Set Up Payer-Specific Requirements

Help Guide for NextGen® Enterprise PM 8

Service Items Library for Dental Billing

When setting up SIM codes for dental, set the Form field on the Service Item Library Maintenance window to ADA. Service Library Maintenance Set Up Payer-Specific Requirements Parent topic: Dental Billing

File Maintenance Help for NextGen® Enterprise 8

Set Up a Dental and Medical SIM

Service Items can be set up and billed as dental or medical SIMs. They must be set up at the Payer level in the Service Item Library. Open a SIM in a Service Item Library. Select the General tab. Ensure that 1500 or UB is selected in the Form drop-down list. Select the Payer tab. Select the applicable dental payer from the Payer drop-down list. You must designate this payer as a dental payer on the Payer tab of the Service Item Library Maintenance window. See Payer tab for more information. In the table, enter the applicable effective and expiration dates in the Eff and Exp fields. Select ADA from the Form drop-down list. Enter any additional information that is applicable. Select OK. Parent topic: Dental SIMs

File Maintenance Help for NextGen® Enterprise 8

Set Up a SIM Used as an Anesthesia and a Dental SIM

Service items can be set up and billed as anesthesia or dental SIM. They must be set up at the Payer level in the Service Item Library. Open a SIM in a Service Item Library. Select the General tab. Ensure that 1500 or UB is selected in the Form drop-down list. Enter the applicable base units, up to four digits, in the Base Unit field. Note: One base unit is equal to either 10 or 15 minutes depending on the Anesthesia Minutes Per Unit setting on the Payer Defaults - 2 tab of the Payer master file. Check the Anesthesia SIM check box and then select the Payer tab. Select the applicable dental payer from the Payer drop-down list. You must designate this payer as a dental payer on the Payer tab of the Service Item Library Maintenance window. See Payer tab for more information. Enter the applicable effective and expiration dates in the Eff and Exp fields. Select ADA from the Form drop-down list. Enter any additional information that is applicable. Select OK. Parent topic: Dental SIMs

File Maintenance Help for NextGen® Enterprise 8

Set Up ADA SIMs

Service items that are only used as Dental SIMs are designated as a Dental SIM by selecting ADA from the Form drop-down list on the General tab of the Service Item Library Maintenance window for that SIM. Service items designated as Dental SIMs can only be billed on an ADA Dental claim or as patient responsibility; they do not populate an 1500/837 Professional or UB/837 Institutional form. Open a SIM in a Service Item Library. In the File Maintenance window, select the General tab. Select ADA from the Form drop-down list. Select OK. Parent topic: Dental SIMs

Help Guide for NextGen® Enterprise PM 8

Set Up a Service Item for Regular UB Users

Access the service item from the Service Item Library to attach a payer and set the Form field to UB. Access File Maintenance. Select Libraries > Service Items. Right-click a Service Item library, and then select Open. To create a new SIM, select an existing SIM or select the open menu button. Select the Payer tab and select the applicable payer. Enter an effective date in the Eff field and an expiration date in the Exp field. Select the General tab, and then select UB from the Form field. Select the Add button, and then select OK. Parent topic: Set Up UB Claims for Regular UB Users

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by Revenue Code

To set up a SIM code for roll-up billing by revenue code, do the following: Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. Do one of the following: To add a SIM code, select Open Menu and select New. To modify a SIM code, search for the code and then select the code from the list on the left. Select the General tab. Each SIM code that is to roll-up to a single line item on the claim must have the following parameters defined. Revenue Code: Select the appropriate Revenue Code for UB/837I claims. This is the default revenue code for all UB payers. If the roll-up payer requires a different revenue code, the Alt Rev code must be defined on the Payer tab for the roll-up payer. Form: Select 1500. This is the default type of form for all payers. If the roll-up payer requires a different form (e.g. UB), additional

Set Up Payer-Specific Requirements

Recommendations

Service Items Library for Dental Billing

Set Up a Dental and Medical SIM

Set Up a SIM Used as an Anesthesia and a Dental SIM

Set Up ADA SIMs

Set Up a Service Item for Regular UB Users

Set Up SIM Codes for Roll-Up Billing by Revenue Code

Set Up Payer-Specific Requirements

Service Items Library for Dental Billing

Set Up a Dental and Medical SIM

Set Up a SIM Used as an Anesthesia and a Dental SIM

Set Up ADA SIMs

Set Up a Service Item for Regular UB Users

Set Up SIM Codes for Roll-Up Billing by Revenue Code