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Set Up CCI Edits
In File Maintenance, select
Libraries
>
Claim Edits
>
Claim Edits Libraries
.
Select the applicable claim edit library.
The
Claim Edit Library Maintenance
window appears.
Check
the appropriate CCI bundling edits as needed. You can set the CCI bundling edits with a severity level based on business practices.
Select
System
>
Payers
, and then select the applicable payer.
The
Modify Payer Information
window appears.
Select the
Practice
tab, and then the
Libraries
tab on the bottom of the window.
Attach the claim edit library to the payer by selecting a library in the
Claim Edit Library
field.
Select
OK
.
Bundling CCI Edits
CCI Bundling Anesthesia Edits
CCI Bundling Lab Edits
Help Guide for NextGen® Enterprise PM 8
Select Mutually Exclusive Edits in the Claim Edit Library
Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits
Help Guide for NextGen® Enterprise PM 8
CCI Bundling Anesthesia Edits
Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify Anesthesia for followed by a general area of surgical intervention. When the following CPT codes are reported with an anesthesia code, it is assumed that these services are being reported as part of the anesthesia service and so will not be paid in addition to the anesthesia code. Because it is recognized that many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day, these codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service. CPT codes describing services that, when performed as part of the anesthesia service, would be considered included in the anesthesia code include the following partia
Help Guide for NextGen® Enterprise PM 8
Claim Edits Library
Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M
File Maintenance Help for NextGen® Enterprise 8
Claim Edits Library
Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M
Help Guide for NextGen® Enterprise PM 8
Libraries tab on the Practice tab
You can override the default Claim Edits Library selected on the Practice Preferences Libraries window in the Payers file. In File Maintenance, access the Payers master file. On the Payers List window, double-click the applicable payer. Select Practice and then Libraries. In the Claim Edits Library field, select the applicable library. Select OK. Parent topic: Assign a Default Claim Edits Library
Help Guide for NextGen® Enterprise PM 8
Claim Modifiers Library
The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl
