Settings - default transaction codes for the alternate payer

Field	Description
Default Payment	Select a third-party payment transaction code for the alternate payer. The code defaults to the Pay Code field on the Payment Entry screen for manually entered payments and for ERA payments received from the alternate payer. If a transaction code is not selected, then the Default Payment code from the Practice > Transactions is used for payments from the alternate payer.
Default Adjustment	Select a third-party adjustment transaction code for the alternate payer. The code defaults to the Adj Code field on the Payment Entry screen for manually entered adjustments and for ERA adjustments received from the alternate payer. If a transaction code is not selected, then the Default Adjustment code from the Practice > Transactions is used for adjustments from the alternate payer.
Default Payment for Bad Debt	Select a third-party bad debt payment transaction code for the alternate payer. The code defaults to the Pay Code field on the Payment Entry screen for manually entered payments and for ERA payments received from the alternate payer on encounters in Bad Debt status. Note: The Use payer default bad debt tran codes option must be enabled inPractice > Transactions. If a transaction code is not selected, then the Default Payment for Bad Debt code from the Practice > Transactions is used for payments from the alternate payer on Bad Debt encounters.
Default Adjustment for Bad Debt	Select a third-party bad debt adjustment transaction code for the alternate payer. The code defaults to the Adj Code field on the Payment Entry screen for manually entered adjustments and for ERA adjustments received from the alternate payer on encounters in Bad Debt status. Note: The Use payer default bad debt tran codes option must be enabled in Practice Preferences > Transactions. If a transaction code is not selected, then the Default Adjustment for Bad Debt code from the Practice > Transactions is used for adjustments from the alternate payer on Bad Debt encounters.
Reversals & Corrections Payment	Select a third-party payment transaction code for the alternate payer. The code defaults to the Pay Code field on the Payment Entry screen for ERA reversal and correction payments received from the alternate payer in the 835 file with a Claim Status of 22. If a transaction code is not selected and the Remittance Profile Library is setup to allow posting of reversal/correction payments, then the Reversals & Corrections Payment code from the Practice > Transactions is used for ERA reversal/correction payments from the alternate payer.
Reversals & Corrections Adjustment	Select a third-party adjustment transaction code for the alternate payer. The code defaults to the Adj Code field on the Payment Entry screen for ERA reversal and correction adjustments received from the alternate payer in the 835 file with a Claim Status of 22. If a transaction code is not selected and the Remittance Profile Library is setup to allow posting of reversal/correction adjustments, then the Reversals & Corrections Default Adjustment code from the Practice > Transactions is used for ERA reversal/correction adjustments from the alternate payer.

Help Guide for NextGen® Enterprise PM 8

Set Up Default Transaction Codes for an Alternate Payer

When you are using the alternate payer functionality, you might find that the main payer on the Payer master file, and the alternate payer on the Payers-Alt Payer master file has different Default Transaction Codes. In File Maintenance, select Master Files > System > PM > Payers-Alt Payers. The Payers-Alt Payers List window opens. From the Payers-Alt Payers List window, select and open the applicable alternate payer. The Modify Alt- Payer Information - Demo Payer window opens. Select the Alt Payer Transaction Option tab. The fields under the Alt Payer Transaction Option tab appear. Select default transaction codes for the alternate payer. For more information, see Settings - default transaction codes for the alternate payer To save the changes and close the window, select OK. Note: For more information on the Payers-Alt Payers master file go to NextGen Healthcare Success Community and download the latest Claims User Guide for NextGen® Enterprise PM. Settings - default transaction codes

