Set Up a Fee Schedule for Contract Payers

Help Guide for NextGen® Enterprise PM 8

Add or Modify Contracts

In File Maintenance, select Libraries and then Contracts. The Contracts Libraries window opens. To add a new contract, select the open menu button, and choose New. To modify an existing contract, highlight the contract, select the open menu button, and then select Open. The Contract Library Maintenance window opens. Enter or modify the Contract Name, Effective Date, and Expiration Date. Enter or modify the Contract Defaults information. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, enable the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter or modify the information in the Automatic Adjustments section that applies. Select the Fee Schedule tab. Enter or modify the CPT4 code that is applicable to t

Help Guide for NextGen® Enterprise PM 8

Set Up Auto Charge Adjustments for Non-Participating Providers

Before you begin For the Contract's auto-charge adjustment to work properly, you must populate the following fields on the General tab of the Contract Library Maintenance window: Add a value to the % of Allowed Amount for NonParticipants field Select the Automatically adjust charges check box The application enables you to set up auto-adjustments for non-participating providers based on the terms of their contract. When charges are entered, they are adjusted according to the terms of the contract for the non-participating providers. In File Maintenance, access the Payers Master File. The Payer List window appears. Select the open menu button and select New to set up a new payer or select Open to modify an existing payer. The Add/Modify Payer Information window appears. Select the Practice tab and then select the Libraries tab. Select the drop-down arrow in the Managed Care Contract field and select the contract that meets the contract terms of the payer. When you select a contract, the

File Maintenance Help for NextGen® Enterprise 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

Help Guide for NextGen® Enterprise PM 8

Fields on the Fee Schedule Tab

Field Description Date Range Indicates the Effective date when the fee is to begin, and the Expiration date when the fee will end. The Date Range for the specific CPT4 code must fall within the date range for the contract as defined on the General tab. You can enter multiple date ranges for a CPT4 code in cases where you need to update your contract to meet new requirements. Note: The Fee Schedule rows display in descending date order by Effective Date. The most recent dates display first. Example: 01/01/2016 and then 01/01/2000. Type Specifies the Fee for Service (FFS) as the type of charge. Note: Capitated type is not supported at this time. Non-Facility/Facility Indicates whether the reimbursement for a service performed at a facility or non-facility service location. Allowed Indicates the amount allowed by the contract for the charge. An adjustment will be made between the charge amount and the allowed amount during charge entry if the Automatically adjust charges check box is sele

File Maintenance Help for NextGen® Enterprise 8

Add or Modify a Contract

In File Maintenance, select Libraries > Contracts. The Contracts Libraries window opens. To add a new contract, select open menu button and select New. The Contract Library Maintenance window opens. Enter the Contract Name, Effective Date, and Expiration Date. Enter default information for the Contract. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, select the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter the information in the Automatic Adjustments section that applies. To add the CPT 4 code applicable to the contract, select the Fee Schedule tab. Then select open menu button or question mark. To find a CPT4 code, select open menu button and select Lookup to display a list of CPT4 codes and des

Help Guide for NextGen® Enterprise PM 8

Set Up a New Contract Exception

In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Select a library and select open menu or right-click the selected library, and then select Contract Exceptions. The Contract Exceptions List window opens. Select open menu button, or right-click in the Description area of the window, and then select New. The Contract Exception Maintenance window opens. In the Contract Exception Name field, enter a name for the Contract Exception that describes the group of exceptions. Note: If you do not want this exception to display in the Contract Exceptions List window, select the Hide Exception option. To use this contract as the base contract, select the Use as Base Contract check box (instead of being used as an exception to the contract). Enter the Filter Criteria to control which CPT4 items display in the CPT4 list, as follows: Enter the first number of the CPT4 item in Type the first number(s) of the CPT4 item you want to locate. If the CPT4 column conta

Set Up a Fee Schedule for Contract Payers

Recommendations

Add or Modify Contracts

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up a Fee Schedule for Contract Payers

Fields on the Fee Schedule Tab

Add or Modify a Contract

Set Up a New Contract Exception

Add or Modify Contracts

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up a Fee Schedule for Contract Payers

Fields on the Fee Schedule Tab

Add or Modify a Contract

Set Up a New Contract Exception