Set the SIM Configuration Hierarchy

Help Guide for NextGen® Enterprise PM 8

Set Up Encounter Rate SIM Maintenance Configurations

After you set the SIM configuration hierarchy, you must set up specific parameters for the encounter rate SIM code. Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Select a library from the list. The Encounter Rate Billing Library Maintenance window opens. Right-click the Encounter Rate SIM grid, and then select New. The Encounter Rate SIM Maintenance window opens. Encounter Rate SIM Maintenance window Enter the service item number. Select the effective and expiration dates. Enter the co-pay amount. Select a condition code for Field Locator 18 on UB claims. Note: The Description and Amount fields are automatically filled in based on the service item description for the encounter and the corresponding dollar value from the SIM. You can modify the values. Optional: In the Required CPT4 section, select the open record button, and then select the codes. Select the payer in COB. Optional: In the Valid Primary Payers section, se

Help Guide for NextGen® Enterprise PM 8

Set Up the COB Claims Tab

The COB Claims tab on the Encounter Rate Billing Library Maintenance window defines whether or not payers that may be subsequent to an encounter rate payer require the ER SIM code on their secondary/tertiary claims. For example, Medicare requires an Encounter Rate SIM code, or pay code, on qualified FQHC claims. Medicare then pays on that ER SIM. To create a balanced electronic secondary claim, the Medicare ER SIM must appear on the secondary claim with the appropriate CAS segments. In the case where the primary is an encounter rate payer and the secondary is not, but the secondary needs to see the ER SIM from the primary payer on the claim, the setup can be either of the following: Setup the Encounter Rate Library for the primary payer to insert the ER SIM as a charge, so the charge can be flagged to bill to the next payer. Setup the Encounter Rate Library for the primary payer to insert the ER SIM on Encounter Maintenance, and then setup an ER Library for the secondary payer to inser

Help Guide for NextGen® Enterprise PM 8

Set the SIM Configuration Hierarchy

Before you build an encounter rate, you must configure your hierarchy for diagnosis code, CPT4 code, location, provider, sex, and age. NextGen® Enterprise PM uses this hierarchy to determine which encounter rate SIM to use during billing. For example, if diagnosis has a higher position in the hierarchy than location, the application uses an Encounter Rate SIM that applies to a specific diagnosis for all locations instead of an encounter rate that applies to all diagnoses for a specific location. Note: In most cases, the default hierarchy does not need to be changed. Open the Encounter Rate Billing library. The Encounter Rate Billing List window opens. Select the Open Menu button and select New. The Encounter Rate Billing Library Maintenance window opens. Encounter Rate Billing Library Maintenance In the Encounter Rate SIM section, select the Set Configuration Hierarchy button. The SIM Configuration Hierarchy window appears. The hierarchy is set from the top down. SIM Configuration Hier

Help Guide for NextGen® Enterprise PM 8

Add or Modify an Encounter Rate Billing Library

The Encounter Rate Billing library enables you to configure the billing process for payers who require a flat encounter rate. This library is used to configure the business rules applicable to a payer. The Encounter Rate Billing library provide the flexibility to set up multiple rate codes to accommodate the different billing requirements of individual payers. The appropriate library can then be attached to the payer. A SIM with the appropriate CPT4 code must be set up in the SIM library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing library, the SIM Configuration Hierarchy and the encounter rate information are also copied. To add or modify an Encounter Rate Billing library, do the following: Access File Maintenance. Select Libraries, and then Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select Open Menu and select New. To modify a library, select the library from the list, and

File Maintenance Help for NextGen® Enterprise

Add or Modify an Encounter Rate Billing Library

Before you begin A SIM with an appropriate CPT4 code must be set up in the SIM Library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing Library, the SIM configuration hierarchy and the encounter rate information are also copied. Encounter Rate Billing Library provides flexibility to set up multiple rate codes to accommodate different billing requirements of individual payers. You can generate both Encounter Rate Library Listing and Encounter Rate Library with Claim Detail Rules reports from the Encounter Rate Billing Library. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library, select the library from the list, select the open menu button and th

File Maintenance Help for NextGen® Enterprise 8

Add or Modify an Encounter Rate Billing Library

Before you begin A SIM with the appropriate CPT4 code must be set up in the SIM Library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing Library, the SIM configuration hierarchy and the encounter rate information are also copied. Encounter Rate Billing Library provides flexibility to set up multiple rate codes to accommodate different billing requirements of individual payers. You can generate both Encounter Rate Library Listing and Encounter Rate Library with Claim Detail Rules reports from the Encounter Rate Billing Library. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide forNextGen®Enterprise PM. To add or modify an Encounter Rate Billing Library, do the following: Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library,

Set the SIM Configuration Hierarchy

Recommendations

Set Up Encounter Rate SIM Maintenance Configurations

Set Up the COB Claims Tab

Set the SIM Configuration Hierarchy

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Set the SIM Configuration Hierarchy

Set Up Encounter Rate SIM Maintenance Configurations

Set Up the COB Claims Tab

Set the SIM Configuration Hierarchy

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library

Add or Modify an Encounter Rate Billing Library