Set Up Encounters for Enhanced UB Claims (Before Billing)

Help Guide for NextGen® Enterprise PM 8

Set Up Encounters for Enhanced UB Claims (After Billing)

Access the Encounter Maintenance window for the patient and encounter the UB claim was created for. In NextGen® Enterprise PM, select the Chart button on the main toolbar. The Patient Lookup window opens. Enter Search Criteria to locate the desired patient and then select Find. From the Matching Records section, double-click to open the desired patient. The Patient Chart window opens. Select the Encounters tab. Right-click the encounter, and then select Open. The Service Location field is no longer accessible once an encounter has been billed. Select the UB tab. Encounter Maintenance The fields on this window automatically default the applicable information once the encounter has been billed. Do not change any of the information on this window. Select the Occurrence Codes tab. UB The fields on this window automatically default the occurrence code information once the encounter has been billed. These occurrence codes are attached to the revenue codes, which are attached to the service i

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Enhanced UB Users

In File Maintenance, select Master Files - System > Payers. Right-click the applicable payer and then select Open. The Modify Payer Information window appears. Select the Practice tab and then the UB tab. Modify Payer Information In the Location field, select the practice location, if applicable. This enables all the fields and check boxes on the tab. The location that you select must be the same as the location that is selected on the Create Encounter or Encounter Maintenance window. Enter the applicable information in the Field Locator fields and enable the check boxes to display the information on the UB claim. The following conditions must be met for Enhanced UB users that want to use the automated UB billing process: Field Locator 51 must be populated. The Type of Facility field must be equal to 7 (Clinic). The Bill Classification field must be equal to 4 (Outpatient Rehab Facility). The Bill Frequency field must be blank. Select OK. Parent topic: Setting Up UB Claims for Enhanced

Help Guide for NextGen® Enterprise PM 8

Set Up an Encounter for Regular UB Users

Access the Encounter Maintenance window for the patient and encounter the UB claim is being created for if you want occurrence and value codes to display on the UB claim. In NextGen® Enterprise PM, select the Chart icon on the main toolbar. The Patient Lookup window appears. Enter the search criteria and then select Find. To open the chart, right-click the chart and then select Open. On the Encounters tab, right-click the encounter and then select open menu icon . The Encounter Maintenance window appears. Select the UB tab, then the Occurrence Codes sub-tab. Enter the occurrence codes and dates in the field locator fields, if applicable. To enter the value codes and associated dollar value or unit value, select the Value Codes tab and enter the data in the Field Locator fields. Select OK. To enter the charges for the patient and the encounter, open the Charge Posting window. Bill the encounter and create the UB claim. Parent topic: Set Up UB Claims for Regular UB Users

Help Guide for NextGen® Enterprise PM 8

UB Claims

This section provides information about the process of setting up UB claims for a regular UB user and an enhanced UB user. The rules for setting up and billing UB claims are different for the two types of users. Therefore, as a user, you should fit into one of the following two categories, if your practice processes UB claims: A Regular UB user is a practice that does some, but not exclusive UB claims billing. For example, if your practice primarily does 1500 claims processing and a small percentage of UB claims, then you would be considered a Regular UB user. An Enhanced UB user is a doctor or multiple doctors at a specific practice location that exclusively does UB claims billing. For example, a clinical rehabilitation practice with specific doctors at separate locations for Physical Therapy, Occupational Therapy, and Speech Therapy that exclusively process UB claims at one location would be considered an Enhanced UB user. UB claims must be set up by entering configuration informatio

Help Guide for NextGen® Enterprise PM 8

Add Benefit Information to Patient Insurance

You can record annual and lifetime benefit information to help determine patient responsibility. Open NextGen® Enterprise PM. On the main toolbar, select Chart or Chart Lookup . The Patient Lookup window opens. In the Search Criteria section, enter the patient's information, and then select Find. Patient records that match the search criteriaa ppear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select the Encounters tab. The encounters associated with the patient appear in the Encounters section. Select the Insurance tab and then select the encounter from the Encounters section. Right-click the selected insurance, and then select Open. The Insurance Maintenance window opens. Select the Benefits Info tab and then select the Eligibility and Benefits tab. To view existing benefit information, select open menu and then select New or Open. The Eligibility and Benefit Maintenance window opens. Eligibilty and Benefit Information Win

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounters for UB Claims

The following list outlines the areas of the Encounter Maintenance window that are important to the setup of UB claims: On the General tab, complete the Service Location field. On the UB tab, access the following sub-tabs: Condition Codes, Occurrence Codes, and Value Codes. Encounter Maintenance Note: For Enhanced UB users, the automated UB claims process only applies to payers who are considered primary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes, which are explained in the following sections, only occurs for primary payers who have the required criteria. UB/General Tab UB/Condition Codes Tab UB/Occurrence Codes Tab UB/Value Codes Tab Setting Up Practice Preferences for UB Claims Parent topic: UB Claims

Set Up Encounters for Enhanced UB Claims (Before Billing)

Recommendations

Set Up Encounters for Enhanced UB Claims (After Billing)

Set Up Payers for Enhanced UB Users

Set Up an Encounter for Regular UB Users

UB Claims

Add Benefit Information to Patient Insurance

Setting Up Encounters for UB Claims

Set Up Encounters for Enhanced UB Claims (After Billing)

Set Up Payers for Enhanced UB Users

Set Up an Encounter for Regular UB Users

UB Claims

Add Benefit Information to Patient Insurance

Setting Up Encounters for UB Claims