To set up a group that has the same Group Provider number for payers at all or several practice locations, do the following:
- In File Maintenance, under Master Files, select .
The Groups List window opens.
- Double-click a group.
The
Group Information window opens.
- From the Service Location list, select the <Default> option.
- Select one of the following options based on the following information:
- To set up the group on the default payer, double-click the Default row listed under the Payer Name column.
The Group Information window opens additional fields. This set up is for the default payer and the Payer Name field is disabled.
- To set up a specific payer for the group, right-click in the Group Information section, then select New.
The Group Information window opens additional fields. Because this setup is for a specific payer, the Payer Name field is available. From the Payer Name list, select a payer.
- In the Group Number field, enter the group number.
- In the Opt Group Val field, enter the value for the alternate group number for a specific payer at a specific location. This number can be used for a default location and a default payer. This field is used for paper and electronic claims.
- Select a taxonomy code for the group at the location level.
- Enter the effective and expiration dates for the group.
Note: When a group is attached to a provider using the location and payer combination, the system first checks the effective and expiration dates for the provider. If the provider’s dates are valid for the claim being processed, then the attached group’s dates are checked. If the claim’s date of service falls on or between the group’s dates, then the group information is used to process the claim.
- Select the option to determine whether the Attending (2310A) and Rendering (2310B) loops should be suppressed.
For more information about suppressing the 2310A Attending and 2310B Rendering loops, go to
NextGen Healthcare Success Communityand download the latest
Claims User Guide forNextGen® Enterprise PM.
- Select a location in the Bill-to-Location field if you want to use a specific practice location's information instead of the billing provider information for the NM1, NM3, and NM4 segments (billing name, address, and city-state-zip). When you select a location is selected, the submitter profile Pay-To options are ignored for that particular claim.
Note: These options display on the
Exception Options tab of the submitter profile under
Billing/Pay-To Provider (2010AA/2010AB Loops):
- Populate Billing address with Service Location and Pay-To with Billing information.
- Populate Pay-To Provider with Group and Billing Provider with Rendering.
- Enter the tax ID for the group.
- Enter the remaining information in the appropriate fields on the window.
- If you want to attach a taxonomy code at the procedure level for specific procedure ranges, select CPT4 Group Information
. For details about group taxonomy codes, go to the NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise.
- Select OK.
