Set Up the Payer Master

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

Entering a Courtesy Charge for a Claim

When you enter the charge for a courtesy claim, ensure that you are using the payer with the contract and contract exception on the encounter. Note: The rendering on the encounter is Non-Par, so the Benefits Not Assigned display in red bold text in the Verification section of the Encounter/Insurance tab on the patient's chart. In the charge window, the INS1 bucket is checked to bill and the full balance is in the Patient bucket. You can generate the claim immediately after the charge is entered by selecting on the Bill icon in the charge window. 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

Generating Courtesy Claims

A courtesy claim is a claim that you, the provider, does not submit to a payer (because you are non-par with the patient’s contract) for charges related to services you have rendered on the patient. It is a claim that you generate, but do not send. Instead, you give it to the patient so they can submit it. The example in this section shows how a courtesy claim can be generated. This example assumes that some providers in your office are par with the contract and the services are to be billed. Set Up the Payer Master Set Up the Contract Library for Courtesy Claims Set Up Contract Exceptions for Courtesy Claims Entering a Courtesy Charge for a Claim Parent topic: Generating and Submitting Claims

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

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

Set Up the Payer Master

Recommendations

Set Up the Contract Library for Courtesy Claims

Entering a Courtesy Charge for a Claim

Set Up Contract Exceptions for Courtesy Claims

Generating Courtesy Claims

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up the Contract Library for Courtesy Claims

Entering a Courtesy Charge for a Claim

Set Up Contract Exceptions for Courtesy Claims

Generating Courtesy Claims

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up Auto Charge Adjustments for Non-Participating Providers