Set Up Claim Break Options for a Payer

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Break Options for a Payer

Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Double-click to open the desired payer. The Modify Payer Information window opens. Select the Practice tab, and then the Other sub-tab. If applicable, select the Disable rendering claim break check box and select one of the following options in the drop-down field: Use Encounter Rendering: The claim will use the Rendering provider entered on the Encounter Maintenance window. Note: Supervisor billing occurs if the rendering provider on the encounter has a supervisor. Use Provider from the First Charge Line on the Claim: The claim will use the Rendering provider entered on the Charge Posting window for the first charge. Note: Supervisor billing occurs if the rendering provider on the first charge has a supervisor. Use the Provider with the Greatest Total Charge Amount: The claim will use the Rendering provider with the greatest total charge amount on the Charge Posting window. Not

File Maintenance Help for NextGen® Enterprise

Supervisor Billing

You can create encounters that require that a supervisor is billed instead of a mid-level rendering provider. To set up this type of billing, you must do the following: Supervisor Billing is enabled by default for all payers, but you can disable it for payers that do not need it. Enable supervisor billing so that a supervisor is always required for a specific provider at the current practice. If necessary, enable or disable supervisor billing in the specific payer rows in the provider master file. The payer row setting overrides the practice-level setting on the Practice tab for just that provider/payer combination. The payer-level settings are available for payer rows at either the Default location (which will apply to all locations) or a specific location (which will only apply for that location). Make the Supervisor field available on the Encounter Maintenance window in NextGen® Enterprise PM. For more information, refer to Add the Supervisor Field on the Encounter Maintenance Windo

Help Guide for NextGen® Enterprise PM 8

Encounter Incident-To Billing

Selecting the Incident-To Bill Encounter check box on the Encounter Maintenance window allows you to bill an encounter using the supervising provider's name on the claim, even though the mid-level rendering provider is setup to normally bill for the payer on the encounter. To use the Incident-To Billing feature, you must enable the Supervisor provider option in the Encounters preferences in the Practice Preferences. In addition, the mid-level provider must be set up to Enable Supervisor Billing in the Providers Master File. For more information on Practice Preferences and the Providers Master File, refer to the following user guides: File Maintenance Preferences Guide for NextGen Enterprise File Maintenance Master Files Guide for NextGen Enterprise Setup an Encounter for Incident-To Billing You can setup an encounter for incident-to billing so that you can bill an encounter using the supervising provider's name on the claim. Parent topic: General Information about Patient Encounter

Help Guide for NextGen® Enterprise PM 8

Encounter Incident-To Billing

Selecting the Incident-To Bill Encounter check box on the Encounter Maintenance window allows you to bill an encounter using the supervising provider's name on the claim, even though the mid-level rendering provider is setup to normally bill for the payer on the encounter. To use the Incident-To Billing feature, you must enable the Supervisor provider option in the Encounters preferences in the Practice Preferences. In addition, the mid-level provider must be set up to Enable Supervisor Billing in the Providers Master File. For more information on Practice Preferences and the Providers Master File, refer to the following user guides: File Maintenance Preferences Guide for NextGen Enterprise File Maintenance Master Files Guide for NextGen Enterprise Setup an Encounter for Incident-To Billing You can setup an encounter for incident-to billing so that you can bill an encounter using the supervising provider's name on the claim. Parent topic: General Information about Patient Encounter

Help Guide for NextGen® Enterprise PM 8

Supervisor Billing

You can create encounters that require that a supervisor is billed instead of a mid-level rendering provider. To set up this type of billing, you must do the following: Supervisor Billing is enabled by default for all payers, but you can disable it for payers that do not need it. Enable supervisor billing so that a supervisor is always required for a specific provider at the current practice. If necessary, enable or disable supervisor billing in the specific payer rows in the provider master file. The payer row setting overrides the practice-level setting on the Practice tab for just that provider/payer combination. The payer-level settings are available for payer rows at either the Default location (which will apply to all locations) or a specific location (which will only apply for that location). Make the Supervisor field available on the Encounter Maintenance window in NextGen® Enterprise PM. For more information, refer to Add the Supervisor Field on the Encounter Maintenance Windo

File Maintenance Help for NextGen® Enterprise

Reassign Provider Licenses

When a rendering provider leaves the practice, the NextGen Healthcare product licenses currently used by that provider can be reassigned to another provider joining the practice. CAUTION: Before removing licenses from a rendering provider, verify that all patient encounters for the provider have been created. Clinical information must be documented for all encounters in NextGen® Enterprise EHR, and charges must be entered for all encounters in NextGen® Enterprise PM. Once the licenses are removed, you will no longer be able to select that provider as rendering for new appointments, encounters, charges, etc. To remove licenses from a provider: In File Maintenance, select Master Files > System > Providers. The Providers List window displays. Double-click to open the rendering provider from which the licenses are to be removed. The Modify Provider Information window displays. Select the System tab. In the Provider Licensing section, deselect (uncheck) the licenses for the appropriate Next

Set Up Claim Break Options for a Payer

Recommendations

Set Up Claim Break Options for a Payer

Supervisor Billing

Encounter Incident-To Billing

Encounter Incident-To Billing

Supervisor Billing

Reassign Provider Licenses

Set Up Claim Break Options for a Payer

Supervisor Billing

Encounter Incident-To Billing

Encounter Incident-To Billing

Supervisor Billing

Reassign Provider Licenses