Rules for Non-Coordinated SIM Configuration

Help Guide for NextGen® Enterprise PM 8

Add or Modify a Non-Coordinated SIM Library

Open File Maintenance. Select Libraries, and then Non-Coordinated SIM Library. The Non-Coordinated SIM List window opens. Do one of the following: To create a library, select open menu button and select New. To modify a library, select the library from the list, and then select open menu button and select Open. The Non-Coordinated Service Item Library Maintenance window opens. In the Non-Coordinated SIM Library Name field, enter a name for the library. This field is required. Set up Non-Coordinated SIM Configuration as needed. For more information on setting up Non-Coordinated SIM Configuration, see Set up Non-Coordinated SIM Configurations. To save changes and close the window, select OK. Set Up Non-Coordinated SIM Configurations In Non-Coordinated library, you can configure billing rules for SIM codes. Parent topic: Non-Coordinated SIM Library

File Maintenance Help for NextGen® Enterprise 8

Rules for Non-Coordinated SIM Configuration

If you configure a rule with SIM and valid payer, then the balance will move to the valid payer or the patient if you have a matching SIM in the charge. If you configure a rule with the combination of SIM, provider credential, and valid payer, then the non-coordinated SIM rule is applied only when you have a matching provider credential and SIM. You can configure multiple rules with the same SIM having different combinations as follows: SIM and valid payer SIM, provider credential, and valid payer SIM, prior payer, and valid payer When you configure multiple rules with the same SIM but different combinations, the rule with the combination of SIM, valid payer, and provider credential will be considered first. If this rule does not match, then the rule with combination of SIM, valid payer, and prior payer will be considered. If none of the first two rules match, then the rule with matching SIM and valid payer will be considered. If you configure multiple rules with the same SIM and valid

Help Guide for NextGen® Enterprise PM 8

Non-Coordinated SIM Library

The Non-Coordinated SIM library enables you to set up billing rules for payer-specific service items. This includes service items that are only reimbursed by specific payers such as a state plan, special grant program, or Medicaid, that would not be reimbursed if billed to other payers. Example: A range of behavioral health SIM codes can be billed to Medicaid but not to any other payer. That range of SIM codes can be set up in this library with Medicaid selected as the only valid payer, therefore making the SIM codes “non-coordinated” for all other payers. The library also defines other parameters that affect how non-coordinated SIM codes are handled during charge posting and billing. These parameters include options and settings for Balance Control, auto-adjustments, and claims. A single library can be created and used by the practice. The library may include multiple detail rows, each with different parameters and requirements for a specific payer. Note: This is a practice level libr

File Maintenance Help for NextGen® Enterprise 8

Non-Coordinated SIM Library

The Non-Coordinated SIM library enables you to set up billing rules for payer-specific service items. This includes service items that are only reimbursed by specific payers such as a state plan, special grant program, or Medicaid, that would not be reimbursed if billed to other payers. Example: A range of behavioral health SIM codes can be billed to Medicaid but not to any other payer. That range of SIM codes can be set up in this library with Medicaid selected as the only valid payer, therefore making the SIM codes “non-coordinated” for all other payers. The library also defines other parameters that affect how non-coordinated SIM codes are handled during charge posting and billing. These parameters include options and settings for Balance Control, auto-adjustments, and claims. A single library can be created and used by the practice. The library may include multiple detail rows, each with different parameters and requirements for a specific payer. Note: This is a practice level libr

File Maintenance Help for NextGen® Enterprise 8

Set Up Non-Coordinated SIM Configurations

You can configure billing rules for SIM codes that are valid for specific payers, and are therefore considered invalid or non-coordinated for other payers on the Non-Coordinated SIM Maintenance window. The rules can be configured in a way that ensures a non-coordinated SIM code is billed only to a valid payer. The rules can also be configured to ensure that services rendered by a provider with a specific credential are billed only to a valid payer. You can define additional rules for balance control, auto-adjustments, and claims. In File Maintenance, select Libraries, and then select Non-Coordinated SIM Library. The Non-Coordinated SIM List window opens. Double-click a library. The Non-Coordinated Service Item Library Maintenance window opens. In the Payer SIM Configuration section, do one of the following: To create a new SIM configuration or row, select open menu and then select New. To modify an existing SIM configuration, select the row, select open menu and then select Open. The N

Help Guide for NextGen® Enterprise PM 8

Set Up Non-Coordinated SIM Configurations

You can configure billing rules for SIM codes that are valid for specific payers, and are therefore considered invalid or non-coordinated for other payers on the Non-Coordinated SIM Maintenance window. The rules can be configured in a way that ensures a non-coordinated SIM code is billed only to a valid payer. The rules can also be configured to ensure that services rendered by a provider with a specific credential are billed only to a valid payer. You can define additional rules for balance control, auto-adjustments, and claims. In File Maintenance, select Libraries, and then select Non-Coordinated SIM Library. The Non-Coordinated SIM List window opens. Double-click a library. The Non-Coordinated Service Item Library Maintenance window opens. In the Payer SIM Configuration section, do one of the following: To create a new SIM configuration or row, select open menu and then select New. To modify an existing SIM configuration, select the row, select open menu and then select Open. The N

Rules for Non-Coordinated SIM Configuration

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