Option for Billing Provider Secondary Reference Qualifiers

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

UB Claims Tab on Secondary References Tab

Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51 - (This option only displays on the UB Claims tab.) The default for the 2010A Billing Provider references from Field Locator 51 on the UB claims from the payer master. Physician Billing ID - If the provider is attached to a billing group, the Physician Billing ID is the group number. If not, then it is the individual provider number. The Physician Billing ID is the default for the 2010A Billing Provider references on HCFA claims. Group Nbr - The group number for the rendering physician. If the rendering physician is not attached to a group, the field will be blank. Indiv Phys ID - The individual provider number for 2010A Billing Provider and 2310B Rendering Provider references. The supervising physician's individual ID fo

Help Guide for NextGen® Enterprise PM 8

System Tab

To set up provider secondary references, use the ADA Claims tab on the Claims sub-tab on the System tab of the Modify Payer Information window. Modify Payer Information Use the following table to set up your Provider Secondary References for dental payers. Provider Secondary Reference Qualifier / Data Element Billing Tab Employer ID Number (EI) / Tax ID Referring Tab <none> / <none> Rendering Tab <none> / <none> Service Facility Tab <none> / <none> Payer Billing Tab <none> / <none> Note: For more information on provider secondary references, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise, and then refer to the Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs section. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Secondary References Sub-Tab

The Secondary References tab contains additional tabs for 1500 Claims, UB Claims, and ADA Claims qualifiers and data elements. The sub-tab names, and the qualifier and data element options vary depending on whether you have selected the 1500 Claims, UB Claims, or ADA Claims tab. Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs Note: TheUB Claimstab only displays when you have set up theUB Claim Formoptions in theEncountersPractice Preferences. Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is t

File Maintenance Help for NextGen® Enterprise 8

Secondary References Sub-Tab

The Secondary References tab contains additional tabs for 1500 Claims, UB Claims, and ADA Claims qualifiers and data elements. The sub-tab names, and the qualifier and data element options vary depending on whether you have selected the 1500 Claims, UB Claims, or ADA Claims tab. Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs Note: TheUB Claimstab only displays when you have set up theUB Claim Formoptions in theEncountersPractice Preferences. Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is t

Option for Billing Provider Secondary Reference Qualifiers

Recommendations

Enable Supervisor Billing at the Provider/Practice Level

Supervisor Billing

UB Claims Tab on Secondary References Tab

System Tab

Secondary References Sub-Tab

Secondary References Sub-Tab

Enable Supervisor Billing at the Provider/Practice Level

Supervisor Billing

UB Claims Tab on Secondary References Tab

System Tab

Secondary References Sub-Tab

Secondary References Sub-Tab