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| Field | Description |
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| Note Template | Select the note template to use when a user creates an encounter during check-in. A new note will be created based on this template.
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| Auto Delay Reason Code | Select a delay reason code to be used by the payer as a default delay reason code. A delay reason code set at the claim/encounter level overrides a delay reason code set at the payer level. This field works in conjunction with the Auto Delay Reason Code Days field. |
| Auto Delay Reason Code Days | Set this number to control when the Auto Delay Reason Code is applied to a claim. When the number of days elapsed between the billing date and the encounter date is greater than the Auto Delay Reason Code Days, then it is applied to the claim. |
| Delay Billing [0-365] Days From Enc. Date | Enter the number of days to hold batch billing starting from the encounter date. This setting allows charges billed to a non-Medicare payer to be held for the specified number of days before claims are generated. For example, if the encounter date is July 1 and the hold days are set to 5, then the hold date is July 6. The hold date is calculated when a user attaches insurance to an unbilled encounter. The hold date then displays in the Hold Until Date field on the Billing & Collections tab in Encounter Maintenance in NextGen® Enterprise PM.
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| Enable NPI on electronic claims | Select how you want to handle enabling the NPI from the options below:
The payer master file setting on the Other tab of the Practice overrides both the submitter profile setting and the system level setting. |
| User-defined claims override price | Select the user-defined pricing from the SIM Library to print on your claims. Select either User Defined Price 1 or User Defined Price 2. The two options you can select from can be renamed on the Libraries tab of the Enterprise Preferences. To set up the pricing, you must enter prices on the General tab of the Service Item Library Maintenance in the following fields: UD1 Price - Non-Facility, UD1 Price - Facility, UD2 Price - Non-Facility, UD2 Price - Facility. |
| Patient Pmt Balance Reversal Reason Code | This field only displays if a managed care contract and the Transfer non-participating charges to patient check box are selected on the Libraries tab of the Payer master file. Select Settled Move to Secondary (or Forwarded Move to Secondary) from the drop-down list. This setting moves the balance from the patient bucket to the secondary insurance. When the patient has a balance and the applicable reason code is used to post the payment, the balance will transfer to the secondary and will be marked to rebill. This move can only occur once for a patient's payment on each charge. The list is determined by the Patient Reason Code Library selected in the Transactions Practice Preferences.
There are two setup requirements:
A reason code must be added to the applicable Reason Code Library in order to populate this field. The following requirements must be met when adding the reason code:
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| Payer User-Defined 1 Field | For this field to appear, it must have a label assigned to it. The label is assigned on the General tab in Practice Preferences. The user-defined field displays on the Insurance Maintenance window for the encounter. |
| Populate 2400 CLIA (Professional Only) | Select one of the following options:
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| Authorization Required | Enable this check box if authorization is required by the payer. |
| Verification Required | Enable this check box if verification is required by the payer. |
| Referral Support | Enable this check box to enable the ability to submit referral requests to the payer using NextGen® Eligibility Verification. |
| Do not print statements | Enable this check box to exclude printing encounters on statements for this payer. This option only applies to batch mode for those encounters where the check box is checked for the primary payer and the encounter has a zero patient balance. An encounter will print on a statement even if this check box is checked for the primary payer, if there is a balance in the patient bucket. |
| Accept financial responsibility for primary copay amt | Enable this check box to default the copay amount to the secondary insurance instead of the patient bucket. This accommodates those states that require the copay amount be the responsibility of the secondary payer. |
| Force rendering provider from primary claim as rendering on secondary claim | Enable this check box to use the rendering provider from the primary claim to create the secondary claim, regardless of the provider being credentialed. |
| Enable medical necessity check at appointment | Enable this check box to trigger a medical necessity check for specified payers during appointment creation and for payers who are added at check-in. |
| Notification required | Enable this check box if the payer requires notification. |
| Copay percent calc | Enable this check box to give users the choice of entering either a dollar amount or a percentage on the Insurance Maintenance window in NextGen® Enterprise PM. |
| Eligibility Support | Enable this check box to enable the ability to submit eligibility requests to the payer using NextGen® Eligibility Verification. |
| Encounter Copay Required | Enable this check box to make the encounter Co-pay Amt field required. |
