Set Up Behavioral Health SIM Codes

Help Guide for NextGen® Enterprise PM 8

Service Items Library

The Service Items Library defines all services that a practice performs. Each service code, or SIM code, includes defined parameters that affect charge posting, billing, claims, and reports in NextGen® Enterprise PM. You must set up Behavioral Health SIM codes in the Service Items library. Set Up Behavioral Health SIM Codes You can set up Behavioral Health SIM codes on the Service Item Library Maintenance window. Parent topic: Behavioral Health Billing

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Billing

In NextGen® Enterprise PM, you can setup the billing requirements for Behavioral Health Billing. Behavioral health SIM codes are set up in the Service Items Library with a base minute value of 15, 30, 60, 240, or a custom value. In addition, the price per time unit is defined for each SIM code. During charge posting, behavioral health SIM codes prompt for the entry of a start and stop time, and then total time units for the charge are calculated based on the times entered. Payers are set up in the Payers master file with a base minute rounding method that is used to round the total time entered on each charge up or down when calculating time units. When multiple behavioral health charges on a single encounter have the same CPT4 code, the same modifiers, the same base minutes and the same unit price, those charges roll-up, or bundle, into a single line item on the claim. The total units on the claim for the roll-up line item is calculated using the total time entered on all of the indiv

Help Guide for NextGen® Enterprise PM 8

Set Up CCBHC SIM Codes

To track charges in NextGen® Enterprise PM for Certified Community Behavioral Health Clinic (CCBHC) services, an option must be enabled in the Service Items library for each SIM code. Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. Double-click to open the desired library. The Service Item Library Maintenance window opens. In the Search field on the left, enter all or part of the CCBHC SIM code. From the list on the left, select the CCBHC code. In the Qualifying Encounter field on the General tab, select the CCBHC Qualifying Encounter check box. Note: The check box is available for selection only if the CCBHC Qualifying Encounter option is enabled in Practice Preferences > Encounters. To save changes and close the window, select OK. Parent topic: Certified Community Behavioral Health Clinics (CCBHC)

NextGen® Adaptive Content Engine Help Enterprise 8

Map Behavioral Health Service Codes

On the Service Code Mapping system template, click the Practice field and select the desired practice name. Note: The values you establish here apply only to the selected practice. In the Payer field, select the payer configured in File Maintenance. In the Visit type field, click to select a value. Select a value from the optional Licensure field. Note: The Licensure picklist is configured on the Custom DB Picklist system template. For more information on how to modify the custom lists on this template, go to NextGen Healthcare Success Community and download the latest Custom DB Picklists System Template for NextGen® Adaptive Content Engine. Click the Service code or Service description field to select a service to be mapped with the selected practice for Behavioral Health billing. The values in the Service Item Mstr picklist are configured in a Service Categories master file called Behavioral Health. You can modify the list values in File Maintenance. Once configured, selecting the Se

File Maintenance Help for NextGen® Enterprise 8

Add a New Service Item

On the Service Item Library Maintenance window, select open menu button , then select New. Enter a CPT code or select on the to search for the CPT code. If you search for the code, the CPT4 Code Search window opens. Under Search Method, select either Code or Description to determine how you want the search results to list, then enter the search data either by code or description. Select the appropriate code, and then select OK. The service item number and default description automatically populate. The default description for the SIM is the same as the CPT4 code description. You can change the description if necessary. For example, if the description Office/outpatient visit, new, problem focused is not meaningful to the staff, you could change it to simply Office Visit New Patient. Enter the information on the General tab, including effective date range and price. Required fields display with red labels. If there are payers that use alternate codes for the SIM, then enter that informat

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Behavioral Health Billing

Use the following procedure to set up a claim modifier for Behavioral Health SIM codes. Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character behavioral health modifier. This field is required and cannot be modified after the modifier is saved. For example: AF: Services provided by a Psychiatrist AH: Services provided by a Psychologist AJ: Services provided by a Licensed Clinical Social Worker HQ: Services provided in a group setting In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier Change for Claims field, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when t

Set Up Behavioral Health SIM Codes

Recommendations

Service Items Library

Behavioral Health Billing

Set Up CCBHC SIM Codes

Map Behavioral Health Service Codes

Add a New Service Item

Set Up Claim Modifiers for Behavioral Health Billing

Service Items Library

Behavioral Health Billing

Set Up CCBHC SIM Codes

Map Behavioral Health Service Codes

Add a New Service Item

Set Up Claim Modifiers for Behavioral Health Billing