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Set Up the Contract Library for Courtesy Claims
Select the
Contract
Library that is associated with the payer.
On the
General
tab of the
Contract Library Maintenance
window, enable the following check boxes:
Prorate Insurance Balance
Create Zero Dollar Claim
Ensure that there is a detail record set up for the CPT4 for participating providers.
Set Up the Contract Library for Courtesy Claims
Help Guide for NextGen® Enterprise PM 8
Set Up the Payer Master
In the Payer Master file, on the Practice Parameters/Other tab, select the following options: Default Non-Participating Providers Accept Assignment to No Transfer Non-Par Charges to patient Select Managed Care Contract. When a contract is selected, the check boxes required for setting up a courtesy claim are displayed. Select only providers who are participating providers. Parent topic: Generating Courtesy Claims
Help Guide for NextGen® Enterprise PM 8
Set Up Contract Exceptions for Courtesy Claims
To generate courtesy claims for a payer, access the Contract library list and right-click on the applicable payer and then select Contract Exceptions. The Contract Exception Maintenance window opens. Enter the name of the type of extension in the Contract Exception Name (required) field. In the exception, select the CPT4 code for generating a courtesy claim. Enter the full charge in the Allowed column. Enter the full charge in the Co-Pay Amount column. Note: For more information about setting up contract exceptions, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide forNextGen® Enterprise. Parent topic: Generating Courtesy Claims
Help Guide for NextGen® Enterprise PM 8
Set Up the Contract Library for Courtesy Claims
Select the Contract Library that is associated with the payer. On the General tab of the Contract Library Maintenance window, enable the following check boxes: Prorate Insurance Balance Create Zero Dollar Claim Ensure that there is a detail record set up for the CPT4 for participating providers. Parent topic: Generating Courtesy Claims
Help Guide for NextGen® Enterprise PM 8
Set Up Contract Exceptions for Courtesy Claims
To generate courtesy claims for a payer, access the Contract library list and right-click on the applicable payer and then select Contract Exceptions. The Contract Exception Maintenance window opens. Enter the name of the type of extension in the Contract Exception Name (required) field. In the exception, select the CPT4 code for generating a courtesy claim. Enter the full charge in the Allowed column. Enter the full charge in the Co-Pay Amount column. Note: For more information about setting up contract exceptions, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide forNextGen® Enterprise. Parent topic: Generating Courtesy Claims
Help Guide for NextGen® Enterprise PM 8
Set Up the Payer Master
In the Payer Master file, on the Practice Parameters/Other tab, select the following options: Default Non-Participating Providers Accept Assignment to No Transfer Non-Par Charges to patient Select Managed Care Contract. When a contract is selected, the check boxes required for setting up a courtesy claim are displayed. Select only providers who are participating providers. Parent topic: Generating Courtesy Claims
File Maintenance Help for NextGen® Enterprise 8
Charges and Contracts
Note: After the charges have been generated, the Balance Control window reflects the charges set up in the Contract Library Maintenance window. The amount from the Co-Pay Amount field is automatically entered into the patient's bucket. The system checks to see which payer is associated with the encounter. The system checks payer maintenance to see which contract is attached and whether the provider is participating or non-participating. The contract is searched to see if anything has been entered for the specific CPT4 code that was charged in the encounter. If it has, then it uses the specified information. If not, it uses the default information from the top of the contract dialog box. Parent topic: Setup an Exception Through the Contract Library
