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.
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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
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
File Maintenance Help for NextGen® Enterprise 8
Add or Modify a Contract
In File Maintenance, select Libraries > Contracts. The Contracts Libraries window opens. To add a new contract, select open menu button and select New. The Contract Library Maintenance window opens. Enter the Contract Name, Effective Date, and Expiration Date. Enter default information for the Contract. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, select the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter the information in the Automatic Adjustments section that applies. To add the CPT 4 code applicable to the contract, select the Fee Schedule tab. Then select open menu button or question mark. To find a CPT4 code, select open menu button and select Lookup to display a list of CPT4 codes and des
Help Guide for NextGen® Enterprise PM 8
Set Up Auto Charge Adjustments for Non-Participating Providers
Before you begin For the Contract's auto-charge adjustment to work properly, you must populate the following fields on the General tab of the Contract Library Maintenance window: Add a value to the % of Allowed Amount for NonParticipants field Select the Automatically adjust charges check box The application enables you to set up auto-adjustments for non-participating providers based on the terms of their contract. When charges are entered, they are adjusted according to the terms of the contract for the non-participating providers. In File Maintenance, access the Payers Master File. The Payer List window appears. Select the open menu button and select New to set up a new payer or select Open to modify an existing payer. The Add/Modify Payer Information window appears. Select the Practice tab and then select the Libraries tab. Select the drop-down arrow in the Managed Care Contract field and select the contract that meets the contract terms of the payer. When you select a contract, the
File Maintenance Help for NextGen® Enterprise 8
Set Up Auto Charge Adjustments for Non-Participating Providers
Before you begin For the Contract's auto-charge adjustment to work properly, you must populate the following fields on the General tab of the Contract Library Maintenance window: Add a value to the % of Allowed Amount for NonParticipants field Select the Automatically adjust charges check box The application enables you to set up auto-adjustments for non-participating providers based on the terms of their contract. When charges are entered, they are adjusted according to the terms of the contract for the non-participating providers. In File Maintenance, access the Payers Master File. The Payer List window appears. Select the open menu button and select New to set up a new payer or select Open to modify an existing payer. The Add/Modify Payer Information window appears. Select the Practice tab and then select the Libraries tab. Select the drop-down arrow in the Managed Care Contract field and select the contract that meets the contract terms of the payer. When you select a contract, the
