Set Up Auto Charge Adjustments for Non-Participating Providers

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

File Maintenance Help for NextGen® Enterprise 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

Help Guide for NextGen® Enterprise PM 8

Example of an Auto Adjustment for a Non-Participating Provider

This example shows the contract set up to automatically adjust the charge to 70% for the primary insurance and 30% for the guarantor. Contract Automatic Adjustment Charge Posting Window Parent topic: Set Up Auto Charge Adjustments for Non-Participating Providers

File Maintenance Help for NextGen® Enterprise 8

Allowed and FFS/Balance Distribution

Field Allowed and FFS/Balance Distribution Descriptions Fee for Service Enter the percentage of the full fee that you expect to get for participating and non-participating physicians. % of Allowed Amount for Participants Enter the percentage of the allowed amount a participating provider expects to be reimbursed. A provider is a participant when the contract is selected for it in the Providers master file. % of Allowed Amount for Non-Participants Enter the percentage of the allowed amount a non-participating provider expects to be reimbursed. Prorate Insurance Balance If this option is selected and it is also selected on Other tab (of Practice in the Add/Modify Payer Information window) then: The patient's charges will be prorated between the Primary Insurance and the Secondary or Patient bucket. The proration is based on the Fee for Service percentages. The prorated balances can be viewed in the patient's Balance Control window. Note: If you prorate the patient's charges, you can get

Help Guide for NextGen® Enterprise PM 8

Allowed and FFS/Balance Distribution

Field Allowed and FFS/Balance Distribution Descriptions Fee for Service Enter the percentage of the full fee that you expect to get for participating and non-participating physicians. % of Allowed Amount for Participants Enter the percentage of the allowed amount a participating provider expects to be reimbursed. A provider is a participant when the contract is selected for it in the Providers master file. % of Allowed Amount for Non-Participants Enter the percentage of the allowed amount a non-participating provider expects to be reimbursed. Prorate Insurance Balance If this option is selected and it is also selected on Other tab (of Practice in the Add/Modify Payer Information window) then: The patient's charges will be prorated between the Primary Insurance and the Secondary or Patient bucket. The proration is based on the Fee for Service percentages. The prorated balances can be viewed in the patient's Balance Control window. Note: If you prorate the patient's charges, you can get

File Maintenance Help for NextGen® Enterprise 8

Add Libraries to a Practice

Libraries are attached to the payer on the Practice tab, they are only active for the practice in which you are working. If you have multiple practices within your enterprise, you must access each practice to activate the libraries as necessary. To attach libraries to a payer: Open the File Maintenance. Open the System > Practice > Payer master file > Practice. Select the Libraries tab. Select the necessary libraries and settings. Libraries are available only when the current practice has practice access to them. Field Description Claim Edit Library Select the Claim Edits Library that you want to use for this payer. This selection overrides the default Claim Edits library selected in the Practice Preferences for Libraries. Type of Service Library Select the appropriate Type of Service Library for the payer. Place of Service Library Select the drop-down arrow and select the appropriate Place of Service Library for the payer. This enables you to attach a library with alternative place of

Set Up Auto Charge Adjustments for Non-Participating Providers

Before you begin

Recommendations

Add or Modify Contracts

Set Up Auto Charge Adjustments for Non-Participating Providers

Example of an Auto Adjustment for a Non-Participating Provider

Allowed and FFS/Balance Distribution

Allowed and FFS/Balance Distribution

Add Libraries to a Practice

Add or Modify Contracts

Set Up Auto Charge Adjustments for Non-Participating Providers

Example of an Auto Adjustment for a Non-Participating Provider

Allowed and FFS/Balance Distribution

Allowed and FFS/Balance Distribution

Add Libraries to a Practice