisor Billing at the Provider/Practice Level

Enable Supervisor Billing at the Provider/Practice Level

Supervisor Billing

Option for Billing Provider Secondary Reference Qualifiers

Fields in the Claims Tab of Modify Payer Information