Payer Claim Break Options

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Break Options for a Payer

Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Double-click to open the desired payer. The Modify Payer Information window opens. Select the Practice tab, and then the Other sub-tab. Modify Payer Information window; Practice tab; Other sub-tab If applicable, select the Disable rendering claim break check box and select one of the following options in the drop-down field: Use Encounter Rendering: The claim will use the Rendering provider entered on the Encounter Maintenance window. Note: Supervisor billing occurs if the rendering provider on the encounter has a supervisor. Use Provider from the First Charge Line on the Claim: The claim will use the Rendering provider entered on the Charge Posting window for the first charge. Note: Supervisor billing occurs if the rendering provider on the first charge has a supervisor. Use the Provider with the Greatest Total Charge Amount: The claim will use the Rendering provider with the g

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering. These rules determine which provider goes on the claim and includes the following criteria: Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios. If None is selected, then claims create using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim. If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim. On the Anesthesia Library Payer Maintenance window, select the Claim Options tab. Define Claim Options parameters for the selected valid payer(s): Send surgical as SV item: Select t

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering. These rules determine which provider goes on the claim and includes the following criteria: Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios. If None is selected, then claims create using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim. If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim. On the Anesthesia Library Payer Maintenance window, select the Claim Options tab. Define Claim Options parameters for the selected valid payer(s): Send surgical as SV item: Select t

Help Guide for NextGen® Enterprise PM 8

Disable Rendering Claim Breaks

Disable Rendering Claim Breaks is used in relief and discontinuous time scenarios to determine which rendering or MD Anesthesia goes on the claim as the rendering provider. When there is more than one anesthesia service line. Claims are created by the rules set in File Maintenance > Libraries > Anesthesia > Anesthesia Library Payer Maintenance > Claim Options tab. If you do not select any options on this window, then claims are created using existing claim splitting rules. The following options are available for selection to identify the rendering provider or MDA to go on the claim when there is more than one anesthesia service line: Option Description Use Encounter MDA (intended for non-split billing) Uses the Encounter MDA Anesthesia for non-split billing, if there is no MDA then it uses the Encounter Rendering. Use Encounter Rendering (intended for split billing) Uses the Encounter MDA on the MDA claim and Encounter Rendering on the CRNA claim. Use MDA from First Anesthesia Charge L

Help Guide for NextGen® Enterprise PM 8

Billing Anesthesia Encounters

Anesthesia encounters are billed according to the in-progress billing rules and disabling rendering claim break rules identified in File Maintenance > Libraries > Anesthesia > Anesthesia Library Payer Maintenance > Claim Options tab. In Progress Billing Disable Rendering Claim Breaks You can disable the claim break functionality for rendering providers. Parent topic: The Billing Process

Help Guide for NextGen® Enterprise PM 8

Set Up Exceptions for the Primary Payer

The Claim Printing options available for the 1500 form on the Exceptions: When Payer is Primary tab apply only when the payer associated with the library is the primary payer. In File Maintenance, select Libraries and then Claim Printing. The Claim Printing List window opens. Double-click the applicable library or select Open Menu and select New. Select the Exceptions: When Payer is Primary tab. Select the claim type in the 1500 Claims, UB Claims, or the ADA Claims fields. Choose the settings for the options you want to use and then select OK. Parent topic: Claim Print Options in Claim Printing Library

Payer Claim Break Options

Recommendations

Set Up Claim Break Options for a Payer

Set Up Claim Options for Anesthesia Billing

Set Up Claim Options for Anesthesia Billing

Disable Rendering Claim Breaks

Billing Anesthesia Encounters

Set Up Exceptions for the Primary Payer

Set Up Claim Break Options for a Payer

Set Up Claim Options for Anesthesia Billing

Set Up Claim Options for Anesthesia Billing

Disable Rendering Claim Breaks

Billing Anesthesia Encounters

Set Up Exceptions for the Primary Payer