Set up SIM Codes for Test Results

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Edits for Test Results

During the billing process, when a SIM code is set up to create MEA test result segments on electronic 837P claims, but the charge does not have the test date or test result details, then you can activate the claim edits instead of creating a new claim. Open File Maintenance. Select Libraries, and then Claim Edits. The Claim Edits List window opens. Double-click the desired library. The Claim Edit Library Maintenance window opens. In the claim edit grid, do the following: Select the row with the IDs 286 and 287. In the Severity column, select either Critical or Required for the selected IDs. This severity selection prevents the claims from being created when the edit fails. Select OK. Parent topic: Setting up Charge Test Results

Help Guide for NextGen® Enterprise PM 8

View Code Tables for Test Results

A Test Results Qualifier table is pre-installed in File Maintenance > Code Tables. Each test includes a two-digit qualifier code that is sent in the MEA test result segment on electronic 837P (1500) claims. Note: You cannot add or modify the Test Results Qualifier codes. Open File Maintenance. Select Code Tables. The Code Tables List window opens. Select Test Results Qualifier from the Code Table list. The list of pre-defined tests and two-digit qualifier codes displays. Select Close. Parent topic: Setting up Charge Test Results

Help Guide for NextGen® Enterprise PM 8

Setting up Charge Test Results

The setup required for sending MEA test result segments on electronic 837P (1500) claims involves the following areas in File Maintenance. Service Items Library Claim Edits Library Code Tables Set up SIM Codes for Test Results You can set up SIM Codes to create MEA test results on electronic claims. Set Up Claim Edits for Test Results You can set up claim edits to create MEA test results on electronic claims. View Code Tables for Test Results You can view code tables for test results on the Code Tables List window. Parent topic: Charge Test Results on Electronic Claims

Help Guide for NextGen® Enterprise PM 8

Charge Test Results on Electronic Claims

Some payers require the test result details to be included on electronic 837P (1500) claims for reimbursement on specific tests, such as Creatinine, Hemoglobin and Hematocrit. The information required includes a qualifier that identifies the test, the test date, and the test result. An electronic 837P claim can create up to five separate MEA test result segments for results that you can enter manually from the Charge Posting window in NextGen® Enterprise PM or receive it through an interface. The MEA test results are included in the 2400 DTP*738 segment in the 837P electronic claim file. Note: You can use this functionality for electronic 837P (1500) claims. It does not apply to electronic 837I (UB) or 837D (ADA) claims. Setting up Charge Test Results You can set up charge test results on electronic claims for reimbursement. Enter Test Results for a Charge You can enter test results for a charge on the Charge Posting window. Significant Events for Charge Test Results You can enable sig

Help Guide for NextGen® Enterprise PM 8

Set Up Payer-Specific Requirements

Not all payers require an ADA claim form. Some payers may require a 1500 form. To set up a SIM code to use 1500 forms for a payer, do the following: From the Service Item Library Maintenance window, select the applicable service item. Select the Payer tab. Payer In the Payer field, select the payer. In the Eff and Exp columns, enter the effective and expiration dates for the SIM code/payer. In the Form column, select 1500. To save changes and close the window, select OK. Parent topic: Service Items Library for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

To set up a SIM code for roll-up billing by CPT4 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 se

Set up SIM Codes for Test Results

Recommendations

Set Up Claim Edits for Test Results

View Code Tables for Test Results

Setting up Charge Test Results

Charge Test Results on Electronic Claims

Set Up Payer-Specific Requirements

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

Set Up Claim Edits for Test Results

View Code Tables for Test Results

Setting up Charge Test Results

Charge Test Results on Electronic Claims

Set Up Payer-Specific Requirements

Set Up SIM Codes for Roll-Up Billing by CPT4 Code