Set Up Claim Options

Help Guide for NextGen® Enterprise PM 8

Set Up Billing Options

The Billing Options tab is used to specify which Place of Service code and ICD codes should be used on claims when multiple Behavioral Health charges on an encounter each have different codes. It also allows selection of an adjustment reason code for auto-balancing a variance amount on COB claims. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. From the list, double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Billing Options tab. Complete the fields to set up Billing Options. For more information on each field, see Billing Options Field Descriptions. To save changes and close the window, select OK. Billing Options Field Descriptions Parent topic: Add or Modify a Behavioral Health Billing Library

Help Guide for NextGen® Enterprise PM 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Claim Options tab. Complete the fields to set up Claim Options. For more information on each field, see Claim Options Field Descriptions. To save changes and close the window, select OK. Claim Options Field Descriptions Parent topic: Behavioral Health Billing Libra

Help Guide for NextGen® Enterprise PM 8

Add or Modify a Behavioral Health Billing Library

Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Do one of the following: To create a library, select open menu button and select New. To modify a library, select the library from the list, and then select open menu and select Open. The Behavioral Health Billing Library Maintenance window opens. In the Behavioral Health Billing Library field, enter a name for the library. This field is required. Complete parameters as needed on the following tabs: Charge Options, for more information see Set Up Charge Options. Claim Options, for more information see Set Up Claim Options. Billing Options, for more information see Set Up Billing Options. To save changes and close the window, select OK. Set Up Charge Options Set Up Claim Options Set Up Billing Options Parent topic: Behavioral Health Billing Library

Help Guide for NextGen® Enterprise PM 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

File Maintenance Help for NextGen® Enterprise 8

Add or Modify a Behavioral Health Billing Library

Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Do one of the following: To create a library, select open menu button and select New. To modify a library, select the library from the list, and then select open menu and select Open. The Behavioral Health Billing Library Maintenance window opens. In the Behavioral Health Billing Library field, enter a name for the library. This field is required. Complete parameters as needed on the following tabs: Charge Options, for more information see Set Up Charge Options. Claim Options, for more information see Set Up Claim Options. Billing Options, for more information see Set Up Billing Options. To save changes and close the window, select OK. Parent topic: Behavioral Health Billing Library

Set Up Claim Options

Recommendations

Set Up Billing Options

Set Up Charge Options

Set Up Claim Options

Add or Modify a Behavioral Health Billing Library

Claim Options Field Descriptions

Add or Modify a Behavioral Health Billing Library

Set Up Claim Options

Set Up Billing Options

Set Up Charge Options

Set Up Claim Options

Add or Modify a Behavioral Health Billing Library

Claim Options Field Descriptions

Add or Modify a Behavioral Health Billing Library