Populate the Populate 2400 PS1 Purchase Service Segment

Help Guide for NextGen® Enterprise PM 8

Add or Modify a Payer

From the Master Files - System list, select Payers. The Payers List window opens. To add a payer, select open menu , and then select New. The Add Payer Information window opens. Enter all the required information under the following tabs: Payer Defaults - 1 Defaults - 2 System Practice Alt Payer External Co-Pays Select OK to save the changes. To modify a payer, select the payer from the list, select open menu , and then select Open. The Modify Payer Information window opens. Do the required changes and then select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Co-Pays Tab

Because co-payments can vary among different departments and services, you can create multiple co-payments. When you enable multiple co-pays, co-pay settings display in the Payers master file in File Maintenance and in Insurance Maintenance in NextGen® Enterprise PM. The co-pay information created in the payers master file becomes the default for all insurance. However, you can change the co-pay settings when you modify insurance in NextGen® Enterprise PM. To enable multiple co-pays: On the General tab of the Enterprise Preferences window, select the Enable Multiple Co-Pays check box. Note: If you enable this option but no co-pays exist in the Payers master file, users can still add specialty co-pays in Insurance Maintenance. To create multiple co-pay information: Select Co-Pays tab on Modify Payer Information window in the Payers master file . Note: The tab displays only when multiple co-pays is enabled in Enterprise Preferences. The tab displays co-pay information that is used in Ins

Help Guide for NextGen® Enterprise PM 8

Select Media Types

You can select the media type for secondary and tertiary COB levels in the Payer master file. You can set the default media type for primary, secondary, and tertiary claims to be different for a particular payer. To access this window, open File Maintenance, select Master Files > PM > Payers, and then select the applicable payer. On the Modify Payer Information window, select the Practice tab and then the Claims sub-tab. In addition, you can set the Payer master file to force secondary and tertiary claims to paper for another payer. In other words, regardless of the media type setting in the Payer master file for the next payer, you can override those settings and force the claim to paper for the payers getting the secondary and tertiary claim. To force secondary and tertiary claims to paper for the next payer, activate the following options on the Practice Parameters tab of the Payer master file: When Primary, force Secondary claims to paper When Secondary, force Tertiary claims to pa

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Payers Master File

Payers are the third-party entities, other than guarantors or employers, that you expect to receive reimbursement from. Some examples of payers are commercial insurance companies, Medicaid, and Medicare. In the Payers master file, you can specify the contract associated with the payer, the participating providers, how to submit claims, and other general payer information. You can generate Payers Master File reports from the Payers master file. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Auditing Payers Master File Add or Modify a Payer Payer Defaults - 1 Tab Defaults - 2 Tab System Tab Practice Tab Configuring Alternate Payers You an use the Alternate Payer Simultaneous Billing feature to associate an alternate payer to a payer. External Tab for Payer Information Co-Pays Tab Changing the Payer Address and Associated Patient Records Activate and Assign a Payer to a Practice You can limit a practi

Help Guide for NextGen® Enterprise PM 8

Enable Segments for Claim-level Approved Amounts and Adjustments

The Submitter Profile library and the Payer master file both have settings that add the claim-level allowed amount segment and the claim-level adjustment segment to the electronic claim file. Because the settings work independently of each other, you can enable them at either level. However, if the same option is enabled at both levels, the Payer master file setting always overrides the Submitter Profile library setting. The following table shows the various results according to how the submitter profile and payer-level options are set: If the Submitter Profile setting is... And the payer-level setting is set to... Then the segment will... Enabled <none> (blank) Create Enabled Create Disabled Not create Disabled <none> (blank) Not create Enabled Create Disabled Not create Do one of the following: To set the options at the Submitter Profile level: In File Maintenance, select Libraries > Submitter Profiles. Open a submitter profile, and then select the Exception Options tab. Select in th

Populate the Populate 2400 PS1 Purchase Service Segment

Recommendations

Add or Modify a Payer

Co-Pays Tab

Select Media Types

Attach a Submitter Profile to the Payer Master

Payers Master File

Enable Segments for Claim-level Approved Amounts and Adjustments

Add or Modify a Payer

Co-Pays Tab

Select Media Types

Attach a Submitter Profile to the Payer Master

Payers Master File

Enable Segments for Claim-level Approved Amounts and Adjustments