NextGen Knowledge Center

Set Up Concurrency and Claim Rules for Anesthesia Billing

The Concurrency and Claim Rules section of the Anesthesia Library Maintenance window enables you to define rules for specific payers, for all other payers, and for self-pay. Each set of rules is defined with an effective and expiration date. The date of service and payer on an anesthesia charge determines which set of rules is applied during the Anesthesia Concurrency Audit and billing processes in NextGen Enterprise PM.

  1. Access File Maintenance.
  2. Select Libraries, and then Anesthesia.
    The Anesthesia Library List window opens.
  3. From the list, double-click to open the desired library.
    The Anesthesia Library Maintenance window opens.
  4. In the Concurrency and Claim Rules section, do one of the following:
    • To create a new rule set, or row, select open menu button and select New.
    • To modify an existing rule set, or row, select the open menu button and select Open.
    The Anesthesia Library Payer Maintenance window opens.

  5. In the Effective Date field, enter the date the rule set becomes effective. This field is required.
  6. In the Expiration Date field, enter the date the rule set expires. This field is required.
  7. In the Description field, enter a free-text description for the rule set. This field is required.
  8. In the Concurrency and Claim Rules section at the top of the window, do one of the following:
    • To define a rule set for all payers that do not have a specific rule set defined, select the Use as default Anesthesia Library for any payer not configured check box.

      The Open Folder in the Valid Payers section becomes disabled.

    • To define a rule set for self-pay, select the Use as default for Self Pay check box.

      The Open Folder in the Valid Payers section becomes disabled.

    • To define a rule set for specific payers, select Open Folder in the Valid Payers section.

      The Payers window opens.

      Select one or more payers for the rule set from the Available section on the left and move them to the Included section on the right. To save changes and close the window, select OK.

  9. Complete options and parameters on the following tabs as needed:
    • Medical Direction
    • Concurrency Rules
    • Claim Options
    • SIM Options
  10. To save changes and close the window, select OK.
    The rule set appears as a separate row in the Concurrency and Claim Rules section of the Anesthesia Library Maintenance window.
    The rule set with the Use as default Anesthesia Library for any payer not configured option selected displays with a green check mark indicator in the Default column.