Help Guide for NextGen® Enterprise PM 8

Set Up Default Payment/Adjustment Transaction Codes

Access File Maintenance. Select System Master Files > PM > Payers. The Payers List window opens. From the list, select and open the desired payer. The Modify Payer Information window opens. Select the Practice tab, and then select the Transactions sub-tab. Use the following table to select Transactions parameters for the payer. To save changes and close the window, select OK. Field Description Default Payment Select a third-party payment transaction code for the payer. The code defaults to the Pay Code field on the Payment Entry screen for manually entered payments and for ERA payments received from the payer. This field is required. Default Adjustment Select a third-party adjustment transaction code for the payer. The code defaults to the Adj Code field on the Payment Entry screen for manually entered adjustments and for ERA adjustments received from the payer. This field is required. Default Payment for Bad Debt Select a third-party bad debt payment transaction code for the payer. Th

File Maintenance Help for NextGen® Enterprise 8

Set Up Default Payment/Adjustment Transaction Codes

Access File Maintenance. Select System Master Files > PM > Payers. The Payers List window opens. From the list, select and open the desired payer. The Modify Payer Information window opens. Select the Practice tab, and then select the Transactions sub-tab. Use the following table to select Transactions parameters for the payer. To save changes and close the window, select OK. Field Description Default Payment Select a third-party payment transaction code for the payer. The code defaults to the Pay Code field on the Payment Entry screen for manually entered payments and for ERA payments received from the payer. This field is required. Default Adjustment Select a third-party adjustment transaction code for the payer. The code defaults to the Adj Code field on the Payment Entry screen for manually entered adjustments and for ERA adjustments received from the payer. This field is required. Default Payment for Bad Debt Select a third-party bad debt payment transaction code for the payer. Th

File Maintenance Help for NextGen® Enterprise 8

Setting up of Payer-Level Default Bad Debt Transaction Codes

You can set payer-level bad debt transaction codes to be used as the default codes when insurance payments are processed for bad debt encounters. To set the default transaction codes for encounters with Bad Debt status, perform the following steps: If you want to set the transaction code as the default used for payments or adjustments, open the Payers master file. Do one of the following: For the main payer, select the Practice > Transactions. For the alternate payer, select the Alt Payer tab. In the Default Payment for Bad Debt and Default Adjustment for Bad Debt fields, select the default transaction codes to use for ERA and manual transaction entry when the encounter is in Bad Debt status. These fields list the codes designated in the Transaction Codes master file as Third Party and Bad Debt Only. Open the Transactions Practice Preferences, and then select the Use payer default bad debt tran codes check box to enable the use of the default transaction codes set up in the Payers mast

Help Guide for NextGen® Enterprise PM 8

Additional Information on Alternate Payer Transaction Options

The following table provides additional information on the alternate payer transaction options. Field Description ERA Payer Numbers The system checks the payer number in the ERA Payer Numbers field and the GS02 segment of the ERA file. If the payer number matches, then the payments are posted against the alternate payer. In the 835 IG, the ERA payer number can be located in the GS02 segment. Require both payments before settling If you select the Require both payments before settling check box, and the billing status shows up as waiting for another payment, then the default status on the line item is set to None to prevent further billing until you receive both the payments. Default Reason Code The default reason code exists at the line item level, and not at the transaction level. Therefore, when posting payments, the default reason code for the alternate payer will be applied to the line item. ERA Reason Code Library You must use the Reason Codes library when the payer number in the

File Maintenance Help for NextGen® Enterprise 8

Additional Information on Alternate Payer Transaction Options

The following table provides additional information on the alternate payer transaction options. Field Description ERA Payer Numbers The system checks the payer number in the ERA Payer Numbers field and the GS02 segment of the ERA file. If the payer number matches, then the payments are posted against the alternate payer. In the 835 IG, the ERA payer number can be located in the GS02 segment. Require both payments before settling If you select the Require both payments before settling check box, and the billing status shows up as waiting for another payment, then the default status on the line item is set to None to prevent further billing until you receive both the payments. Default Reason Code The default reason code exists at the line item level, and not at the transaction level. Therefore, when posting payments, the default reason code for the alternate payer will be applied to the line item. ERA Reason Code Library You must use the Reason Codes library when the payer number in the

Settings - default transaction codes for the alternate payer

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