Service Items Library for Dental Billing
When setting up SIM codes for dental, set the
Form
field on the
Service Item Library Maintenance
window to
ADA
.
Set Up Payer-Specific Requirements
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Help Guide for NextGen® Enterprise PM 8
Payers Master File for Dental Billing
Three areas in the Payers master file must be set up for dental claims. These setup requirements are on the following tabs of the Payers master file: Payer Defaults - 2: Used to set up a payer for dental billing and ADA claims. System: Used to set up provider secondary references. Practice: Used to set up electronic claims. Defaults-2 Tab System Tab Practice Tab Parent topic: Dental Billing
Help Guide for NextGen® Enterprise PM 8
Set Up Payer-Specific Requirements
Not all payers require an ADA claim form. Some payers may require a 1500 form. To set up a SIM code to use 1500 forms for a payer, do the following: From the Service Item Library Maintenance window, select the applicable service item. Select the Payer tab. Payer In the Payer field, select the payer. In the Eff and Exp columns, enter the effective and expiration dates for the SIM code/payer. In the Form column, select 1500. To save changes and close the window, select OK. Parent topic: Service Items Library for Dental Billing
File Maintenance Help for NextGen® Enterprise 8
Set Up ADA SIMs
Service items that are only used as Dental SIMs are designated as a Dental SIM by selecting ADA from the Form drop-down list on the General tab of the Service Item Library Maintenance window for that SIM. Service items designated as Dental SIMs can only be billed on an ADA Dental claim or as patient responsibility; they do not populate an 1500/837 Professional or UB/837 Institutional form. Open a SIM in a Service Item Library. In the File Maintenance window, select the General tab. Select ADA from the Form drop-down list. Select OK. Parent topic: Dental SIMs
File Maintenance Help for NextGen® Enterprise 8
Set Up a Dental and Medical SIM
Service Items can be set up and billed as dental or medical SIMs. They must be set up at the Payer level in the Service Item Library. Open a SIM in a Service Item Library. Select the General tab. Ensure that 1500 or UB is selected in the Form drop-down list. Select the Payer tab. Select the applicable dental payer from the Payer drop-down list. You must designate this payer as a dental payer on the Payer tab of the Service Item Library Maintenance window. See Payer tab for more information. In the table, enter the applicable effective and expiration dates in the Eff and Exp fields. Select ADA from the Form drop-down list. Enter any additional information that is applicable. Select OK. Parent topic: Dental SIMs
File Maintenance Help for NextGen® Enterprise 8
Dental SIMs
To accurately use the Dental billing feature, the service items that are used for billing dental charges need to be designated Dental SIMs in the Service Item Library. A service item is designated a Dental SIM three different ways depending on the following ways it is used: SIMs only used as a Dental SIM SIMs used as a Medical and a Dental SIM SIMs used as an Anesthesia SIM and a Dental SIM Set Up ADA SIMs Set Up a Dental and Medical SIM Set Up a SIM Used as an Anesthesia and a Dental SIM Parent topic: Add a New Service Item
Help Guide for NextGen® Enterprise PM 8
Dental Billing
This section provides information on dental billing for Health Centers that perform dental services. Specific setup in File Maintenance is required so that dental charges can be entered on encounters and then billed to dental payers on either 1500, ADA or UB claim forms. The type of claim form generated is determined by the setup for each dental payer. The following claim formats are supported in NextGen® Enterprise PM: 1500: Electronic 837PPaper CMS 1500 Form (2012) ADA: Electronic 837D Paper ADA Form (2024) UB: Electronic 837IPaper UB04 Form (2004) Dental billing in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Code Tables CPT4 Codes SIM library Claim Edits library Claim Printing library Transaction Codes Payers Set Up Practice Preferences for Dental Billing View Code Tables for Dental Billing Service Items Library for Dental Billing Claim Edits for Dental Billing Claim Printing Library for ADA Claims Payers Master File for Dental Billi
