Setting Up the Service Location

Help Guide for NextGen® Enterprise PM 8

Setting Up UB Claims for Enhanced UB Users

Setting up UB claims for Enhanced UB users is different from the set up for Regular UB users, especially if you want to use the automated claims process. For Enhanced UB users, the automated UB claims process only applies to payers who are considered the primary payer. The automated UB claims process is not for payers who are considered secondary or tertiary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes only occurs for primary payers who have the required criteria. Set Up Payers for Enhanced UB Users Set Up Encounters for Enhanced UB Claims (Before Billing) Set Up Encounters for Enhanced UB Claims (After Billing) Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounters for UB Claims

The following list outlines the areas of the Encounter Maintenance window that are important to the setup of UB claims: On the General tab, complete the Service Location field. On the UB tab, access the following sub-tabs: Condition Codes, Occurrence Codes, and Value Codes. Encounter Maintenance Note: For Enhanced UB users, the automated UB claims process only applies to payers who are considered primary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes, which are explained in the following sections, only occurs for primary payers who have the required criteria. UB/General Tab UB/Condition Codes Tab UB/Occurrence Codes Tab UB/Value Codes Tab Setting Up Practice Preferences for UB Claims Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up Practice Preferences for UB Claims

To set up a payer for UB claims, two fields must be set up in Practice Preferences > Claims in the UB Claim > Form section: Type of Facility Bill Classification When the above fields are populated, a UB tab displays in the following areas on the Modify Payer Information window: System > Claims > Provider Secondary References > UB Claims Practice > Claims > UB Claims Practice > Secondary References > UB Claims Practice > UB Parent topic: UB Claims Parent topic: Setting Up Encounters for UB Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up a Payer for UB Claims

After you set up Practice Preferences, the following UB tabs display on the Modify Payer Information window of the Payers master file: On the System > Claims sub-tab, UB Claims tab displays in the Provider Secondary References section and the Provider Paper Qualifiers section. On Practice > Claims sub-tab, the UB Claims tab displays. On Practice > Secondary References sub-tab, the UB Claims tab displays. System Tab/Claims Tab/UB Claims Tab UB Claims Tab on Claims Tab UB Claims Tab on Secondary References Tab Practice tab on UB Tab Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

UB Claims

This section provides information about the process of setting up UB claims for a regular UB user and an enhanced UB user. The rules for setting up and billing UB claims are different for the two types of users. Therefore, as a user, you should fit into one of the following two categories, if your practice processes UB claims: A Regular UB user is a practice that does some, but not exclusive UB claims billing. For example, if your practice primarily does 1500 claims processing and a small percentage of UB claims, then you would be considered a Regular UB user. An Enhanced UB user is a doctor or multiple doctors at a specific practice location that exclusively does UB claims billing. For example, a clinical rehabilitation practice with specific doctors at separate locations for Physical Therapy, Occupational Therapy, and Speech Therapy that exclusively process UB claims at one location would be considered an Enhanced UB user. UB claims must be set up by entering configuration informatio

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Enhanced UB Users

In File Maintenance, select Master Files - System > Payers. Right-click the applicable payer and then select Open. The Modify Payer Information window appears. Select the Practice tab and then the UB tab. Modify Payer Information In the Location field, select the practice location, if applicable. This enables all the fields and check boxes on the tab. The location that you select must be the same as the location that is selected on the Create Encounter or Encounter Maintenance window. Enter the applicable information in the Field Locator fields and enable the check boxes to display the information on the UB claim. The following conditions must be met for Enhanced UB users that want to use the automated UB billing process: Field Locator 51 must be populated. The Type of Facility field must be equal to 7 (Clinic). The Bill Classification field must be equal to 4 (Outpatient Rehab Facility). The Bill Frequency field must be blank. Select OK. Parent topic: Setting Up UB Claims for Enhanced

Setting Up the Service Location

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Setting Up UB Claims for Enhanced UB Users

Setting Up Encounters for UB Claims

Setting Up Practice Preferences for UB Claims

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UB Claims

Set Up Payers for Enhanced UB Users

Setting Up UB Claims for Enhanced UB Users

Setting Up Encounters for UB Claims

Setting Up Practice Preferences for UB Claims

Setting Up a Payer for UB Claims

UB Claims

Set Up Payers for Enhanced UB Users