Set Up Contract Exceptions for Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Set Up the Contract Library for Courtesy Claims

Select the Contract Library that is associated with the payer. On the General tab of the Contract Library Maintenance window, enable the following check boxes: Prorate Insurance Balance Create Zero Dollar Claim Ensure that there is a detail record set up for the CPT4 for participating providers. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Set Up the Payer Master

In the Payer Master file, on the Practice Parameters/Other tab, select the following options: Default Non-Participating Providers Accept Assignment to No Transfer Non-Par Charges to patient Select Managed Care Contract. When a contract is selected, the check boxes required for setting up a courtesy claim are displayed. Select only providers who are participating providers. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Entering a Courtesy Charge for a Claim

When you enter the charge for a courtesy claim, ensure that you are using the payer with the contract and contract exception on the encounter. Note: The rendering on the encounter is Non-Par, so the Benefits Not Assigned display in red bold text in the Verification section of the Encounter/Insurance tab on the patient's chart. In the charge window, the INS1 bucket is checked to bill and the full balance is in the Patient bucket. You can generate the claim immediately after the charge is entered by selecting on the Bill icon in the charge window. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Generating Courtesy Claims

A courtesy claim is a claim that you, the provider, does not submit to a payer (because you are non-par with the patient’s contract) for charges related to services you have rendered on the patient. It is a claim that you generate, but do not send. Instead, you give it to the patient so they can submit it. The example in this section shows how a courtesy claim can be generated. This example assumes that some providers in your office are par with the contract and the services are to be billed. Set Up the Payer Master Set Up the Contract Library for Courtesy Claims Set Up Contract Exceptions for Courtesy Claims Entering a Courtesy Charge for a Claim Parent topic: Generating and Submitting Claims

Help Guide for NextGen® Enterprise PM 8

Add an Exception to an Existing Contract Exception Group

In File Maintenance, select Libraries and then Contract. In the Contracts List window, right-click on your library selection, and then select Contract Exceptions. Double-click on the Contract Exception name. The Contract Exception Maintenance window opens. To enter an exception for a contract, do one of the following: If your library has fewer than 50 CPT4 items, press the Tab key or arrow keys on your keyboard to move to the next CPT4 item. If your library has 50 or more CPT4 items, go back to the Type the first number(s) of the CPT4 item you want to locate field and enter the first few numbers of the next CPT4 item to enter an exception for. The CPT4 item displays in the spreadsheet area of the window. Continue this process until you enter all of exceptions and then select OK. Parent topic: Setting Up Exceptions In the Contract Library

File Maintenance Help for NextGen® Enterprise 8

Add an Exception to an Existing Contract Exception Group

In File Maintenance, select Libraries and then Contract. In the Contracts List window, right-click on your library selection, and then select Contract Exceptions. Double-click on the Contract Exception name. The Contract Exception Maintenance window opens. To enter an exception for a contract, do one of the following: If your library has fewer than 50 CPT4 items, press the Tab key or arrow keys on your keyboard to move to the next CPT4 item. If your library has 50 or more CPT4 items, go back to the Type the first number(s) of the CPT4 item you want to locate field and enter the first few numbers of the next CPT4 item to enter an exception for. The CPT4 item displays in the spreadsheet area of the window. Continue this process until you enter all of exceptions and then select OK. Parent topic: Setup an Exception Through the Contract Library

Set Up Contract Exceptions for Courtesy Claims

Recommendations

Set Up the Contract Library for Courtesy Claims

Set Up the Payer Master

Entering a Courtesy Charge for a Claim

Generating Courtesy Claims

Add an Exception to an Existing Contract Exception Group

Add an Exception to an Existing Contract Exception Group

Set Up the Contract Library for Courtesy Claims

Set Up the Payer Master

Entering a Courtesy Charge for a Claim

Generating Courtesy Claims

Add an Exception to an Existing Contract Exception Group

Add an Exception to an Existing Contract Exception Group