Setting up Charge Test Results

Help Guide for NextGen® Enterprise PM 8

Enter Test Results for a Charge

When you enter a charge on the Charge Posting window for a SIM code that is set up in the Service Items library to create MEA test result segments, the system allows you to enter a test Qualifier, Date, and Result. A confirmation message appears stating that the charge is saved. Note: If test results are received from an HL7 interface, all the fields for charge test results fill automatically. Open NextGen® Enterprise PM. Select Charges. The Charge Posting window opens. Select the desired patient and encounter. Do the following for the SIM code that is set up to create MEA test result segments. Enter a new charge, and then select Save or Next. Select an existing charge, and then select the Test Results button on the charge toolbar. The Test Data for this Charge window opens. Note: You can enter up to five test qualifiers and results. In the Qualifier field, select one of the following: HT(Height) R1(Hemoglobin) R2(Hematocrit) R3(Epoetin Starting Dosage) R4(Creatinine) A qualifier canno

Help Guide for NextGen® Enterprise PM 8

Set up SIM Codes for Test Results

You can set up specific SIM codes in the Service Items Library to create MEA test result segments on electronic 837P (1500) claims. Open File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. Double-click the desired library. The Service Item Library Maintenance window opens. Select Search, and then enter the desired SIM code. Select the General tab. Select Form, and then select 1500 from the list. Select the Other tab. Select the Create Test Results MEA Segment check box. Note: Create Test Results MEA Segment check box is not available if either UB or ADA is selected in the Form field on the General tab. Select OK. Parent topic: Setting up Charge 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

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

Process Charges that Require Test Results for Claims

SIM codes for specific tests, such as Creatinine, Hemoglobin and Hematocrit, can be set up to require a test qualifier, test date and test result for claims. This information is sent in an MEA test result segment on electronic 837P (1500) claims. You can identify SIM codes that require test results for claims before processing pending charges by running the EHR Manual Charge Processing Pending report. Include the column Test Result Required on the report. The EHR Manual Charge Processing History report can also be used after charges are processed, by including the same column. While processing the pending charges, if SIM codes are missing that is required test result information needed for claims, the system alerts the user. Note: For more information on setting up the SIM codes, go to NextGen Healthcare Success Community and download the latest Billing and Collections User Guide for NextGen® Enterprise PM, and then refer to the Charge Test Results on Electronic Claims section. Process

Setting up Charge Test Results

Recommendations

Enter Test Results for a Charge

Set up SIM Codes for Test Results

Set Up Claim Edits for Test Results

View Code Tables for Test Results

Charge Test Results on Electronic Claims

Process Charges that Require Test Results for Claims

Enter Test Results for a Charge

Set up SIM Codes for Test Results

Set Up Claim Edits for Test Results

View Code Tables for Test Results

Charge Test Results on Electronic Claims

Process Charges that Require Test Results for Claims