| Use allowed amount on paper/electronic claims | Enable this check box to bill the allowed amount from a contract instead of the charge amount on paper and electronic claims. If you enable this check box, you must also set up the allowed amount in a contract to pull on the claim. If an item is billed that is not in the contract, the system uses the Service Item library (SIM) price. |
| Default Accept Assignment to No | Enable this check box to set the default assignment of benefits to No for all encounters for this payer when the rendering provider is a non-participating provider on the contract associated with the insurance. This check box is disabled by default. When this option is selected, the first line in the Verification section of the Patient Chart - encounters/Insurance tab will display Benefits NOT Assigned. In addition, on the paper and electronic claim, Accept Assignment will be set to No. The Default Accept Assignment to No option will always have priority over the Default Non-Participating Provider's Accept Assignment to No option. When this option is enabled, the Default Non-Participating Provider's Accept Assignment to No option will automatically be checked and disabled. |
| Prompt for note during checkin of encounter | Enable this check box so that a new note is automatically created when a user creates an encounter during the check-in process. When you enable this check box, the Note Template field becomes available. The note is based on the selected template in the Note Template field. The note is not required; the user can close the note without saving it. |
| Require case management | Enable this check box to require case management in NextGen® Enterprise PM. When this payer is attached to an encounter, a case is required. |
| Auto create referral based on Elig results | Enable this check box to automatically create a referral from the NextGen® Eligibility Verification results when a 278 is successfully returned. |
| Bill encounter diagnoses | Select this option and the Enable billing of encounter diagnoses option in practice preference to fill in any empty diagnosis slots on the claim header during billing with encounter diagnoses not already present on the claim.
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| Always bill as primary | Enable this check box if you want all claims billed at this practice with this payer in the secondary or tertiary encounter payer COB position to bill as primary and to have no information on any other payers included on the claim. For additional details about using the Always bill as primary check box, see Billing a Payer as Primary Regardless of Encounter COB. |
| Bill with prior payer | Enable this check box if you want charges created for this payer at this practice to automatically flag this payer's COB to be billed along with the preceding payer's COB when the preceding payer's COB flag is checked on. For example, a secondary payer will bill if this option is selected. Likewise, a tertiary payer will bill only if the secondary payer is set to bill and this option is selected for the tertiary payer. For additional details about using the Bill with prior payer check box, see Billing a Payer as Primary Regardless of Encounter COB. |
| Ignore modifiers on roll-up | When enabled, the Ignore modifiers on roll-up check box ignores modifiers when charges are billed and roll-up is enabled. For example, the ignored modifiers do not print on claims. |
| Print Doc Mgmt Images with Claim | Enable this check box if you want the images (such as X-rays) associated with an encounter to print when you generate a claim for the encounter. This option configures the individual payer for printing images with claims. However, you can also set specific document types to print with claims. |
| Referral required | Enable this check box to require a manual referral. When this check box is enabled, the Referral Required check box is enabled on the Insurance Maintenance window. |
| Enable APG | Enable this check box to enable the NextGen APG Expected Reimbursement interface between NextGen® Enterprise PM and 3M Group Plus Content Services software. |
| Authorization Support | Enable this check box to enable the ability to submit authorization requests to the payer using NextGen® Eligibility Verification. |
| Force claim form (1500/UB) primary claim for secondary/tertiary claims for Financial Class | Enable this check box to set up a payer so that when a secondary or tertiary payer uses a claim form (UB or 1500) different from the primary payer, the secondary or tertiary payer bills on the same claim form as the primary payer for the selected financial classes. The financial class is selected from a drop-down menu under Financial Class. You can select one or multiple financial classes for the primary payer. If no financial classes are selected, all financial classes will apply. |
| ERA - If any line is selected for bill, select all lines for bill to next insurance | Enable this check box to select all lines for billing to the next insurance. |
| Disable rendering claim break | Select one of the following options to define how NextGen® Enterprise PM handles rendering provider claim breaks on all electronic and paper claim forms:
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| Disable location claim break | Select the Disable location claim break option and then select one of the following options to define how NextGen® Enterprise PM handles location claim breaks on all electronic and paper claim forms:
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