Set Up Payers for Enhanced UB Users

Help Guide for NextGen® Enterprise PM 8

Set Up Encounters for Enhanced UB Claims (Before Billing)

Access the Create Encounter or Encounter Maintenance window for the patient and encounter the UB claim is being 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 Encounter Maintenance window opens. Encounter Maintenance Enter the date the patient first began experiencing symptoms, in the Onset Date field. Select a service location in the Service Location field. The service location must be the same as the service location that was selected on the UB tab of the Modify Payer Information window. Select OK. Parent topic: Setting Up UB Claims for Enhanced UB Users

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. 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 UB Users

Help Guide for NextGen® Enterprise PM 8

Setting Up UB Claims for Enhanced UB Users

Setting up UB claims for Enhanced UB users is different from the set up for Regular UB users, especially if you want to use the automated claims process. For Enhanced UB users, the automated UB claims process only applies to payers who are considered the primary payer. The automated UB claims process is not for payers who are considered secondary or tertiary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes only occurs for primary payers who have the required criteria. Set Up Payers for Enhanced UB Users Set Up Encounters for Enhanced UB Claims (Before Billing) Set Up Encounters for Enhanced UB Claims (After Billing) Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Set Up the Payer Master File for Recurring UB Billing

The Frequency of Bill field must be set up in the Payer Master file to trigger recurring UB billing. In File Maintenance, select Master Files - System > Payers. Select the applicable payer from the list, and then select the UB tab on the Practice tab. In the Modify Payer Information window, select the location in the Location field if your practice has multiple locations. When the location is entered, the remaining fields in the window display the data you have set up for the payer. Note: The location that you select must be the same location as shown on the encounter. Select the rendering providers in the Rendering Provider field. Leave the Frequency of Bill field blank or set to <none>. This field must be blank for recurring billing. Enter data in other fields, as applicable for the payer for enhanced UB billing. For setup information on enhanced UB billing, refer to Setting Up UB Claims for Enhanced UB Users. Select OK. Parent topic: File Maintenance Settings Required for Recurring

Help Guide for NextGen® Enterprise PM 8

Set Up a UB Claim Form in the Payer Master File

When you set up a practice location as an enhanced UB user, the application generates a UB claim for the payer after billing. In File Maintenance, select Master Files - System > Payers. Select the applicable payer from the list and then select the UB tab of the Practice tab. In the Modify Payer Information window, select the location in the Location field if your practice has multiple locations. Note: The location that you select must be the same location as shown on the encounter. Enter the number provided by the payer in the Field Locator 51 field. Select the rendering providers in the Rendering Provider field. Enter data in other fields, as applicable for the payer. Select OK. Parent topic: Setting Up UB Claim Forms

Help Guide for NextGen® Enterprise PM 8

UB/General Tab

All the fields on the UB > General sub-tab can be automatically populated. The information on this tab can be overridden, but it is not recommended, especially if you are an Enhanced UB user and you want to use the automated UB claims process. Regular UB users should not use the fields on this window, except to change the Source of Admission field. Regular UB users should continue to use the Billing & Collections tab on the Encounter Maintenance window to review or change the values that display on the UB claim form. Encounter Maintenance Field Description Type of Bill This field is divided into three positions. The values for each position are described separately. First Position After the UB claim is billed, this position is populated automatically with the value that is in the Type of Facility field located on Modify Payer Information > Practice > UB sub-tab. If this field does not contain a value, this position is populated from the Type of Facility field in Practice Preferences >

Set Up Payers for Enhanced UB Users

Recommendations

Set Up Encounters for Enhanced UB Claims (Before Billing)

Set Up Payers for Enhanced UB Users

Setting Up UB Claims for Enhanced UB Users

Set Up the Payer Master File for Recurring UB Billing

Set Up a UB Claim Form in the Payer Master File

UB/General Tab

Set Up Payers for Enhanced UB Users

Set Up Encounters for Enhanced UB Claims (Before Billing)

Set Up Payers for Enhanced UB Users

Setting Up UB Claims for Enhanced UB Users

Set Up the Payer Master File for Recurring UB Billing

Set Up a UB Claim Form in the Payer Master File

UB/General Tab