Service Items Library

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

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Billing Library

The Behavioral Health Billing library defines parameters for “variance” charges which can be calculated and added to encounters during the billing process for specific payers. The library also defines other claim and billing parameters that may be needed when billing Behavioral Health services to specific payers. A single library can be created and linked to the practice to be used for all payers. Or payer-specific libraries can be created and linked only to those payers. You can generate the Behavioral Health Billing report from the Behavioral Health Billing library , go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Add or Modify a Behavioral Health Billing Library Parent topic: Behavioral Health Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Behavioral Health SIM Codes

Behavioral Health SIM codes are set up by selecting the appropriate SIM Type and the default Behavioral Health Base Minutes for each code. Open File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the Service Items list, double-click to open the library. The Service Item Library Maintenance window opens. Service Item Library Maintenance window If you want to modify an existing SIM code, enter the code in the Search field, and then select the code from the list. Displays existing parameters defined for the SIM code. If you want to create a SIM code, select Open Menu next to the Service Item # field, and the select New. In the CPT4 Code field, do one of the following. This field is required. Enter the CPT4 code to be used on claims. Select the Search button to search and select the CPT4 code to be used on claims. Note: The code must exist in the CPT4 Codes master file. The Service Item # field defaults to the selected CPT4 code and can be

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Billing

In NextGen® Enterprise PM, you can setup the billing requirements for Behavioral Health Billing. Behavioral health SIM codes are set up in the Service Items Library with a base minute value of 15, 30, 60, 240, or a custom value. In addition, the price per time unit is defined for each SIM code. During charge posting, behavioral health SIM codes prompt for the entry of a start and stop time, and then total time units for the charge are calculated based on the times entered. Payers are set up in the Payers master file with a base minute rounding method that is used to round the total time entered on each charge up or down when calculating time units. When multiple behavioral health charges on a single encounter have the same CPT4 code, the same modifiers, the same base minutes and the same unit price, those charges roll-up, or bundle, into a single line item on the claim. The total units on the claim for the roll-up line item is calculated using the total time entered on all of the indiv

File Maintenance Help for NextGen® Enterprise 8

Service Items Library

The Service Items library is the center of the billing functions. Within the Service Items library you can set up CPT4 codes for each practice, along with prices, and claim form designations. You can also group Service Items together under one main number or name. Libraries are available enterprise-wide, but each practice must designate which Service Items library to use by selecting it in the Libraries Practice Preferences. You can generate the Service Item Library Listing report from the Service Items library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up the Service Item Library You can set up your Service Item Library by setting up CPT4 codes for each practice, along with the prices and claims. General Tab Other Tab - SIM Library Payer Tab - SIM Library Labels Tab - SIM Library Notes/Significant Events Tab - SIM library Drugs Tab - SIM library Add a New Service Item Editing the Provider

Help Guide for NextGen® Enterprise PM 8

Service Items Library

The Service Items library is the center of the billing functions. Within the Service Items library you can set up CPT4 codes for each practice, along with prices, and claim form designations. You can also group Service Items together under one main number or name. Libraries are available enterprise-wide, but each practice must designate which Service Items library to use by selecting it in the Libraries Practice Preferences. You can generate the Service Item Library Listing report from the Service Items library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up the Service Item Library Set Up Anesthesia SIMs Parent topic: Setting Up Claims

Service Items Library

Recommendations

Non-Coordinated SIM Library

Behavioral Health Billing Library

Set Up Behavioral Health SIM Codes

Behavioral Health Billing

Service Items Library

Service Items Library

Non-Coordinated SIM Library

Behavioral Health Billing Library

Set Up Behavioral Health SIM Codes

Behavioral Health Billing

Service Items Library

Service Items Library