When a Provider Hierarchy is NOT Established

Help Guide for NextGen® Enterprise PM 8

Establishing a Provider Hierarchy

The following rules apply when setting up the provider hierarchy: The provider hierarchy is blank when creating a new library. A specialty can only display one time in the hierarchy. Specialties hidden in the Specialties master file do not display in the Select Responsible Attending Provider by Specialty list. You must select at least one specialty from the Select Responsible Attending Provider by Specialty list. Parent topic: Claim Header Rules and Claim Consolidation Rules

File Maintenance Help for NextGen® Enterprise 8

When a Provider Hierarchy is NOT Established

When a provider hierarchy is not established, in NextGen® Enterprise PM the user must enter a Primary Provider, for one of the encounters, in the Primary Responsible Attending field on the Consolidated Services Claim sub-tab on the Claims tab of the Encounter Maintenance window. Parent topic: Claim Header Rules and Claim Consolidation Rules

Help Guide for NextGen® Enterprise PM 8

Claim Header Rules and Claim Consolidation Rules

Use the Claim Header Rules tab to establish a provider hierarchy and identify the attending provider for consolidated service claims (CSC). The physician with the highest-ranking specialty is automatically listed as the attending provider in the header data of the CSC claim. All CSC claims are sent to the payer as EDI files. These hierarchy rules will apply to all of the payers in the Valid Payers list. Establishing a Provider Hierarchy When a Provider Hierarchy is NOT Established Add Claim Consolidation Rules to a CSC Library Add Claim Header Rules to a CSC Library Eligible Number of Patient Days Billing Parent topic: Consolidated Service Claims

File Maintenance Help for NextGen® Enterprise 8

Establishing a Provider Hierarchy

The following rules apply when setting up the provider hierarchy: The provider hierarchy is blank when creating a new library. A specialty can only display one time in the hierarchy. Specialties hidden in the Specialties master file do not display in the Select Responsible Attending Provider by Specialty list. You must select at least one specialty from the Select Responsible Attending Provider by Specialty list. Parent topic: Claim Header Rules and Claim Consolidation Rules

File Maintenance Help for NextGen® Enterprise 8

Claim Header Rules and Claim Consolidation Rules

Use the Claim Header Rules tab to establish a provider hierarchy and identify the attending provider for consolidated service claims (CSC). The physician with the highest-ranking specialty is automatically listed as the attending provider in the header data of the CSC claim. All CSC claims are sent to the payer as EDI files. These hierarchy rules will apply to all of the payers in the Valid Payers list. Establishing a Provider Hierarchy When a Provider Hierarchy is NOT Established Add Claim Consolidation Rules to a CSC Library Add Claim Header Rules to a CSC Library Eligible Number of Patient Days Billing Parent topic: Consolidated Services Claim Library

Help Guide for NextGen® Enterprise PM 8

Primary Credential Conflicts and Messages

You can enter multiple Primary Credentials for a provider on the Credentialing tab. However, there can only be one primary credential in effect at a time. When you enter a primary credential with an effective or expiration date that overlaps with another, the following prompt displays: Effective/Expiration dates overlap with another Primary Credential. Primary Credential Conflict/Message 1 A provider's Primary Credential, in combination with another credential, can be used in the configuration of the Claim Modifiers Library to add a charge-level modifier to claims during the billing process in NextGen® Enterprise PM. The Claim Modifiers Library adds the modifier only if the primary credential is defined in both the Credentialing and Primary Credentials sections of the Credentialing tab. When you enter a primary credential for a provider that is not listed as one of their credentials, the following prompt displays: The Credential does not exist in the Credentialing table above. The Clai

When a Provider Hierarchy is NOT Established

Recommendations

Establishing a Provider Hierarchy

When a Provider Hierarchy is NOT Established

Claim Header Rules and Claim Consolidation Rules

Establishing a Provider Hierarchy

Claim Header Rules and Claim Consolidation Rules

Primary Credential Conflicts and Messages

Establishing a Provider Hierarchy

When a Provider Hierarchy is NOT Established

Claim Header Rules and Claim Consolidation Rules

Establishing a Provider Hierarchy

Claim Header Rules and Claim Consolidation Rules

Primary Credential Conflicts and Messages