Set Up Claim Break Options for a Payer

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

File Maintenance Help for NextGen® Enterprise 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. Disable Supervisor Billing for a Payer Enable Supervisor Billing at the Provider/Practice

File Maintenance Help for NextGen® Enterprise 8

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

Help Guide for NextGen® Enterprise PM 8

Claim Hierarchy to Determine Type of Claim

NextGen® Enterprise PM follows a hierarchy that determines what type of claim form (1500 or UB) is created for each payer. The system moves from the highest to the lowest level in the hierarchy to make the claim determination. It is important to understand the claim hierarchy to properly troubleshoot claim related issues. Claim Hierarchy (from highest to lowest): Payer > Alternate Payer > Location/SIM: The first place the system looks in determining the type of claim to be created is the Modify Payer Information window in the Alt Payer tab for the payer attached to the encounter. If the Alt Payer tab is completed for the Location on the encounter, and one or more SIM codes have been defined, then encounters for that location having one or more of the specified SIM codes entered as charges create the type of claim defined on the Alt Payer tab. Payer > Practice > UB > Location/Provider: The second place the system looks in determining the type of claim to be created is the Modify Payer I

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. Disable Supervisor Billing for a Payer Enable Supervisor Billing at the Provider/Practice

Help Guide for NextGen® Enterprise PM 8

Change the Payer Address in the Payer Master File

To change a payer address: From the Master Files - System list, select Payers. The Payers List window opens. Select the payer you want to modify, select the open menu button, and then select Open or double-click the payer. The Modify Payer Information window opens. On the Payer Defaults - 1 tab, select either Main Address or Refund Address. You can enter one address for each kind. Enter the new address in the address fields. The first space is for street number and name. The second space is for other address details such as suite number. If the ZIP code table is set up, you can enter the ZIP code, and the city, state, county, and country automatically display. Select OK. If any person or patient records have this payer with the old address, a message states how many records will be affected. Select Yes to update all the records. If you select No, the records will keep the old address. Note: The application searches all fields for an exact match. This message displays only if the inform

Set Up Claim Break Options for a Payer

Recommendations

Encounter Incident-To Billing

Supervisor Billing

Reassign Provider Licenses

Claim Hierarchy to Determine Type of Claim

Supervisor Billing

Change the Payer Address in the Payer Master File

Encounter Incident-To Billing

Supervisor Billing

Reassign Provider Licenses

Claim Hierarchy to Determine Type of Claim

Supervisor Billing

Change the Payer Address in the Payer Master File