Mutually Exclusive Edit Example

Help Guide for NextGen® Enterprise PM 8

Select Mutually Exclusive Edits in the Claim Edit Library

Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Mutually Exclusive CCI Edits

Mutually Exclusive codes are those codes that cannot reasonably be done in the same session.CPT codes that are mutually exclusive of one another based either on the CPT definition or the medical impossibility/improbability that the procedures could be performed at the same session can be identified as code pairs. These codes are not necessarily linked to one another with one code narrative describing a more comprehensive procedure compared to the component code, but can be identified as code pairs that should not be reported together. Parent topic: CCI Edits

NextGen® Adaptive Content Engine Help Enterprise 8

Record Cancer Staging Details

Open the Histories - Dermatology template. In the Skin Cancer Log panel, in the Staging section, click Add. The Cancer Details template opens. In the Cancer Type section, do the following: Select the cancer type as Primary or Secondary. Do one of the following: To enter the details in all the fields, select Enable free text check box. To select the options from the respective picklist for each field, clear Enable free text. Select a diagnosis or click Add common assessment to select a diagnosis. Click Cancer Type / Site and select the cancer type from the Cancer Type Details template. Enter or select the Status and Behavior value from the picklist. Enter or select the Histology and Laterality value from the picklist. In the Cancer Staging section, do the following: If staging details are not available, select the appropriate option: Staging pending Insufficient data No staging system If the staging details are available, verify and update the date and time of cancer staging. Select the

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M

File Maintenance Help for NextGen® Enterprise 8

Claim Edit Columns

The columns in the Claim Edit Library Maintenance window have the following flexibility: You can sort columns alphabetically or numerically in ascending or descending order. You can adjust most column widths to display more or less information. The following columns appear on the Claim Edit Library Maintenance window: Active – The fields in this column can be checked or unchecked at your discretion. When the field is checked, the claim edit that it corresponds to is considered Activated, which means that the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID – The fields in this column display a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit – The fields in this column display the claim edits that are available in the Claim Edits Library. Help Text – The fi

Help Guide for NextGen® Enterprise PM 8

Claim Edit Columns

The columns in the Claim Edit Library Maintenance window have the following flexibility: You can sort columns alphabetically or numerically in ascending or descending order. You can adjust most column widths to display more or less information. The following columns appear on the Claim Edit Library Maintenance window: Active – The fields in this column can be checked or unchecked at your discretion. When the field is checked, the claim edit that it corresponds to is considered Activated, which means that the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID – The fields in this column display a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit – The fields in this column display the claim edits that are available in the Claim Edits Library. Help Text – The fi

Mutually Exclusive Edit Example

Recommendations

Select Mutually Exclusive Edits in the Claim Edit Library

Mutually Exclusive CCI Edits

Record Cancer Staging Details

Claim Edits Library

Claim Edit Columns

Claim Edit Columns