Set Up Default Transaction Codes for an Alternate Payer

Help Guide for NextGen® Enterprise PM 8

Settings - default transaction codes for the alternate payer

Field Description Default Payment Select a third-party payment transaction code for the alternate payer. The code defaults to the Pay Code field on the Payment Entry screen for manually entered payments and for ERA payments received from the alternate payer. If a transaction code is not selected, then the Default Payment code from the Practice > Transactions is used for payments from the alternate payer. Default Adjustment Select a third-party adjustment transaction code for the alternate payer. The code defaults to the Adj Code field on the Payment Entry screen for manually entered adjustments and for ERA adjustments received from the alternate payer. If a transaction code is not selected, then the Default Adjustment code from the Practice > Transactions is used for adjustments from the alternate payer. Default Payment for Bad Debt Select a third-party bad debt payment transaction code for the alternate payer. The code defaults to the Pay Code field on the Payment Entry screen for man

Help Guide for NextGen® Enterprise PM 8

Create Zero Balance Claims to Subsequent Payers

A practice may have a need to send a claim to the next payer even though the previous payer paid the claim in full. For example, an FQHC practice reports to a secondary “wrap” payer by sending a claim showing services that were completely paid by the primary payer. Line item charges that have been paid in full by the previous ERA payer, and now have a $0.00 balance, can be settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box. In the field to the right, select the subsequent Payer(s). To save changes and close the window, select OK. Additional Information Parent topic: Set

Help Guide for NextGen® Enterprise PM 8

Setting Up Payers for ERA

All payers from whom ERA 835 files will be received must be configured prior to importing the electronic files in NextGen® Enterprise PM. If there are multiple master files for the same payer (e.g. Aetna, Aetna HMO, Aetna PPO, etc.), the setup should be done to all master files for that payer. ERA Payer Number Cross-over Indicator Select All Lines for Bill to Next Insurance Create Zero Balance Claims to Subsequent Payers Set Up Default Transaction Codes for a Payer Set Up Default Transaction Codes for an Alternate Payer You can set up default transaction codes for an alternate payer in File Maintenance. Reason Code Library Remittance Profile Library Parent topic: Setting Up ERA

Help Guide for NextGen® Enterprise PM 8

Enter the ERA Payer Number for an Alternate Payer

When you are using the alternate payer functionality, you might find that the main payer on the Payer master file and the alternate payer on the Payers-Alt Payers master file has different ERA payer numbers. In File Maintenance, select Master Files > System > PM > Payers-Alt Payers. The Alt-Payers List window opens. From the Alt-Payers List window , select and open the applicable payer. The Modify Alt Payer Information - Demo Payer window opens. Select the Alt Payer Transaction Option tab. The fields under the Alt Payer Transaction Option tab appear. For the ERA Payer Number , enter the payer number for the alternate payer. To save changes and close the window, SELECT OK. Parent topic: ERA Payer Number

File Maintenance Help for NextGen® Enterprise 8

Post a Payment to an Alternate Payer

When you post a payment for an encounter having multiple alternate payers associated with a payer, all the payers are listed in the Payer field. Note: You can apply a payment to the alternate payer even if the alternate payer was not billed during the billing process. In NextGen® Enterprise PM, selec the Posting icon. The Batch Posting window opens. Double-click an existing batch. The Payment Entry window opens. Select the applicable patient or encounter number. In the Payer field, select an alternate payer associated with a payer. Enter the payment amount and adjustment amount. Select the payment code and adjustment code. Note: If you have set up the default payment and default adjustment code in the Payers-Alt Payers master file for the alternate payer, then the payment code and adjustment code automatically appears when you enter the payment and adjustment amount. If you have not set up the default payment and default adjustment code in the Payers-Alt Payers master file, then the al

Help Guide for NextGen® Enterprise PM 8

Post a Payment to an Alternate Payer

When you post a payment for an encounter having multiple alternate payers associated with a payer, all the payers are listed in the Payer field. Note: You can apply a payment to the alternate payer even if the alternate payer was not billed during the billing process. In NextGen® Enterprise PM, selec the Posting icon. The Batch Posting window opens. Double-click an existing batch. The Payment Entry window opens. Select the applicable patient or encounter number. In the Payer field, select an alternate payer associated with a payer. Enter the payment amount and adjustment amount. Select the payment code and adjustment code. Note: If you have set up the default payment and default adjustment code in the Payers-Alt Payers master file for the alternate payer, then the payment code and adjustment code automatically appears when you enter the payment and adjustment amount. If you have not set up the default payment and default adjustment code in the Payers-Alt Payers master file, then the al

Set Up Default Transaction Codes for an Alternate Payer

Recommendations

Settings - default transaction codes for the alternate payer

Create Zero Balance Claims to Subsequent Payers

Setting Up Payers for ERA

Enter the ERA Payer Number for an Alternate Payer

Post a Payment to an Alternate Payer

Post a Payment to an Alternate Payer

Settings - default transaction codes for the alternate payer

Create Zero Balance Claims to Subsequent Payers

Setting Up Payers for ERA

Enter the ERA Payer Number for an Alternate Payer

Post a Payment to an Alternate Payer

Post a Payment to an Alternate Payer